What is Uremia?
This is a toxic disease resulting from kidney disorder that is marked by retention of waste products, usually excreted in the urine, in the blood of sufferers. It is a condition in which the blood urea nitrogen level, which is an indicator of the nitrogenous waste products in the body, is found to be increased. The term is also used to narrowly describe the disorder accompanying kidney failure.
The condition should not be confused with Hyperuricemia, or uricemia, which indicates an accumulation of uric acid in the bloodstream.
The condition arises due to any disorder that impairs the ability of the kidneys to filter waste products. The disease may originate due to any disorder that damages the kidney. These renal causes include:
- Injury to the kidney
- Kidney damage from hypertension or diabetes
- Renal artery embolism or occlusion (obstruction of blood flow to the kidney)
- Certain medications, such as high doses of intravenous contrast material or non-steroidal anti-inflammatory drugs (NSAIDs)
- Kidney disease (including any problem associated to the kidney, such as kidney failure, kidney stones and kidney anomalies)
Uremia may also arise due to various other disorders, which lead to reduced flow of blood or low blood volume. These other causes include:
- Excessive vomiting
- Excessive bleeding
- Excessive diarrhea
- Congestive heart failure (worsening of the ability of the heart to pump blood)
- Dehydration (deficiency of electrolytes and body fluids, which can be life-threatening when acute and untreated)
The problems occurring due to this condition are associated to kidney damage that prevents filtration of nitrogen wastes by kidneys. In the absence of proper filtering, the wastes accumulate in the bloodstream and cause poisoning in the body.
The signs and symptoms of this disorder can be categorized into two types:
- Dry mouth and nose
- Abdominal pain
- Edema (swelling)
- Excessive thirst
- Rapid heart rate (tachycardia)
- Weakness (loss of strength)
- Pale skin or pallor
- Low blood pressure (hypotension)
- Confusion or loss of consciousness for even a brief moment
- Low urinary output
- Temporary loss of consciousness or mental confusion
In some cases, the problems can be life-threatening.
The conventional diagnostic procedures for this disorder include:
- Routine blood test
- Routine urine test
- Ct scans
- MRI scans
- Glomerular filtration rate
- Renal function examination
- Blood biochemical examination
Physicians also ask patients whether they are suffering from the following symptoms:
- High blood pressure
- Poor appetite
Doctors also check for presence of Edema and change in amount of urinary wastes. Uremia patients have a pale facial appearance, which also helps in determining the presence of the condition.
Specialized urine or blood tests can help a healthcare provider in diagnosing this condition. Blood area nitrogen tests are useful in determining how effectively the kidneys are functioning. The test measures the amount of nitrogen wastes in the blood of patients. Creatinine tests also help in measuring the amount of creatinine in the body of sufferers. Physicians might also conduct a sodium urine test to assess the amount of sodium in the urine or blood.
Uremia Differential Diagnosis
The differential diagnosis of this disorder includes making sure that the symptoms experienced by patients are those of Uremia and not those of similar conditions like:
- Acute Renal Failure
- Chronic Renal Failure
- Diabetes Mellitus, Type 1
- Diabetes Mellitus, Type 2
- Diabetic Nephropathy
- Uremic Encephalopathy
- Acute Glomerulonephritis
- Chronic Glomerulonephritis
Generally, the disease requires to be cured in hospital. Treatment usually begins with addressing the cause of flow of blood through the kidneys. This is followed up with focusing on removal of nitrogenous wastes from the bloodstream followed by restoring of blood pressure and blood volume. Finally, ongoing treatment may be needed to prevent buildup of wastes and damage to the kidneys as well as addressing their underlying causes.
Acute Uremia Treatment
Cure for the disease usually begins within 24 hours after it is first diagnosed. Immediate treatment is required to stabilize a patient and address the underlying cause of the disorder. Immediate cure may include:
- Blood transfusions
- Blood products
- Fluid therapy
- Intravenous fluid
- Hemodialysis (filtering blood outside the body)
- Medicines, such as dopamine, to increase cardiac output and blood pressure
Ongoing Uremia Treatment
Treatment may be continued when doctors have managed to restore blood pressure of patients. Long-term cure may involve use of medications, dialysis and dietary modification.
Uremia and Medications
The medicines that are usually employed for managing the condition are used for controlling related electrolyte and metabolic abnormalities, such as:
- Iron deficiency
Other drugs that are used, include:
- EPO for anemia
- Phosphate binders
- Calcitriol for hypocalcemia and PTH suppression
- Water-soluble vitamins (such as Vitamin C and Folate)
The choice of drug and usage depends on the medical state of patients, which may change with the severe clinical setting of sufferers.
Uremia and Diet
Dietary changes should be made for Uremia patients only by a dietician who possesses the expertise needed for curing renal conditions, especially in patients who have not yet begun dialysis therapy. Some of the symptoms of this disease may be alleviated with the aid of low-protein diets. A low-protein diet is often recommended to people with mild to moderate cases of renal failure.
However, this approach remains controversial. In studies conducted in this regard, few benefits were found to be associated with this type of diet. There is another problem associated to this disorder; the patients may become malnourished due to deficiency of protein in their diet. A high number of Uremia sufferers are found to die out of malnourishment on starting dialysis.
Unless treated properly in time, the disorder can give rise to various acute complications. These include:
- Cardiac arrest
In case of severe Uremia, spontaneous bleeding may occur and may include the following problems:
- Gastrointestinal (GI) bleeding
- Spontaneous subdural hematomas
- Increased bleeding from any underlying disorder
- Bleeding associated with trauma
In case of acute underlying abnormalities in electrolyte levels, such as metabolic acidosis, hyperkalemia or hypocalcemia, cardiac arrest may also ensue.
Uremia and Acute Tubular Necrosis
Uremia patients occasionally develop a condition, known as Acute Tubular Necrosis. In this disease, the kidney tissues get severely damaged. Patients might eventually suffer from acute kidney failure, a disease characterized by abrupt stoppage of function of the kidneys. Some patients might suffer from convulsions.
Uremia Mortality Rate
The rates of hospitalization and death associated with this condition are quite high, as a result of existing co-morbid conditions like:
- Coronary artery disease
- Peripheral vascular disease
Uremia Risk Factors
The risk of development of the disorder is increased by a number of factors. These risk factors include:
- Low blood pressure (Hypotension)
- Recent trauma or injury
- Recent surgery
- Recent infection
- Intake of several medicines, like intravenous contrast material or NSAIDs (non-steroidal anti-inflammatory drugs)
Unless the condition is treated with the aid of renal replacement therapy (such as transplantation or dialysis), the outcome is poor for sufferers with Uremia of CRF. If treated fast, the condition can be reversed although there is a possibility that the kidneys may suffer permanent damage. The underlying processes that lead to uremia may also result in kidney failure.
The prevention of this disorder includes preventing and managing various kidney disorders that can result in Uremia. Prevention also involves avoiding contact with renal toxicities. The risk for complications can be prevented or minimized by following a proper treatment plan designed by healthcare providers for sufferers of Uremia. The measures for preventing complications include:
Patients of Uremia should have proper nutrition and rest. Sufferers should not take part in strenuous activities that exert them.
Patients should undergo dialysis if the renal functions cannot be reversed. Dialysis therapy involves Hemodialysis and Oral and Peritoneal dialysis. Oral dialysis is only suited for patients of mild cases of Uremia.
Avoiding contact with toxic chemicals
Sufferers should avoid inhalation or skin contact with chemicals that contain cadmium, tetrachloroethylene, chloroform and ethylene glycol. These chemicals can be found in household cleansers, pesticides, paints and vehicle exhausts.
Restricting intake of cadmium-rich foods
Patients should limit the amount of foods that are rich in cadmium, such as unclean vegetables, mussels, halibut, scallops and oysters.
Limiting or giving up smoking
Smoking adversely affects the condition of the kidneys. Naturally, giving up smoking is the best measure to ensure good health of the organs. If that is not possible, smoking should be reduced to a minimum to minimize the risks of Uremia and other ailments of the kidneys.
Uremia Vs Azotemia
Azotemia refers to a problem in blood composition in which some constituents exceed their normal range. An individual suffering from Azotemia suffers from too much nitrogenous compounds in the bloodstream. The disorder usually occurs when the kidney is severely damaged and loses 70-75% of its ability. Uremia mainly refers to a buildup of urea in the blood while Azotemia can refer to an accumulation of urea, creatinine and other nitrogenous wastes in blood. The term Azotemia is generally used when the abnormality can be chemically measured but is not acute enough to produce symptoms. But when the condition begins to produce symptoms (generally at the onset of kidney failure), the accompanying ailments are termed as Uremia.
If you suspect yourself to be exhibiting signs of Uremia, call 911 to seek medical care on an immediate basis. It is important for patients to undergo treatment very quickly to avoid permanent damage to the organs.