Uremia

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Introduction

What is uremia?

Uremia is a clinical state in which the blood urea nitrogen level, an indicator of nitrogen waste products, is elevated. In uremia, the kidneys’ failure to filter nitrogen waste properly leads to excessively high levels of nitrogen wastes in the bloodstream. Uremia is life-threatening because too much nitrogen in the blood is toxic to the body. Symptoms of uremia include confusion, loss of consciousness, low urine production, dry mouth, fatigue, weakness, pale skin or pallor, bleeding problems, rapid heart rate (tachycardia), edema (swelling), and excessive thirst. Uremia may also be painful.

Uremia is reversible if treated quickly; however, permanent damage to the kidneys may occur. Kidney failure may also result from the underlying processes that cause uremia.

Treatment for uremia frequently requires hospitalization. It begins with treating the cause of the kidney injury so that nitrogen waste will not continue to build up in the blood. Treatment may require dialysis, which filters the waste out of the blood while the kidneys recover. Fluid therapy, blood transfusions, and blood pressure medications may also be administered. Ongoing treatment after the acute symptoms of uremia have been addressed may include medication, dialysis, or dietary modification.

Seek immediate medical care (call 911) for any symptoms of uremia. It is important that the cause of your uremia be treated quickly to prevent permanent damage. Symptoms include low urine output, confusion, loss of consciousness, and excessive thirst.

Symptoms

What are the symptoms of uremia?

Symptoms of uremia are related to kidney damage that prevents the kidneys from filtering out nitrogen waste. This nitrogen waste builds up in the bloodstream, poisoning the body. The symptoms of uremia are serious and may occur very quickly.

General symptoms of uremia

Some of the symptoms of uremia may be generalized. These are serious symptoms, and when present with other symptoms of uremia, should be evaluated in a medical setting. General symptoms of uremia include:

  • Abdominal pain
  • Confusion or loss of consciousness for even a brief moment
  • Dry mouth and nose
  • Easy bruising
  • Edema (swelling)
  • Excessive thirst
  • Fatigue
  • Low blood pressure (hypotension)
  • Pale skin or pallor
  • Rapid heart rate (tachycardia)
  • Weakness (loss of strength)

Serious symptoms that might indicate a life-threatening condition

In some cases, uremia can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Confusion or loss of consciousness for even a brief moment
  • Low urine output
Causes

What causes uremia?

Uremia is caused by any condition that impairs the kidneys’ ability to filter waste products.

Renal causes of uremia

Uremia may arise from any condition that damages the kidney including:

  • Autoimmune disorders

  • Certain medications, such as high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) or intravenous contrast material

  • Kidney damage from hypertension or diabetes

  • Kidney disease (includes any type of kidney problem, such as kidney stones, kidney failure and kidney anomalies)

  • Obstruction that interferes with normal urine flow

  • Renal artery embolism or occlusion (blockage of blood flow to the kidney)

  • Surgery

  • Traumatic injury to the kidney

Other causes of uremia

Uremia may also arise from a number of other conditions that cause low blood volume or decreased blood flow including:

  • Burns

  • Congestive heart failure (deterioration of the heart’s ability to pump blood)

  • Dehydration (loss of body fluids and electrolytes, which can be life threatening when severe and untreated)

  • Excessive bleeding

  • Excessive diarrhea

  • Excessive vomiting

  • Shock

What are the risk factors for uremia?

A number of factors increase the risk of developing uremia. Not all people with risk factors will get uremia. Risk factors include:

  • Diabetes

  • Low blood pressure (hypotension)

  • Recent infection

  • Recent injury

  • Recent surgery

  • Taking certain medications, such as nonsteroidal anti-inflammatory drugs or intravenous contrast material

Treatments

How is uremia treated?

Uremia usually needs to be treated in the hospital. Treatment begins with addressing the cause of low blood flow through the kidneys. Then, it focuses on removing nitrogen waste from the blood stream and restoring blood volume and pressure. Finally, ongoing treatment may be required to prevent and address waste buildup and kidney damage.

Acute uremia treatment

Immediate treatment for uremia (within the first 24 hours after diagnosis) is needed to stabilize the patient and address the cause of uremia. Immediate treatment for uremia may include:

  • Blood products
  • Blood transfusions
  • Fluid therapy
  • Hemodialysis (filtering blood outside the body)
  • Hospitalization
  • Intravenous fluid
  • Medication to increase blood pressure and cardiac output such as dopamine

Ongoing uremia treatment

Once blood pressure has been restored, treatment may be continued. Long-term treatment for uremia may include:

  • Dialysis
  • Dietary modification
  • Medication

What are the potential complications of uremia?

Uremia is a serious disease that requires immediate treatment in order to be reversible. Damage from uremia can be permanent. Complications of untreated or poorly controlled uremia can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of uremia include:

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 5
  1. Prerenal azotemia. PubMed Health. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001537/.
  2. Hemolytic-uremic syndrome. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000510.htm.
  3. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl 2013; 3:5.
  4. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy. Philadelphia: Saunders, 2013.
  5. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
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