Contents
Uremia is a syndrome that signals the progression of renal failure. It develops against the background of poisoning the body with an excessive accumulation of nitrogenous and other metabolites. It is impossible not to notice the symptoms of uremia. The patient develops asthenia, the skin becomes pale, with a yellowish tinge, covered with a rash. Chronic itching appears, smells of ammonia from the mouth. The nature of the stool changes, dyspepsia worries.
You can confirm uremia using a biochemical blood test, ultrasound of the kidneys, Reberg’s test. Additionally, urography and nephroscintigraphy can be prescribed. Therapy involves the relief of renal failure. At the same time, efforts are being made to eliminate existing metabolic disorders. In severe cases, a kidney transplant is indicated.
What is uremia?
Uremia is a poisoning of the body with protein metabolism products due to impaired kidney function. In the course of the disease, changes also occur in the neurohumoral regulation.
Uremia is a syndrome that is characteristic of stages 2-3 of acute renal failure or of the final stage of chronic renal failure. If the kidneys function correctly, they completely remove metabolic products from the body. Disturbed work of the organs of the urinary system provokes their accumulation and severe intoxication.
A synonym for the diagnosis of “uremia” is “urination”. It was first used by doctors from France back in 1840. Uremia can be acute or chronic. It is always difficult and often has a poor prognosis.
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Pathogenesis
In renal failure, there is an accumulation of metabolites that cannot leave the body naturally. The value is an excess of urea, ammonia, phenols, skatole, indoles, acetone, peptides and other compounds that are normally regularly excreted in the urine.
The situation with uremia is complicated by the fact that the body suffers from intoxication as a whole. As a result, the work of all systems and organs is disrupted. Against the background of the accumulation of acidic metabolic wastes, the formation of acid mono- and disubstituted sodium phosphate in the renal tubules and an increase in the concentration of ammonia, acidosis develops, and electrolyte imbalance occurs. Such a clinical picture contributes to disruption of the brain, cardiovascular, hormonal and respiratory systems.
Symptoms of uremia
Symptoms of uremia appear gradually and are accompanied by increasing intoxication of the body. Before the clinical manifestation of the disease, you can notice some factors that indicate a violation of kidney function. The urine of such patients is light, excreted in large volume and has a low specific gravity. Large diuresis is accompanied by a delay of chlorides and urea, which are released in small quantities. Over time, the volume of urine excreted decreases, and nitrogenous metabolic products, accumulating in the body, increase the concentration of nitrogen in the blood.
For weeks or months, a pre-coma may continue, which can subsequently lead to uremic coma. The first harbingers of coma are violations of the gastrointestinal tract. First, appetite decreases, later there is an almost complete refusal of food, patients stop eating and drink plenty of water. Urea accumulates in saliva, which causes bitterness in the mouth. When urea is broken down by oral bacteria, ammonia is released, which causes a persistent, characteristic odor from the mouth.
Urea also accumulates in gastric juice, causing uremic gastritis and colitis. The symptoms of uremia are accompanied by nausea, vomiting after eating, subsequently vomiting occurs on an empty stomach, and diarrhea mixed with blood may begin. A toxic effect on the walls of the gastrointestinal tract is exerted by the decomposition products of urea – ammonium salts, which are formed in the stomach under the action of bacteria.
Uremia is also accompanied by disorders of the central nervous system. The patient experiences apathy, weakness, quickly gets tired, he feels stiffness in his movements, he is sleepy, his head seems heavy. With the development of uremic coma, the desire to fall asleep is accompanied by insomnia, twitching of the calf muscles occurs, consciousness is gradually lost. Uremic coma is accompanied by characteristic respiratory movements. The patient breathes noisily, occasionally taking deep breaths, followed by a short exhalation. In the terminal phase, breathing periodically completely disappears (Cheyne-Stokes breathing) due to a decrease in the excitability of the respiratory center.
Body temperature in patients with uremia, as a rule, does not rise above 35 g. Progressive retinitis causes a sharp drop in vision or blindness. The rapid decay of the body’s own cells causes cachexia, anemia develops.
Symptoms of uremia also appear on the skin. Urea and other toxins released through the skin cause dry skin, itching, trophic ulcers, inflammation, and leave a characteristic plaque on the surface of the skin.
Complications of uremia
If therapy is absent, then uremia is complicated by acute degeneration of brain cells. The patient develops hallucinations and delusions, convulsions and myoclonus. An imbalance of ions provokes changes in heart rhythm with further progressive heart failure.
The immune system suffers, which is why any infectious process is especially difficult. Urea crystals released through the serous membranes provoke the development of inflammation of the pleura (pulmonary and parietal) and the heart sac (pericarditis).
All systems are disrupted. The patient develops bleeding (gastric, nasal, intestinal, pulmonary), as the mucous membranes of the organs become covered with ulcers. There is a drop in the level of platelets and blood proteins.
Against the background of uremia, hypocalcemia often develops, leading to osteoporosis, proliferation of parathyroid gland tissues, and a systemic decrease in bone density.
A terrible consequence of uremia is uremic coma, which occurs against the background of a significant increase in the level of ammonia in the body. Metabolic acidosis often causes the death of the patient.
Diagnostics
There are no difficulties in identifying uremia. In addition to obvious symptoms indicating its development, the patient has characteristic changes in blood biochemistry. Targeted diagnostics should be subjected to all persons who suffer from severe disorders in the functioning of the kidneys.
Laboratory and instrumental examination aimed at confirming the diagnosis of “uremia”:
TANK. There is an increase in the level of urea, creatinine and potassium in the blood, the levels of albumin, sodium and calcium are reduced, obviously a violation of the ratio between protein fractions.
Reberg’s test To determine the ability of the kidneys to filter urine, data on the level of creatinine in the blood and in urine are needed. Compensated uremia is characterized by indicators of 60-15 ml / min. If the values are lower, then uremia is considered progressive, which means that the probability of death is high.
Ultrasound examination of the kidneys. Ultrasound makes it possible to assess the state of their cortical and medulla, identify an abscess of organs, detect stones, tumor formations, and tissue sclerosis. These processes serve as a push mechanism in the development of uremia. Ultrasound of the renal vessels allows you to evaluate the renal blood flow.
Kidney x-ray. The study provides information about the shape and contours of the organs, ureters, bladder. Since in patients with impaired renal function, the load on them is increased, a contrast agent is rarely used during radiography. If such a decision was made, then this method is combined with scintigraphy.
HOW in terms of diagnosing uremia is not critical. An increase in ESR, a decrease in the level of hemoglobin, lymphocytes and platelets in the blood can be noted.
OAM reveals a decrease in the density of urine, cylinders and erythrocytes are found in it. Severe uremia is characterized by urine acidity of 4,5-5 points. If necessary, the patient is referred for an MRI or CT scan.
Uremia should be distinguished from hypochloremia, acute pancreatitis, liver disease, critical preeclampsia, and HUS (hemolytic anemic syndrome). Severe uremia can give a similar picture to diabetic coma.
Patients with suspected uremia are shown to consult a hematologist, toxicologist, rheumatologist, oncologist and other narrow specialists. In many ways, the choice of a doctor is determined by the characteristics of the course of the syndrome.
Treatment of uremia
The main task that the specialist faces is to eliminate the cause that provoked uremia. The choice of therapeutic tactics depends on the patient’s well-being. It is necessary to direct efforts to maintain kidney function, remove intoxication and eliminate existing disorders.
In addition to taking medications and surgery, the patient is shown a diet correction. His menu includes low-fat dishes, low in protein. Minimize salt intake, focus on fresh fruits and vegetables.
Complementary therapies:
Infusions with colloid and crystalloid solutions. They allow you to normalize the balance of fluid, electrolytes, acids and alkalis, relieve intoxication. The timely appointment of infusion therapy helps to avoid critical disorders in the work of other organs, in particular, the brain and the cardiovascular system. If necessary, nutrient solutions are administered intravenously.
Medical correctionaimed at eliminating the symptoms of uremia. Patients are prescribed B vitamins, iron preparations. Possible blood transfusion. To eliminate itching, intestinal sorbents and a laxative are used. In heart failure resort to the help of glycosides.
Hardware detox. Hemodialysis is indicated for patients with acute and severe chronic renal failure.
The operation is necessary for patients with acute intoxication, provoked by blockage of the urinary tract. It is possible to remove the stone, or the entire kidney with its subsequent transplantation.
Prophylaxis and prognosis
The prognosis is determined by the degree of kidney damage. In the presence of concomitant diseases, it is worse. If the filtration rate is not lower than 30 ml / min, then the chances of recovery are more favorable.
Dialysis helps to cope with uremia in 65-95% of cases. The transition of the process to the chronic stage requires its life-long implementation, or a kidney transplant.
To prevent the development of uremia allows regular medical examination and timely treatment of any diseases of the urinary system.