Uremic pruritus is caused by chronic kidney failure and is the most common internal systemic cause of itching.

Nalfurafine, an orally administered, centrally acting κ-opioid receptor agonist, is approved to treat the condition in Japan.

The signs and symptoms of uremic pruritus can vary. The intensity ranges from mildly uncomfortable to highly upsetting and causing agitation. The distribution is more prevalent on the back, face, and shunt arm and is typically symmetric and generalized, though it can also be localized. Dryness, heat, cold, stress, and showering all exacerbate pruritus. Patients with this condition frequently have skin devoid of noticeable lesions. But in addition to xerosis, skin lesions like excoriation, crusts, impetigo, and prurigo nodularis may also develop as a result of repeated scratching.

There are several potential causes of uremic pruritus, including immune dysregulation, uremic toxins, neuropathy, and opioid imbalance.

Vitamin A, parathyroid hormone, calcium, phosphate, magnesium, histamine, and phosphate are the most researched potential pruritogens in the pathophysiology of uremic pruritus.

The etiology of uremic pruritus may involve the immune system as well. Research comparing hemodialysis patients with and without uremic pruritus revealed that those with the condition had noticeably higher levels of T helper 1 cells as well as serum interleukin (IL)-6, IL-2, and IL-31.

In uremic pruritus, both peripheral and central neuropathy are thought to be involved.

Uremic pruritus is defined as itching that is directly caused by chronic kidney disease, with no other explainable conditions. Uremic pruritus cannot be diagnosed with laboratory tests or established criteria because of its variability and lack of specific skin lesions. Comprehensive consideration of the diagnosis is necessary, encompassing neuropathic, psychogenic, renal, dermatologic, endocrine, hepatobiliary, hematologic, rheumatologic, oncologic, and endocrine causes.