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Can Hidradenitis Suppurativa Affect the Kidneys?

Posted on July 01, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Elizabeth Wartella, M.P.H.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that has the potential to affect the kidneys. Scientists have found cases of people with both HS and AA amyloidosis, a condition that can damage the kidneys. Other recent studies have found possible connections between HS and the risk of chronic kidney disease (CKD) and renal (kidney) dysfunction.

Research showing that HS could affect the kidneys is relatively new. While HS affects somewhere between 1 percent and 4 percent of people globally, there is not yet enough research to determine the prevalence of people who have HS and HS-related kidney disease.

Currently, there is no evidence that HS causes conditions like AA amyloidosis or kidney disease. The research only highlights associations between the conditions. However, it is still important to look out for signs and symptoms that may indicate a loss of kidney function. Managing your HS symptoms will generally help to reduce the risk of other health conditions and complications.

If you have HS and are concerned about your kidney health, talk to your health care provider. They may recommend tests to determine if your kidneys are functioning properly.

HS and the Risk of Kidney Diseases

HS, also known as acne inversa, causes chronic inflammation and lumps, lesions, and abscesses. It commonly affects areas where skin touches skin, like the armpits and genitals.

HS can progress to painful fistulas, nodules, and tunnels underneath the skin. These symptoms are a result of blocked hair follicles in sweat glands, and they can greatly affect a person’s quality of life. The underlying cause of hidradenitis suppurativa is unclear. It could be a complex combination of risk factors like hormones, genetics, weight, and behavioral habits like smoking cigarettes.

Kidney disease can occur along with other inflammatory conditions, like rheumatoid arthritis. While it is much less common, scientists have also observed cases of people having both kidney disease and HS.

AA Amyloidosis

AA amyloidosis is a disorder in which B cells produce abnormal proteins that accumulate in different organs. Most commonly, AA amyloidosis affects the kidneys. A cross-sectional study in the British Journal of Dermatology found that people with HS had an increased risk of developing amyloidosis as compared to people without HS.

The first case of someone having HS-related amyloidosis was reported in 1966. Since then, there have been other case reports of people having both HS and amyloidosis.

Chronic Kidney Disease

CKD usually occurs as a result of diabetes or high blood pressure (hypertension). It affects up to 13 percent of people worldwide. Research studies have shown connections between inflammatory skin conditions like psoriasis and an increased risk of CKD.

In the British Journal of Dermatology study, scientists found that people with moderate to severe CKD were more likely to have a history of HS as compared to people without CKD. However, these findings do not mean that HS caused kidney disease. It’s possible that people had kidney disease before they developed HS.

Kidney Abnormalities

Kidney dysfunction and abnormalities have been found in people with psoriasis. A study from 2015 examined kidney tissue from people with HS and people without HS. Researchers found possible associations between HS and kidney abnormalities. However, this was the first research study on this topic. More research can help scientists better understand any associations between the conditions.

How Could HS Affect the Kidneys?

Scientists think that HS could negatively affect the kidneys in a few different ways.

Inflammation

HS is a chronic, relapsing condition. People live with the condition for a long period of time, and symptoms can flare and then subside. Living with inflammation for long periods of time may affect a person’s risk of developing other inflammatory conditions. For example, AA amyloidosis usually occurs as a reaction to illnesses or infections that produce chronic inflammation.

Chronic inflammation of the skin could also potentially lead to CKD. The chronic inflammation seen in HS is caused by an abnormal response from the body’s immune system. This response could potentially affect cells in the kidneys and lead to kidney disease.

Medications

Another possibility is that the medications used to treat HS — not the HS itself — may potentially affect the kidneys. Cyclosporine and rifampicin are both used to treat inflammatory skin conditions like psoriasis and HS. A systematic review found cyclosporine to have toxic side effects on the kidneys when used for two years or longer. Other studies have found medications like cyclosporine and rifampicin did not play a role in the association between HS and kidney disease. Ultimately, more research is needed on the topic.

Comorbidities

Comorbidities are medical conditions that a person can have at the same time. It’s possible that a person living with HS may have one or more comorbidities that influence their risk of kidney disease.

Previous research has found associations between psoriasis and metabolic syndrome. Metabolic syndrome can increase a person’s risk of diseases like diabetes and cardiovascular disease — which also increase the risk of kidney disease.

There’s a theory that HS could increase a person’s risk of metabolic syndrome and cardiovascular diseases, which in turn could increase their chance of kidney disease. One research study found signs of metabolic syndrome in people with early HS. Other studies have shown a connection between metabolic syndrome and CKD. These connections are intriguing, but they need to be researched further.

What Symptoms Should I Look Out For?

Whether or not you have HS, several symptoms could be a sign of kidney dysfunction. Some of these symptoms include:

  • Unexplained weight loss
  • Swelling (edema), especially in the feet and ankles
  • Weakness
  • Nausea and vomiting
  • Urinating significantly more or less than usual

Talk with your health care provider if you have any of these symptoms. Your doctor can run tests to check the health and functioning of your kidneys.

How To Prevent Kidney Issues With HS

If you have HS, the best way to prevent kidney issues overall is by managing the symptoms and inflammation caused by HS. There are many treatments for HS, including anti-inflammatory antibiotics and biologic drugs. Talk with your dermatologist about the best ways to manage your HS.

Also talk with your doctor about your risk of kidney disease. Other health and lifestyle factors can contribute to a person’s risk of kidney disease. If your doctor determines you’re at high risk, they may want to test your kidney functioning regularly to make sure it is healthy.

Regular kidney-function screening could help to catch any issues early on, when they are easier to treat and reverse. Some scientists suggest that people with severe HS and proteinuria (excess protein in the urine, a sign of kidney dysfunction) should be screened for kidney disease.

Talk to Others Who Understand

On myHSteam, the social network for people with HS and their loved ones, more than 25,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.

Do you have HS and kidney problems? Share your experience in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Elizabeth Wartella, M.P.H. is an Associate Editor at MyHealthTeam. She holds a Master's in Public Health from Columbia University and is passionate about spreading accurate, evidence-based health information. Learn more about her here.

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