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Uremia – Symptoms, Treatment, Causes and Diagnosis

Uremia Definition

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Uremia, also known as azotemia, which literally means urine in the blood, is associated with kidney failure. It is a serious condition which involves nitrogen-based toxins such as urea and creatinine. This clinical syndrome, which causes the blood urea nitrogen level, an indicator of nitrogen waste products, to elevate,  is associated with electrolyte, fluid, hormone imbalances, and abnormalities in metabolism. This condition is life-threatening because too much nitrogen in the blood is toxic to a person’s body. Nitrogen, which is known as the primary waste product of metabolism, is normally secreted out of the kidney, but with this condition, it stays inside the body, predisposing the person to toxicities.

Uremia Pathophysiology

The kidney participates in the secretion and production of hormones, homeostasis of acids and bases, electrolyte and fluid regulation, and most importantly, waste elimination. When one has been diagnosed with, or is undergoing, renal failure, the functions are not operating adequately, and metabolic abnormalities such as hyperkalemia, anemia, malnutrition, hyperparathyroidism, acidemia, and hypertension can occur. After that, the clearance of creatinine falls to less than 10 mL/min which will result in uremia. Some of these patients who are experiencing renal failure may be showing signs only at increased level clearance.

uremia

The Kidneys

Since the waste product cannot be excreted out by the body, it will affect organs of the body such as:

Heart and Lungs

When there is renal failure, the waste materials and electrolytes keep rotating in the body’s system. Excessive renin in the blood will diffuse into the pleura and pericardium; this high level causes fibrinous pleurisy and pericarditis. Over-secretion of renin will also lead to heart failure, which can cause pulmonary edema. Moreover, discharges of blood urea from the respiratory tract will lead to respiratory tract infection.

Digestive System

Urea circulates in the body, will enter the digestive tract, and will lead to ammonia formation. It stimulates the gastric and enteric mucosa and causes inflammation that leads to ulcers and bleeding in the long run. Urine toxic gastritis, esophagitis, and colonitis are most often encountered. Patients have reported symptoms like nausea, diarrhea, vomiting, abdominal pain, and hematochezia.

Skeletal System

Patients with uremia will develop hypocalcemia (low calcium level). It may be because there is a decline in the kidney’s function to excrete phosphate, resulting in an increase in phosphate and a reduction of the concentration of calcium. In addition, when phosphate, which is deposited in the body, is combined with calcium, it forms indivisible calcium phosphate, thus reducing calcium absorption. Lastly, 1,25 DHCC promotes calcium absorption which is formed when the kidney functions normally. However, in uremic patients, the kidney malfunctions, leading to the disturbance of 1, 25 DHCC. This, in turn, causes malabsorption of calcium in the small intestine and leads to hypocalcemia.

Hemopoietic System

When a person has uremia, it is associated with anemia and bleeding. The causes of anemia are due first to a lack of hemopoietin production because the kidney tissues are damaged. Second, metabolin deposited in the body such as phenol and its ramification can restrain the hematopoiesis of the marrow. Lastly, there is lost transferrin which leads to problems in iron transportation.

Most patients with uremia experience bleeding as expected in the form of epistaxis, hemorrhage in the gut, and gingival bleeding.

Skin

Uremic patients manifest grey yellow skin due to the deposition of urochrome in the skin. Skin itchiness is due to the fact that the waste product, which normally is excreted out of the kidney, is excreted abnormally through the sweat gland and forms crystalloid powder, which is often seen on the face, nose, and cheek.

Nervous System

Uremic waste product can also be found in brain tissues, leading to osmotic pressure elevation which causes  encephaledema (inflammation of the encephalous or brain). Toxic substance can lead to the damage and degeneration of nervous cells. The increased vascular system permeability will aggravate encephaledema. Uremic patients will manifest end-stage symptoms such as lethargy, stupor, coma, and hyperspasmia.

Uremia Symptoms and Signs

Patients with uremia will manifest the following signs and symptoms:

  • Confusion or loss of consciousness
  • Abdominal pain
  • Diarrhea
  • Pale skin
  • Fatigue
  • Low or no urine output
  • Increase Irritability
  • Nausea
  • Vomiting
  • Increased pulse rate
  • Swelling of the entire body
  • Excessive thirst
  • Jaundice or yellowish skin
  • Reduced urination
  • Tremors
  • Seizures
  • Bruises
  • Pericarditis
  • Fever
  • Seizures (rare)
  • Weight loss
  • Low blood pressure
  • Anorexia
Uremia Pathophysiology, Symptoms & Signs
Symptoms and Signs of Uremia at a Glance

Uremia Causes

The causes of uremia are due to any condition that causes kidney damage which that includes:

  • Renal artery embolism or occlusion
  • Surgery
  • Medication such as NSAIDs
  • Diabetes or hypertension leading to kidney damage
  • Kidney disease such as glumerulonephritis
  • Injured kidney or ruptured bladder
  • Burns
  • Shock
  • Congestive heart failure
  • Interstitial disease
  • High-protein diet
  • Gastrointestinal bleeding
  • Dehydration

Uremia Diagnosis

In diagnosing patients with uremia, certain examination and tests will have to be performed such as:

  • Physical exam which shows positive signs of swelling of the liver or spleen and changes in the nervous system
  • Laboratory test which shows acute renal failure and hemolytic anemia. The laboratory test includes:
  • Blood clotting test
  • Comprehensive metabolic test which shows elevated BUN (blood, urea, and nitrogen) and creatinine
  • Complete blood count which shows an increase in white blood cells, indicating infection
  • Platelet count which is reduced
  • Urinalysis which reveals positive blood and protein in urine
  • Urine protein test which indicates amount of protein found in the urine
  • Kidney biopsy
  • Stool culture

Uremia Treatment

Uremia treatment usually involves the following:

  1. Dialysis which removes excess waste product and reduce toxicity
  2. Medication such as corticosteroid which deals with inflammation and relieve pain
  3. Blood and platelet transfusion since there is a bleeding tendency and presence of lower platelets
  4. Plasmapheresis wherein the plasma is filtered to remove the antibodies from the patient’s blood

Complications of Uremia

The associated and possible complications with uremia are the following:

  1. Blood clotting problems
  2. Kidney failure
  3. Nervous system problems
  4. Thrombocytopenia (lower platelets)
  5. Hemolytic anemia

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