uremie

Uremie, commonly referred to as uremia, is a clinical syndrome that results from the accumulation of waste products and toxins in the blood due to severe kidney failure. It most often occurs in advanced chronic kidney disease (stage 4–5) or after an acute kidney injury, when the kidneys cannot adequately filter and excrete nitrogenous waste products.

Its pathophysiology involves retention of nitrogenous wastes such as urea and creatinine, as well as other gut-derived toxins. Electrolyte imbalances, metabolic acidosis, and disturbances in fluid balance accompany the excess waste products. Anemia, inflammation, and impaired immune function are common contributors to the syndrome.

Clinical features include fatigue, nausea, vomiting, loss of appetite, weight loss, and cognitive impairment. Pruritus, a metallic taste, and urinary odor may be reported. In advanced cases, uremic pericarditis, encephalopathy, or platelet dysfunction leading to bleeding can occur, and fluid overload may cause edema and hypertension.

Diagnosis relies on laboratory tests showing elevated blood urea nitrogen and creatinine, along with electrolyte and acid–base abnormalities. The term azotemia describes laboratory elevation of nitrogenous wastes, while uremia refers to the associated symptoms and systemic effects.

Management focuses on treating the underlying kidney failure and systemic complications. Urgent renal replacement therapy with dialysis is indicated for symptomatic uremia or severe metabolic derangements, while long-term management may involve dialysis or kidney transplantation. Supportive care includes careful dietary protein management, correction of electrolyte imbalances, treatment of anemia, and measures to control blood pressure and inflammation.