Uremia

Description, Causes and Risk Factors An excess of urea and other nitrogenous waste in the blood. Uremia NOS 586. Uremia chronic 585. Uremia is a medical disorder characterized by excessive urea, which is a waste product of urine, in the blood. There are a number of causes of uremia. Typically, urea builds up in the patient's blood as the result of inefficiently operating kidneys, which usually results from either acute and chronic kidney failure. In either case, the inefficient kidneys fail to filter the blood appropriately, which causes an imbalance of electrolytes. In addition to problems with the kidney, uremia may also be caused by specific lifestyle choices and certain types of trauma. A high protein diet or drug use, for example, can cause uremia. In addition, an increase in protein breakdown may occur from an infection, surgery, cancer, or trauma. This can also lead to uremia, as can gastrointestinal bleeding. Each of these potential causes of uremia makes the liver produce excessive amounts of urea, which may present in the blood stream. Uremia can also develop because urea is not eliminated from the body quickly enough. This can be caused by a blockage preventing urine from exiting the body. It may also be the result of decreased blood flow in the kidneys, which may be brought on by cardiac failure or hypotension. Symptoms: Some of the early signs include lethargy, mental depression, loss of appetite, and edema; later symptoms include diarrhea, anemia, convulsions, coma, and a gray-brown coloration. Diagnosis: The diagnosis of uremia is primarily based on an abnormal GFR or creatinine clearance, usually evident due to an elevated serum creatinine level. GFR determination can be accomplished by 24-hour urine collection for creatinine clearance, although this is often cumbersome and inaccurate due to improper collection. All patients with an abnormal creatinine clearance should have their GFR estimated using one of several formulas that use easily obtained values. These include the Modification of Diet in Renal Disease (MDRD) formula or the Cockcroft-Gault formula. Both formulas have been shown to provide similar values within a wide range of patient ages and to be accurate in those with renal insufficiency, regardless of race or sex. Nuclear medicine radioisotope (iothalamate) clearances can also be obtained and are the criterion standard for measuring GFR. However, this test is time-consuming and more expensive than estimating GFR using either the MDRD formula or the Cockcroft-Gault formula. Other laboratory tests to consider for abnormalities prevalent with clinical uremia include hemoglobin, calcium, phosphate, PTH, albumin, potassium, and serum bicarbonate values. Urinalysis with microscopic examination should be performed on all patients to evaluate for the presence of protein, cellular casts, oval fat bodies, ketones, hemoglobin, myoglobin, and pH. Treatment Options: Uremia is a potentially fatal condition that demands immediate treatment. Treatment options for uremia include kidney transplant, dialysis, and other treatments typically associated with kidney failure. In some cases, uremia may be alleviated by making specific dietary changes or by otherwise eliminating the underlying cause of the disorder. For example, the blockage in the urinary tract may be removed, or the patient may change his or her diet in order to address the hypotension or to reduce overall protein intake. Through proper care and treatment addressing the underlying causes of uremia, it is possible to treat the disorder without invasive techniques. If these methods fail, however, invasive measures may be necessary in order to save the patient's life. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.  

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