Uremia - Causes, symptoms and treatment. MF.
Jun 23, 2018
Uremia is a pathological condition that arises from the accumulation in the blood of protein metabolism products that normally should be excreted in the urine.
Symptoms of uremia
At the initial stages of the disease, uremia is characterized by general clinical symptoms, such as weakness, fatigue, headache. In the study of blood, there is an increased content of nitrogenous slags in it: residual nitrogen, urea, creatinine.
In a later period, urea and other nitrogen-containing substances accumulating in the blood begin to exudes strongly with the skin( "uremic powder" or "hoarfrost" on the skin), mucous and serous membranes, irritating them. As a result, there are symptoms of uremic gastritis( anorexia, nausea, vomiting), colitis( diarrhea), laryngotracheitis, pleurisy, pericarditis( usually already in the terminal period).
As a result of intoxication, liver and bone marrow functions are disrupted, anemia, thrombocytopenia, bleeding tendency, vision impairment( uremic neuroretinitis).
Appearance of a patient with uremia( uremic powder on the skin)
Causes of uremia
An immediate cause of uremia is acute or chronic renal failure. That is, all the causes that lead to the above pathologies, and are factors in the development of uremia.
To begin it is necessary with oncological diseases of kidneys, as they most often become the causative factors of uremia. As a result of the cancerous process, the hematouremic barrier can break down, and urinary toxins, which are normally excreted in the urine, enter the blood, causing the indicated clinical condition.
The next group of causes of uremia can be considered inflammatory processes of the kidneys. They are divided into purulent and autoimmune. If we talk about suppurative processes, it is necessary to recall such diseases as pyelonephritis followed by kidney abscess. In addition to nonspecific clinical symptoms, they will have complaints of pain in the kidney and elevated body temperature. If we are talking about autoimmune diseases, such as glomerulonephritis, then in addition to general clinical symptoms, there may be an increase in blood pressure.
Very often uremia can be caused by various forms of urolithiasis. Most often it develops with complete blockage of the ureter in its different parts. In this case, urine accumulates in the pelvis, increasing the intrarenal pressure, which leads to the destruction of glomerulus membranes and the ingestion of renal toxins into the blood. Patients with such a disease are concerned about severe pain in the lumbar region, which, as a rule, are not permanent, but paroxysmal. The characteristic renal colic makes it possible to expose the correct diagnosis.
Very often the causes of uremia are not nephrologic, but systemic diseases. For example, kidney damage in diabetes, hypertension or tuberculosis can also lead to the destruction of the structure of the renal tubules, which results in a uremic condition. In order to identify such diseases, it is necessary, first of all, to pay attention to general blood and urine tests.
Another group of causes of uremia, which are realized, mainly through acute renal failure, are various poisoning and intoxications. With regard to poisoning, in our region, the most common is toxicity damage to poisonous fungi. Therefore, it is necessary to be extremely careful when preparing mushrooms, especially those that are collected independently.
As far as chemical systemic intoxication is concerned, practitioners often have to deal with alcohol surrogate poisoning.
Clinical diagnosis of uremia
First of all, if uraemia is suspected, a biochemical blood test should be performed to determine the level of urea and creatinine. It is these indicators that are the direct markers of uremia. Since these substances are the products of protein metabolism, with uremia it is necessary to determine the level of total protein in the blood.
After biochemical analysis, uremia will be determined, it is necessary to conduct a whole range of laboratory and instrumental examinations in order to find out the cause of this clinical condition. First of all, it is necessary to conduct a general urinalysis. Quite often, only based on the results of this study, it is already possible to determine the cause of uremia. For example, if a large number of salts is detected in the general urine analysis, this makes it possible to assume the patient has urolithiasis. With an increased number of bacteria in the patient's urine, one can talk about complicated pyelonephritis.
If the general analysis of urine makes it possible only to presume the presence of a particular disease, then a large range of laboratory and instrumental methods of investigation must be carried out to verify the exact diagnosis. Usually, urologists start with ultrasound diagnostics, because it is inexpensive and covers a wide range of kidney diseases. With the help of ultrasound, it is possible to diagnose such pathologies as urolithiasis, kidney tumor and abscess of this organ.
Kidney ultrasound is an obligatory method for the investigation of uremia
. If ultrasound does not provide an accurate answer about the underlying disease, then other, more specific methods of investigation should be used. For clarification of the functional state of the kidneys, excretory urography is used. It makes it possible not only to diagnose urolithiasis, but also to determine how the concrement overlaps the lumen of the ureter. For the same purpose, computed tomography with contrasting urinary tract can be used.
Careful laboratory diagnosis is more important in cases where the cause of uremia is not the organic pathology of the kidneys, but systemic diseases such as tuberculosis, diabetes mellitus or hypertension. In these cases it is very important to conduct a clinical analysis of blood for sugar and bacteriological study of biological fluids for mycobacterium tuberculosis.
Syndrome treatment of uremia
In fact, uremia is a syndrome that involves a huge number of symptoms, so it uses symptomatic rather than symptomatic treatment for its correction. It can consist of medicamental or apparatus therapy.
As for the medical treatment of uremia, it consists of rehydration and detoxification therapy. To this end, patients are given intravenous infusions of saline, glucose, rheosorbilact and reopolyglucin. The number of drugs is determined by the severity of the general condition of the patient. Typically, the appointment of such drugs reduces clinical symptoms, which, shortly after their abolition, resumes. Along with this, quite often there are situations when symptomatic treatment of uremia remains the patient's only hope, since pathogenetic and etiological therapy no longer makes any sense.
Drug medication for uremia is the method of choice only in the initial stages of the disease or when there is no possibility to apply modern, more serious therapies. To date, a priority method of treating uremia is to consider hematologic dialysis. To conduct it, a special apparatus is used, which among a wide range of people has the trivial name "artificial kidney".In fact, the device is such a hemodialysis membrane, through which the human blood is passed and at the same time all pathological metabolic products are removed from it.
There is an opinion among people that "artificial kidney" can be addictive, so many patients are simply afraid to contact medical institutions for such help. In fact, this information has absolutely no scientific meaning. As practice shows, with such diseases as obstruction of the ureter with concrement, the use of hemodialysis is a single episode in a person's life. After the normal general condition of the patient is restored with the help of this device, the doctors proceed to the aetiological treatment aimed at the primary cause of the pathology.
As for the treatment of folk remedies, it is not recommended for this pathology. The fact is that delay in acute or chronic kidney failure can turn out to be an unfavorable outcome for the patient, therefore such patients should immediately go to specialized medical institutions.
Complications of uremia
In principle, uraemia itself is already a complication of renal failure, but it should be noted that it is not the final link in the development of one pathological process. In the absence of normal treatment, urinary toxins, which are in large quantities in the blood, begin to pass through the blood-brain barrier, which affects the nervous structures of the brain. Patients develop a condition called renal encephalopathy. At this time, the above symptoms are complained of with severe headache, limb tremors, memory dips and periodic loss of consciousness. Over time, patients become inhibited, react poorly to others and do not understand where they are. Such a clinical condition is called a comparison.
If at this stage the patient is not hospitalized in the department of intensive care, then the sopor will slowly pass to the renal or uremic coma. The patient loses consciousness, there is noisy deep breathing( Kussmaul's breathing), less frequent Cheyne-Stokes breathing, a strong smell of ammonia from the patient, pupils narrowed. In a similar state, the patient has no signs of life other than pulse and respiration. The main problem is that even with adequate treatment at this stage it is simply impossible to assess the further prognosis for the patient. In this case, even if a person succeeds in getting out of the state of uremic coma, in the future it is necessary to be afraid of intellectual insolvency. In addition, it must be remembered that with a kidney coma, a high percentage of mortality is noted.
To which doctor to consult with the signs of uremia
As it became clear, going to the doctor with uraemia is not something that is compulsory, but simply vital. But in order not to lose time, which in any case will affect the patient's condition, he needs to properly orient himself, to which specialist to apply first.
If a patient has symptoms of uremia that complete the symptoms of urolithiasis, then such a patient needs a urologist consultation. Only he can correctly diagnose and determine the further tactics of treatment.
If the symptoms of uremia are accompanied by complaints that may be related to oncological pathology, the on-line specialist is an oncologist whose task is to choose the right tactics for managing the patient.
If a patient has chronic systemic diseases such as atherosclerosis or diabetes mellitus, he, before consulting a urologist, should contact his district doctor to correct the treatment plan or refer it to a specialist.
Rev.the doctor the urologist, the sexologist-andrologist Plotnikov А.N.