Uremia or uremic syndrome is a condition that develops when your kidneys become too damaged to filter out harmful substances from the body, particularly urea and creatinine. Instead, increased levels of these substances build up in the blood, leading to the manifestation of dangerous side effects that may eventually become life-threatening.
Chronic kidney disease is often attributed to the development of uremia. The condition is estimated to affect nearly 14 percent of the U.S. population, killing more people than breast or prostate cancer each year.
Prevalence of uremia
The prevalence of uremia in the U.S. is difficult to pinpoint, as most patients start dialysis (a procedure that helps the kidney perform its function) before they develop any symptoms of uremia.
According to data from the U.S. End-Stage Renal Disease (USRDS) program in 2007, the incidence rate of end-stage renal disease (ESRD) maintains relatively stable at 354 cases per million, with a total dialysis prevalent population of greater than 368,000. However, as patients with ESRD are now living longer, it is estimated by the year 2020, more that 750,000 Americans will have ESRD.
The highest prevalence rate of ESRD is reported in Japan, followed by Taiwan, and then the United States. Over half of patients diagnosed with ESRD live in just five countries: United States, Japan, Germany, Brazil, Italy.
The prevalence of uremia among different age groups is unknown, despite ESRD presenting more often in older adults. People over the age of 75 have seen greater occurrence rates. However, current data indicate that older adults are 31 percent less likely to have a delayed start of dialysis compared to patients younger than 40 years of age.
What are the causes and symptoms of uremia?
Causes of uremia can be categorized into three different groups: Prerenal, renal, and postrenal. All of these groups are due to extreme and usually irreversible kidney damage. Regardless of the area damage, the kidney will no longer be able to filter waste products from the body to be excreted in your urine.
The following are various uremia causes:
- Prerenal: Caused by decreased blood flow through the kidneys. This may happen due to low blood pressure, congestive heart failure, shock, bleeding, and dehydration.
- Renal: Attributed to a decrease in kidney function. This may be caused by acute and chronic kidney failure, acute and chronic glomerular nephritis, tubular necrosis, and other kidney diseases.
- Postrenal: Can be caused by decreased elimination of urea. This may be caused by urinary outflow obstruction (ex. Tumors of the bladder or prostate, and kidney stones) or severe infection.
Symptoms of uremia typically begin late in the course of chronic kidney disease and may present as:
- Difficulty concentrating
- Extreme tiredness or fatigue
- Lack of appetite
- Progressive weakness
- Abnormal mental function
- Frequent shallow respiration
- Muscle atrophy
- Metabolic acidosis
Diagnosis of uremia
Uremia can be diagnosed by taking a detailed history and physical examination of the patient. Doctors will check for the presence of any excess fluid accumulation (edema) and other signs and symptoms that may point to uremia.
For the most part, laboratory testing will be the best way to determine the level of urea and creatinine currently in the body. This will come in the form of specialized urine and blood tests that can help physicians determine how effectively the kidneys are functioning and a number of waste products in the blood. Other diagnostic tests may also be utilized.
Ultimately, the best treatment for uremia treatment is initiating dialysis, and in more serious cases, a kidney transplant. Without proper intervention when the signs and symptoms of uremia present themselves, the condition may become life-threatening. The following are various treatment options doctors consider when approaching a case of uremia and kidney failure.
- Surgery: This may involve renal replacement therapy accomplished by hemodialysis, peritoneal dialysis, or renal transplantation. Kidney transplant is considered the best form of therapy and results in improved survival and quality of life.
- Consultations: Speaking with a nephrologist—a doctor who specializes in the kidneys—early in the course of kidney disease can help identify subtle symptoms that may suggest the kidneys are functioning abnormally. Symptoms may include acute hyperkalemia, volume overload, severe acidemia, or a change in mental status.
- Transfer: Being transferred from a center that is more capable to meet the needs of a dialysis patient and has an available nephrologist on call may be an appropriate course of action for complicated kidney failure patients.
- Activity: Due to fatigue that uremic patients face, energy levels are often low. This may be augmented with the use of erythropoietin (EPO), which can improve a patient’s quality of life and energy level. Excessive bleeding is also a potential complication of uremia and should be taken into consideration if patients are at risk of falling.
- Special considerations: Pregnant women with uremia should be looked after by an obstetrician who specializes in the management of high-risk pregnancies, in addition to a nephrologist.
It may be possible to manage early uremia symptoms with low protein diets as studied using rate with experimental chronic renal failure. It was seen that low protein diets help to ameliorate uremic symptoms and certain chronic renal failure symptoms. These diets work because they activate a compensatory mechanism that conserves protein in the body. However, it was not determined if dietary protein restriction can slow the rate of renal failure progression.
Foods to eat
Rich in anti-inflammatory and antioxidant compounds, olive oil can possibly prevent inflammation of the kidneys and protect blood vessels.
A common staple of low-protein diets, fish also contains anti-inflammatory fats that can help lower bad cholesterol levels decreasing the risk of cardiovascular disease
High in fiber and anti-inflammatory properties, apples can help reduce inflammation of the kidneys to some degree, as well help prevent constipation and lower cholesterol.
Can improve blood circulation due to its anti-clotting properties. This can help reduce cardiovascular disease in uremia patients.
Rich in vitamin K, vitamin C, potassium, and fiber, all of which are important products for maintaining healthy bodies. Cabbage also contains phytochemical which can help break apart free radicals.
Contain abundant amounts of vitamin C, anti-inflammatory components, as well as fiber, blueberries may provide some benefit in uremic patients. Additionally, they are rich in manganese, which can slow bone breakdown.
Rich in vitamin C and fiber. Strawberries also have anti-inflammatory properties as well that can help reduce inflammation that may present in the kidneys.
A great source of quality protein that is less phosphorus than other sources of protein. Egg whites can also be a great source of essential amino acids for those suffering from uremia.
Stripping as much fat from meat as possible, it can be considered a quality source of protein for uremia patients.
High in vitamin C, folate, and fiber, cauliflower helps combat certain states caused by uremia such as anima, a decreased in red blood cells or hemoglobin.
Foods to avoid
Food restrictions include:
- Controlled intake of potassium—banana, mushrooms, coffee, and pears (to prevent hyperkaliemia and cardiovascular diseases).
- Restrict sodium intake to 4–5 grams per day.
Complications of uremia
If left untreated, serious cases of uremia may lead to:
- Cardiac arrest
Additionally, patients with severe uremia may develop gastrointestinal (GI) bleeding, spontaneous subdural hematomas, increased bleeding from any underlying disorder, or bleeding associated with trauma. Electrolyte abnormalities, such as hyperkalemia, metabolic acidosis, or hypocalcemia, may lead to cardiac arrest as well.
Prevention will require preventing and managing various kidney disorders that can result in uremia. This may include adhering to the following:
- Proper rest: Getting proper nutrition and rest is very important, especially for patients already suffering from uremia.
- Active treatment: If dialysis has been prescribed, it is absolutely vital to maintain dialysis schedules, as they consequence of uremia cannot be reversed otherwise.
- Avoiding contact with toxic chemicals: Avoiding skin contact or inhalation of chemicals that are commonly found in household cleaner, pesticide, and paints. These chemicals include cadmium, tetrachloroethylene, chloroform, and ethylene glycol.
- Restricting intake of cadmium-rich foods: These include unclean vegetables, mussels, halibut, scallops, and oysters.
- Limit or stop smoking: Smoking can adversely affect kidney health. If this is difficult to achieve alone, seeing your doctor may provide additional support
Prognosis of uremia
Unless treatment for kidney disease and uremia is achieved, prognosis for these patients is considered poor. Dialysis or kidney transplant will help improve these patient’s chances of survival dramatically.
Depending on the underlying cause leading to kidney damage, acute kidney injury may be reversible or treatable before significant damage has occurred. However, there are instances where treatment may not be sufficient enough or is implemented too late that may lead to the development of uremia and the inevitable use of dialysis or kidney transplant.
Chronic kidney disease is associated with a very high mortality and hospitalization. This is primarily due to the existing comorbid conditions such as hypertension, coronary artery disease, peripheral vascular disease.
Despite this, the mortality rate of end-stage renal disease has been improving, especially since 1999. The 5–year survival for patients who initiated dialysis sometime between 1998 and 2002 (34 percent) was found to be 10 percent higher than for those who initiated dialysis sometime between 1993 and 1997 (31 percent).
Additionally, the risk of cardiovascular disease is five to 10 times higher in patients with chronic kidney disease and end-stage renal disease when matched with controls of the same age. Cardiovascular disease is considered the primary cause of death in these patients, followed by sepsis and cerebrovascular disease.