Uremia

Uremia is a term for an excessive buildup of toxins in the blood, which happens when the kidneys are unable to remove waste products, and toxins. Most patients with uremia have ESRD, or end-stage renal disease, a condition resulting from chronic kidney disease.

Last Updated: September 26, 2023

When kidney function is less than 15% (15 ml/min) of normal, most people feel sick, or this is when most symptoms of uremia start to appear. 

 

About 354,000 new cases of ESRD are recorded annually. Men are 1.2 times more likely to get ESRD than women, but women are 1.7 times more likely to put off starting dialysis. Due to the smaller muscle mass and baseline blood creatinine levels that women have, they are also more likely to develop uremic symptoms at lower creatinine levels.

Some signs of uremia are:

  • Muscle cramps
  • Nausea and vomiting
  • Itching
  • Problems with thinking and remembering
  • Fatigue
  • Shortness of breath
  • Appetite loss
  • Unexplained weight loss

In worst cases, a uremic patient may have a urine-like smell on his breath or a metallic taste in his mouth and uremic frost (yellow-white crystals on the skin due to urea in sweat).

Changes in GFR or creatinine clearance that are outside of the normal range establish a diagnosis of renal failure. A 24-hour urine collection may be able to give information about both GFR and creatinine clearance. However, this process takes a lot of work from the patient and the physician and needs to be more accurate.

A urinalysis (with a microscope) and lab tests to check for abnormalities in hemoglobin, calcium, phosphate, parathyroid hormone, albumin, potassium, and bicarbonate will help pinpoint any possible problems. 

Renal ultrasonography can be used to evaluate hydronephrosis, and ureteral and bladder blockage. 

A CT scan may be needed if a patient's mental status changes significantly. MRI may be used to assess renal artery stenosis, thrombosis, or aortic and renal artery dissection, all reversible causes of renal failure.

A renal biopsy may be needed to diagnose acute kidney damage or chronic kidney disease accurately.

Treatment

Dialysis should be started as soon as possible, no matter what the patient's GFR is, if they have symptoms of uremia like nausea, vomiting, high potassium levels, or metabolic acidosis that cannot be treated with any drugs.

Patients experiencing uremic emergencies (e.g., hyperkalemia, acidosis, symptomatic pericardial effusion, or uremic encephalopathy) need emergent dialysis, which should be started carefully.

Although long-term hemodialysis and peritoneal dialysis may also be considered, kidney transplantation is ultimately the most effective renal replacement therapy. 

People with end-stage kidney disease should get dialysis regularly to keep toxins under control. The progression to chronic kidney disease can be halted or slowed in those who do the following:

  • Constant control of high blood pressure, diabetes, or other health problems
  • Religiously taking the medicines, the doctor has prescribed
  • Avoiding drugs that could further damage the kidneys
  • Following a healthy diet
  • Exercising
  • Maintaining a right BMI
  • Quitting smoking 

 

References

Zemaitis MR, Foris LA, Katta S, et al. Uremia. [Updated 2022 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441859/

 

Cleveland Clinic (2022). Uremia. Retrieved December 21, 2022, from https://my.clevelandclinic.org/health/diseases/21509-uremia

Last Updated: September 26, 2023