Uremic Frost
Muzamil Ahmad Wani, Zeeza Hussain Shah
N Engl J Med 2025;393:1327
DOI: 10.1056/NEJMicm2507714
A 52-year-old woman with hypertension presented to the hospital with a 1-month history of fatigue, as well as 6 days of vomiting and 1 day of confusion. Over the past 20 years, she had not received regular treatment for hypertension. Physical examination was notable for pallor of the conjunctiva and oral mucosa, as well as for powdery, crystalline deposits on the arms (Panel A, right arm), legs (Panel B, left leg), trunk, and scalp. Laboratory testing showed a blood urea nitrogen (BUN) level of 375 mg per deciliter (134 mmol per liter; reference range, 5 to 21 mg per deciliter [2 to 7 mmol per liter]), a creatinine level of 22 mg per deciliter (1945 μmol per liter; reference range, 0.5 to 1.5 mg per deciliter [44 to 133 μmol per liter]), and a hemoglobin level of 6.1 g per deciliter (reference range, 13.0 to 16.5). Testing of a skin scraping of the powdery crystals was positive for urea. A diagnosis of advanced end-stage kidney disease with uremic frost was made. Uremic frost is a rare manifestation of end-stage kidney disease that may occur when the BUN level is greater than 200 mg per deciliter (71 mmol per liter). The whitish crystals form on the skin when sweat with a high content of urea evaporates. Treatment with hemodialysis for five consecutive sessions was initiated. Nineteen days after presentation, the patient had a fatal asystolic cardiac arrest in the context of shock secondary to hospital-acquired pneumonia.
