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uremia
Elevated plasma urea. According to ref 3, uremia is a term reserved to the signs & symptoms of azotemia.
Clinical manifestations:
1) uremic signs & symptoms may become apparent as:
a) BUN rises above 100 mg/dL
b) glomerular filtration rate drops below
- 30 mL/min in chronic renal failure (CRF)
- 10 mL/min (most commonly) [3]
- 15 mL/min in diabetic patients [3]
2) neurologic manifestations
a) central nervous system
- lethargy
- seizures
- myoclonus
- asterixis
- dysgeusia
- delirium
- sleep disturbances
b) peripheral neuropathies
- more sensory than motor
- pruritus
- diminished vibratory sensation
- hypoesthesia
- diminished deep tendon reflexes (DTR)
- restless legs syndrome
c) autonomic dysfunction
- orthostatic hypotension
- gastroparesis
3) cardiovascular abnormalities
- pericarditis (pericardial friction rub)
- hypertension
- accelerated atherosclerosis
4) dermatologic abnormalities
- pruritus
- hyperpigmentation
- acne
5) gastrointestinal manifestations
- nausea & vomiting
- anorexia
- pancreatitis
6) hematologic manifestations
- platelet dysfunction
- abnormal B- & T-cell function
- anemia
- increased bleeding time
7) fluid & electrolyte abnormalities
- volume expansion
- hyperkalemia
- hypocalcemia
- hyperphosphatemia
- metabolic acidosis
8) endocrine manifestations
- impaired priduction of 1,25-dihydroxyvitamin D3
- hyperparathyroidism
- altered thyroxine metabolism
- carbohydrate intolerance
- resistance to insulin
- resistance to growth hormone
- decreased renal clearance of insulin
- hypertriglyceridemia
- hyperprolactinemia
- decreased serum testosterone levels
9) pulmonary:
- uremic lung, a form of non-cardiogenic pulmonary edema
- pleural effusion is common - generally transudative
Radiology:
- chest X-ray
a) may show 'butterfly shadows', alveolar infiltrates limited to the inner 2/3 of both lungs with sparing of the peripheral areas
b) chest X-ray changes proportional to degree of azotemia & acidosis in acute renal failure
Complications: (see complications of uremia)
Management:
1) treatment of hypertension & hypervolemia
a) Na+ restriction < 1.5 g/day
b) antihypertensive agents
c) loop diuretics
2) K+ restriction is generally required
3) avoid magnesium-containing antacids
4) correct acidosis: CaCO3 (doubles as phosphate binder)
5) DDAVP first line for acute bleeding
- also preopeoperative prophylaxis
6) hemodialysis if evidence of uremic encephalopathy
- hemodialysis improves platelet function & decreases bleeding
7) conjugated estrogens can improve mucosal bleeding if DDAVP & hemodialysis are not effective
8) platelet transfusions for active bleeding as needed
9) epsilon aminocaproic acid for active bleeding as needed
Related
complications of uremia
urea in serum/plasma
General
azotemia
References
- Manual of Medical Therapeutics, 28th ed, Ewald &
McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 267-268
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 417, 790
- Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 16,
17, 18. American College of Physicians, Philadelphia 1998, 2006,
2012, 2015, 2018