Uremia

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Contents 1 Introduction 2 Clinical-manifestations 3 Radiology 4 Complications 5 Management 6 More General Terms 7 Additional Terms 8 References

Introduction

• Elevated plasma urea. According to ref 3, uremia is a term reserved to the signs & symptoms of azotemia.

Clinical-manifestations

• uremic sign & symptoms may become apparent as:

• BUN rises above 100 mg/dL
• 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]

• neurologic manifestations

• central nervous system

• lethargy
• seizures
• myoclonus
• asterixis
• dysgeusia
• delirium
• sleep disturbances

• peripheral neuropathies

• more sensory than motor
• pruritis
• diminished vibratory sensation
• hypoesthesia
• diminished deep tendon reflexes ( DTR)
• restless legs syndrome

• autonomic dysfunction

• orthostatic hypotension
• gastroparesis

• cardiovascular abnormalities

• pericarditis ( pericardial friction rub)
• hypertension
• accelerated atherosclerosis

• dermatologic abnormalities

• pruritis
• hyperpigmentation
• acne

• gastrointestinal manifestations

• nausea & vomiting
• anorexia
• pancreatitis

• hematologic manifestations

• platelet dysfunction
• abnormal B- & T-cell function
• anemia
• increased bleeding time

• fluid & electrolyte abnormalities

• volume expansion
• hyperkalemia
• hypocalcemia
• hyperphosphatemia
• metabolic acidosis

• 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

• pulmonary:

• uremic lung, a form of non- cardiogenic pulmonary edema
• pleural effusion is common - generally transudative

Radiology

• chest X-ray

• may show 'butterfly shadows', alveolar infiltrates limited to the inner 2/3 of both lungs with sparing of the peripheral areas
• chest X-ray changes proportional to degree of azotemia & acidosis in acute renal failure

Complications

• (see complications of uremia)

Management

• treatment of hypertension & hypervolemia

• Na+ restriction < 1.5 g/day
• antihypertensive agents
• loop diuretics

• K+ restriction is generally required
• avoid Mg+2 containing antacids
• correct acidosis: CaCO3 (doubles as phosphate binder)
• platelet transfusions for active bleeding
• conjugated estrogens
• DDAVP

• pre- surgery
• acute bleeding

More General Terms

• azotemia

Additional Terms

• complications of uremia
• urea in serum (BUN)

References

1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 267-268
2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 417, 790
3. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998, 2006

uremia