uremic

Uremic is an adjective relating to uremia, a clinical syndrome that arises when the kidneys fail to adequately remove waste products from the blood. Uremia is most commonly seen in advanced chronic kidney disease or in acute kidney injury and reflects the accumulation of nitrogenous wastes such as urea, creatinine, and other solutes collectively referred to as uremic toxins.

Causes and pathophysiology: In kidney failure, reduced glomerular filtration rate leads to impaired excretion of wastes and disturbances in fluid, electrolytes, and acid-base balance. Uremic toxins include small solutes and middle molecules produced by metabolism and gut microbiota; retention contributes to platelet dysfunction, inflammation, and cardiovascular risk.

Clinical features: Uremia can cause fatigue, anorexia, nausea, vomiting, weight loss, cognitive dysfunction, pruritus, and a metallic taste. Edema, hypertension, metabolic acidosis, hyperkalemia, and anemia are common. In severe cases, uremic pericarditis or encephalopathy may occur; bleeding tendency due to platelet dysfunction may be present.

Diagnosis and management: Diagnosis is based on laboratory evidence of azotemia with elevated BUN and creatinine, electrolyte abnormalities, and acid-base disturbances in the context of kidney disease. Management aims to remove toxins and correct complications, most effectively with renal replacement therapy (hemodialysis or peritoneal dialysis) when symptomatic or when there are complications. Supportive measures include bicarbonate for acidosis, potassium control, phosphate binders, vitamin D and anemia management, and dietary modifications (restricted protein, sodium, and potassium as appropriate).

Prognosis and variations: Uremic states require ongoing treatment and often renal replacement therapy; prognosis depends on underlying kidney disease, treatment access, and comorbidities. The term reflects a spectrum rather than a single disease, and early recognition improves outcomes.