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See also: Uremia

Uremia: a raised level in the blood of urea and other nitrogenous waist compounds that are normally eliminated by the kidneys.

  • Urea is normally one of the primary components of urine.
  • The literal meaning of uremia is “urine in the blood,” and the condition develops most commonly in the setting of chronic and end-stage renal disease (ESRD), but may also occur as a result of acute kidney injury, which involves a sudden increase in urea or creatinine.
  • Uremic syndrome can be defined as the terminal clinical manifestation of kidney failure (also called renal failure).
  • Uremia is a clinical syndrome marked by elevated concentrations of urea in the blood and associated with fluid, electrolyte, and hormone imbalances and metabolic abnormalities, which develop in parallel with deterioration of renal function.
  • Uremia more commonly develops with chronic kidney disease (CKD), especially the later stages of CKD, but it also may occur with acute kidney injury (AKI) if loss of renal function is rapid. Urea itself has both direct and indirect toxic effects on a range of tissues.
  • It can happen because of a long-running health problem, like diabetes or high blood pressure, or because a severe injury or an infection damages your kidneys. 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

Diagnosis

  • May include seeing a nephrologist (kidney specialist)
  • Blood tests that include:
    • Basic metabolic panel, serum calcium, phosphorus, blood urea nitrogen, and creatinine.
      • Uremia will demonstrate elevation of both urea and creatinine, likely elevated potassium, high phosphate and normal or slightly high sodium, as well as likely depressed calcium levels.
    • Evaluation for anemia and thyroid and parathyroid functions may also be included.
      • Chronic anemia may be an ominous sign of established renal failure.
      • The thyroid and parathyroid panels will help work up any symptoms of fatigue, as well as determine calcium abnormalities as they relate to uremia vs longstanding or unrelated illness of calcium metabolism.
  • Urinalysis which may show blood cells or proteins that shouldn’t be there.
  • A 24-hour urine collection will determine creatinine clearance.

Uremia results in many different compounds being retained by the body. With the failure of the kidneys, these compounds can build up to dangerous levels. There are more than 90 different compounds that have been identified. Some of these compounds can be toxic to the body.

Many regulatory functions of the body are affected. Regulation of body fluids, salt retention, acid and nitrogenous metabolite excretion are all impaired and can fluctuate widely. Body fluid regulation is impaired due to a failure to excrete fluids, or due to fluid loss from vomiting or diarrhea. Regulation of salt is impaired when salt intake is low or the vascular volume is inadequate. Acid excretion and nitrogenous metabolite excretion are impaired with the loss of kidney function

History

Urea was crystallized and identified between 1797 and 1808. Urea was hypothesized to be the source of urinary ammonia during this time and was confirmed in 1817. It was hypothesized that excess urea may lead to specific disorders. Later in 1821, it was confirmed that the body did produce urea and that it was excreted by the kidneys. In 1827, urea was first synthesized in the lab, confirming the composition of urea and making it the first biological substance synthesized. In 1856, urea was produced in vitro via oxidation of proteins. It was in 1850 that Thomas Dutrochet seeded the idea of dialysis with the discovery of separating smaller molecules from larger molecules through a semipermeable membrane. It was in 1829 and 1831 when convincing proof was obtained that in certain patients, blood urea was elevated. They also suggested that harm may be caused by this. Later research suggested that major neurological disorders like coma and convulsions did not correlate with physical findings which included generalized edema of the brain. This suggested that uremia was a form of blood poisoning. In 1851, E.T. Frerich described clinical uremic syndrome and suggested that a toxicity was the mechanism of its cause. It was in 1856 that J. Picard developed a sensitive method to reproducibly measure blood urea. He was able to detect a 40% decrease of urea concentration between the renal artery and the renal vein. This work solidified the fact that renal failure coincided with an increase in blood urea. It was J. Picard with E.T. Frerich's work that made the term uremia popular

Notables who died from Uremia

  1. University Kidney Research Organization – Famous people who have died from kidney disease

Resources & Additional Reading: