What is uremia?

Causes and Symptoms

Uremia is a condition that results when the waste products in the blood, notably urea and creatinine, build up in the bloodstream and are not excreted, as would normally be the case by being transported to the liver and subsequently expelled in the urine. In some patients suffering from uremia, a marked reduction or absence of vitamin B6 is noted. Often, there is inadequate blood supply to the kidneys, especially in cases where hemorrhaging or shock have occurred.

Congestive heart failure
may accompany uremia or may be, at least in part, an initial cause of it. Renal azotemia is a disease affecting the kidneys and may lead to kidney failure. Postrenal azotemia occurs when the flow of urine in the area below the kidneys is blocked. This condition may be attributed to several causes, including kidney stones, pregnancy, compressed ureters, enlargement of the prostate, or bladder stones, often associated with gallbladder problems. When the amino acids that the body uses to produce protein get out of control, uremia may result. In such cases, there is usually no underlying kidney disease, but a heightened resistance to the flow of urine can result in its backing up into the kidneys, which leads to a condition known as hydronephrosis. This condition can lead to dangerous toxicity and, in extreme cases, may prove fatal.

A unique kind of uremia that is found largely in infants and young children is hemolytic uremia. The origins of this disorder are not fully understood, but it appears to result from damage to the red blood cells in the kidneys. Hemolytic uremia is accompanied by excessively high blood pressure. Many specialists in the field believe that the disorder has viral or bacterial origins.

Treatment and Therapy

Patients suffering from uremia sometimes become disoriented and confused. They lose energy and tire easily. They may become nauseated and lose interest in food and in eating. They may also experience some outward manifestations including eruptions on the skin, sores and/or edema in the mouth, and excessive thirst. Medications to deal with nausea and to help the patient return to more normal eating habits are indicated where nausea is a continuing factor.

In relatively mild cases, therapy with vitamin B6 may partially or wholly eliminate the condition. Patients may also respond well to changes in their diet, strongly reducing the protein content of what they consume. This solution, however, must be adhered to strenuously and continued throughout one’s life span unless such treatment as a kidney transplant is successful and permits the patient to experience better health overall.

Extreme cases may require hemodialysis to cleanse the blood of its impurities or may indicate the removal of uric toxins by modified blood separation and absorption therapies. Such treatments can make serious inroads on one’s normal life because treatment in sixty- to ninety-minute sessions is often indicated three or more times a week. In cases of renal failure, a kidney transplant may offer the most effective long-term solution.

When uremia elevates the blood pressure to dangerous levels, particularly in hemolytic uremia, treatment with antihypertensive medications is essential and is usually successful. Dialysis may be necessary so that impurities can be removed, giving the kidneys a chance to recover.

In such cases, the patient may find it virtually impossible to urinate and what urine is excreted may be streaked with blood. Despite such disturbing manifestations, most patients suffering from hemolytic uremia make a full recovery, often in as little as two weeks.

Perspective and Prospects

Uremia exists in varying degrees, but much of it can be managed successfully and controlled to the point that it appears to be cured. With adequate care during the acute stages of the disorder, some patients recover in anywhere from seven to fifteen days, although they may incur some kidney damage, either temporary or permanent.

Uremia is most dangerous when it is accompanied by acute pancreatitis, as it often is. In cases involving this complication, the prognosis is not encouraging, although with adequate care, the death rate is substantially reduced.

Bibliography

Brenner, Barry M. Brenner and Rector’s The Kidney. Philadelphia: Saunders/Elsevier, 2008.

Chen, Shuang. The Guide to Nutrition and Diet for Dialysis Patients. Coral Springs, Fla.: Metier Books, 2008.

Gennan, F. John. Medical Management of Kidney and Electrolyte Disorders. New York: Dekker, 2001.

Gurland, Hans J.  Uremia Therapy: Perspectives for the Next Quarter Century . 1st ed. New York: Springer, 2012. Print.

Massry, Shaùl G., and Richard J. Glassock, eds. Massry and Glassock’s Textbook on Nephrology. Philadelphia: Lippincott Williams & Wilkins, 2001.

Nissenson, Allan R., and Richard N. Fine, eds. Dialysis Therapy. Philadelphia: Hanley and Belfus, 2002.

Tamparo, Carol D. Diseases of the Human Body. Philadelphia: Davis, 2000.