Uremia
Uremia is a dangerous condition that occurs when waste products associated with decreased kidney function build up in your blood. Uremia means urine in the blood and refers to the effects of the waste product accumulation. It affects the entire body.
Causes of Uremia
Healthy kidneys filter waste and fluids from your body through the urine.
Kidneys help maintain normal levels of acids, electrolytes and hormones such as Vitamin D and erythropoietin (EPO).
Damaged kidneys don’t work well, allowing multiple toxins to build up in your blood.
Most people feel sick when kidney function is less than 15% (15 ml/min) of normal and need to start dialysis when function is less than 10% (10 ml/min) of normal.
Lab studies monitor chemicals that are elevated in uremia but not necessarily causative:
Creatinine (waste product produced in muscle and in dietary protein).
Urea (waste product formed in the liver as protein is broken down).
Estimation of overall kidney function using a formula ( eGFR - ml/min).
Stage of CKD from 1 to 5 based on eGFR data from the National Kidney Foundation with dialysis usually starting at Stage 5.
Symptoms of Uremia
Cognitive dysfunction (problems with thinking and remembering).
Fatigue.
Shortness of breath from fluid accumulation.
Loss of appetite.
Muscle cramps.
Nausea and vomiting.
Itching.
Unexplained weight loss.
Diagnosis of Uremia
Your healthcare provider:
Evaluates your symptoms.
Performs a physical exam.
Reviews your health history, especially your kidney health and your family history.
Reviews the lab tests mentioned above. Creatinine and BUN blood tests help your provider confirm a diagnosis of uremia.
These tests check your blood for high levels of waste products. They also used to estimate your glomerular filtration rate (eGFR).
This rate measures your kidney function.
A kidney ultrasound checks the shape and size of your kidneys and looks for scarring.
An ultrasound can also detect kidney blockages, such as kidney stones, or injuries.
Additional tests may be needed in certain situations
Treatment of Uremia
Dialysis (a procedure to clean the blood) is the most common treatment for uremia.
There are two kinds of dialysis.
Hemodialysis uses a machine to filter blood outside the body.
Peritoneal dialysis uses the lining of your belly and a special fluid to filter blood.
You may need a kidney transplant if uremia is the result of end-stage renal (kidney) failure.
A transplant replaces the failing kidney with a donor kidney from either a living or deceased donor.
Your healthcare provider may recommend iron supplementation for anemia, replacement of EPO, calcium and Vitamin D supplements, phosphorus binders taken with meals to prevent bone loss due to hyperparathyroidism.
Blood pressure needs to be controlled and any risks for heart disease need to be addressed.
Other underlying medical problems must also be managed.