UREMIA

INTRODUCTION
Uremia is the condition of having high
levels of urea in the blood. Urea is one of
the primary components of urine. It can be
defined as an excess of amino acid and
protein metabolism end products, such
as urea and creatinine, in the blood that
would be normally excreted in the urine. Uremic syndrome can be defined
as the terminal clinical manifestation of kidney failure (also called renal
failure). It is the signs, symptoms and results from laboratory tests which
result from inadequate excretory, regulatory and endocrine function of the
kidneys. Both uremia and uremic syndrome have been used
interchangeably to denote a very high plasma urea concentration that is the
result of renal failure. The former denotation will be used for the rest of the
article.
Azotemia is another word that refers to high levels of urea and is used
primarily when the abnormality can be measured chemically but is not yet
so severe as to produce symptoms. Uremia describes the pathological and
symptomatic manifestations of severe azotemia.
There is no specific time for the onset of uremia for people with progressive
loss of kidney function. People with kidney function below 50% (i.e. a
glomerular filtration rate [GFR] between 50 and 60 mL) and over 30 years
of age may have uremia to a degree. This means an estimated 8 million
people in the United States with a GFR of less than 60 mL have uremic
symptoms. The symptoms, such as fatigue, can be very vague, making the
diagnosis of impaired renal function difficult. Treatment is to perform
dialysis or a renal transplant.
CAUSES

Conditions causing increased blood urea fall into three different

categories: prerenal, renal, and postrenal.
Prerenal azotemia can be caused by decreased blood flow through
he kidneys (e.g. low blood pressure, congestive heart
failure, shock, bleeding, dehydration) or by increased production
of urea in the liver via a high protein diet or increased protein
catabolism (e.g. stress, fever, major illness, corticosteroid therapy
or gastrointestinal bleeding).
Renal causes can be attributed to decreased kidney function.
These include acute and chronic kidney failure, acute and
chronic glomerular nephritis, tubular necrosis and other kidney
diseases.
Post renal causes can be due to decreased elimination of urea.
These could be due to urinary outflow obstruction such as by
calculi, tumours of the bladder or prostate, or a severe infection.
PREVENTION
The best way to try to prevent uremia if you are in end-stage renal failure
is to have regular dialysis treatments. This will keep the waste filtered
out of your blood. You should also avoid eating anything high in sodium,
phosphorus, and potassium. Eating a healthy diet otherwise and
exercising, if approved by your doctor, can help in the prevention of
uremia.

Since uremia is caused by severe kidney disease and kidney failure, you
can try to prevent uremia by taking steps to prevent kidney disease when
possible. Some ways to prevent kidney disease include:

 controlling diabetes
 maintaining a healthy blood pressure
 taking steps to maintain cardiovascular health
 not smoking
 maintaining a healthy diet and exercise plan to avoid obesity

There are some risk factors — like age and a family history of kidney
disease — that can make it more difficult to prevent kidney disease.
However, taking as many preventive measures as possible will help.
TREATMENT

By the time you have developed uremia, your kidneys are extremely damaged. Dialysis is
the main treatment option for uremia. Dialysis is when the removal of wastes, extra
fluids, and toxins from your bloodstream is handled artificially instead of by your
kidneys. There are two types of dialysis. These types are:

 Hemodialysis: A machine is used to remove the waste from your blood.

 Peritoneal dialysis: A catheter (small tube) is inserted into your abdomen. A

dialysis fluid fills your abdomen. This fluid absorbs the waste and extra fluid.
Eventually, the fluid will remove the wastes from your body when it drains out.

A kidney transplant is another treatment option if you reach end-stage renal failure. A
kidney transplant is when a healthy kidney is taken from a living or deceased donor and
placed into your body. You’ll be put on antirejection medication long-term to prevent
your body from rejecting the donor kidney.
SYMPTOMS

As waste and fluid build up in your blood, you might:

 Feel nauseated
 Feel itchy
 Lose your appetite or taste for some foods
 Feel more tired than usual
 Lose weight
 Have trouble concentrating
 Feel pain, numbness, or cramps in your legs or feet (caused by damage
to your nerves)

If it’s not treated, uremia can also cause other problems, like:

 High blood pressure

 Anemia (when you don’t have enough red blood cells)
 Heart disease
 Brain damage
EFFECTS
Effects on Endocrine System
• Decreased estrogen due to effects of uremic toxins

• Decreased testosterone

• Increased half-life of insulin, causing it to be active for longer time, and increased risk
of hypoglycemia.

Gastrointestinal Effects
• Peptic Ulcer Disease is common, which should not be treated with typical antacids

• Gastroenteritis

• Anorexia

• Nausea/vomiting

Hematologic Effects
• Anemia related to bone marrow suppression and toxic effects of aluminum

• Elevated Parathyroid hormone causes bone marrow fibrosis

• May have blood loss and induced folate deficiency from dialysis and abnormal
homeostasis due to prolonged bleeding time

• Leukocyte suppression
AWARENESS
Uremia today is different from the fatal illness described by Addis1 and Schreiner
and Maher.2 Two million people worldwide who would have died a uremic death
are today being kept alive by dialysis. But these people suffer a new illness, which
Depner3 has aptly named the residual syndrome. This new illness comprises the
ill effects of retained organic waste solutes along with the complications of
treatment and continued inorganic ion disturbances. In many patients, the
residual syndrome is combined with the effects of advancing age and systemic
diseases responsible for kidney failure.
We tend now to restrict the label “uremia” to that part of the residual syndrome
caused by retained waste solutes. This usage is in keeping with the word's
etymology, from the Greek ouron (urine) and haima(blood). But beyond saying
that people get sick when things that belong in the urine accumulate in the blood,
we know remarkably little. Despite a recent renewal of interest in uremic toxicity,
as chronicled by Duranton et al.4 we cannot yet name with confidence any single
Not knowing which uremic solutes are toxic limits our ability to improve therapy.
The contribution of retained solutes to the illness experienced by dialysis patients
is difficult to dissect, but we believe it is large. We know that if dialysis is
withheld, accumulation of waste solutes will cause confusion, coma, and then
death. We believe that this would happen even if the extracellular volume and
inorganic ion concentrations were kept normal, if erythropoietin and 1,25-
hydroxycholecalciferol were replaced, and if patients were protected from all
other insults. We start dialysis when the eGFR has declined to between 5 and 10
ml/min per 1.73 m2 and symptoms have advanced to the point at which
treatment is expected to effect some improvement. Patients avoid death by
undergoing a burdensome treatment that prolongs their uremic illness—in effect
maintaining them in a state of severe renal insufficiency. We could do better if we
identified toxic solutes and lowered their levels. The benefit afforded by renal
transplantation provides the strongest evidence that reduction in solute levels
would benefit patients. Successful transplantation, which can restore solute
clearances to more than half normal, improves overall quality of life and
enhances specific functions, including sleep, cognition, exercise capacity, and
growth in children
CONCLUSION
Uremia is a potentially deadly medical condition that
usually signals a chronic illness.

A person's long-term survival and quality of life depend on

factors, such as their age, overall health, the quality of
their treatment, and the cause of the uremia.

People can survive uremia if they have prompt treatment.

However, no one should delay seeking treatment for
suspected uremia and should ensure they receive
treatment from a doctor specializing in kidney failure.
ACKNOWLEDGEMENT

I would like to express my special thanks of

gratitude to my teacher who gave me the golden
opportunity to do this wonderful project on the
topic (UREMIA) which also helped me in
doing a lot of Research and I came to know
about so many new things I am really thankful
to them.
Secondly I would also like to thanks my parents
and friends who helped me a lot in finalizing
this project within the limited time frame.
CERTIFICATE

This is to certify that the that the project

entitled URAMIA submitted to biology
department of “KHALSA MODEL
SENIOR SECONDAR SCHOOL” for
fulfillment of Biology Practical
Examination 2018-2019 during his
study in Biology Department under my
guidance and supervision.