Uremia (patient information)

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Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
Uremia or Uremia is an abnormally high level of nitrogen-type wastes in the blood.

What are the symptoms of Uremia?
Other symptoms may include:
 * Confusion
 * Decreased alertness
 * Decreased or no urine produced
 * Dry mouth
 * Fatigue
 * Pale skin color
 * Rapid pulse
 * Swelling
 * Thirst


 * Excessive urination at night
 * Pain in the abdomen

What causes Uremia?
Uremia is somewhat common, especially in people who are in the hospital.

The kidneys normally filter the blood. When the volume or pressure of blood flow through the kidney drops, blood filtration also drops, and may not occur at all. Waste products stay in the blood and little or no urine is formed, even though the kidney itself is intact and working.

Lab tests show that nitrogen-type wastes, such as creatinine and urea, build up in the body (azotemia). These waste products act as poisons when they build up. They damage tissues and reduce the ability of the organs to function. The build-up of nitrogen waste products and excess fluid in the body cause most of the symptoms of Uremia and acute kidney failure.

Who is at highest risk?
Uremia is the most common form of kidney failure in hospitalized patients. Any condition that reduces blood flow to the kidney may cause it, including:

Conditions in which blood volume is not lost, but the heart cannot pump enough blood or the blood is pumped at low volume, also increase the risk for Uremia. These conditions include:
 * Burns
 * Conditions that allow fluid to escape from the bloodstream
 * Loss of blood volume (such as with dehydration)
 * Prolonged vomiting or diarrhea, bleeding

It also can be caused by conditions where the blood flow to the kidney is interrupted, such as:
 * Heart failure
 * Shock (such as septic shock)


 * Certain types of surgery
 * Renal artery embolism
 * Renal artery occlusion
 * Trauma to the kidney

When to seek urgent medical care?
Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of Uremia.

Diagnosis
An examination may show:

The following tests may be done for Uremia:
 * Collapsed neck veins
 * Dry mucus membranes
 * Little or no urine in the bladder
 * Low blood pressure
 * Low heart function or hypovolemia
 * Poor skin turgor
 * Rapid heart rate
 * Reduced pulse pressure (difference between systolic blood pressure and diastolic blood pressure)
 * Signs of acute kidney failure


 * Blood creatinine
 * BUN
 * Osmolality and specific gravity
 * Urine tests to check sodium and creatinine levels and to monitor kidney function

Treatment options
The main goal of treatment is to quickly correct the cause before the kidney becomes damaged. People often need to stay in the hospital, and may need treatment in an intensive care unit. Treatment may include hemodialysis or dialysis inside the body (peritoneal dialysis).

Intravenous fluids, including blood or blood products, may be used to increase blood volume. After blood volume has been restored, medications may be used to increase blood pressure and heart output. These may include dopamine, dobutamine, and other heart medications. The cause of the decreased blood volume or blood pressure should be diagnosed and treated.

If the person has other symptoms of acute kidney failure, treatment for it should include medication, diet changes, or dialysis.

Where to find medical care for Uremia?
Directions to Hospitals Treating Uremia

What to expect (Outlook/Prognosis)?
Uremia can be reversed if the cause can be found and corrected within 24 hours. However, if the cause is not fixed quickly, damage may occur to the kidney (acute tubular necrosis).

Possible complications

 * Acute kidney failure
 * Acute tubular necrosis

Prevention
Quickly treating any condition that reduces the volume or force of blood flow through the kidneys may help prevent Uremia.