Uremia is simultaneously one of the stages of chronic renal failure and a special clinical syndrome. It is diagnosed when a lot of decomposition products( especially urea and residual nitrogen) accumulate in the body and autointoxication occurs - that is, self-poisoning of the body. From uremia no one is insured - newborn children, schoolchildren, adults and elderly people. Prolonged uremia is very dangerous and can lead to death.
Uremia - what is it?
Uremia is an intoxication of the body from within, with products of its own protein metabolism. It occurs in stages: first, urea, creatinine, ammonia, uric, glucuronic and oxalic acids, acetone, phenols and other toxins accumulate in the blood. A gradual toxic damage to organs and tissues develops, which at a certain critical point is manifested by external symptoms.
Normally, urea is present in the blood of each person, for each age these figures differ markedly.
Uremia is the urea content in the blood higher than:
| Age of the person | Urea indices, mmol / L |
|---|---|
| Premature newborns | 1,1-8,9 |
| Late newborns | 1,4-4,3 |
| Children under 14 | 1, 8-6,4 |
| Adults( men and women) | 2,5-8,3 |
| Older people | 2,9-7,5 |
There are many natural causes that can affect this indicator. Thus, men have the highest level of urea, and with active sports and protein diet, this figure grows even more, up to 17 mmol / l.
In a person who does not eat meat products, the concentration of urea in the blood is less, a similar situation for women. During pregnancy, the urea index falls even lower in women. Over the years, the function of the kidneys is weakening, so in elderly people the level of urea and toxins in the blood is slightly above average.
In the International Classification of Diseases of the 10th revision, uremia is fixed in several sections at once. If the disease of uremia in a newborn is congenital renal failure, code P96.0 for ICD-10.Chronic and unspecified uremia are codes N18 and N19.When uremia is caused by a decrease in kidney function after abortion, ectopic and molar pregnancy, this is code O08.4.If the cause of extrarenal problems is extrarenal uremia, the ICD-10 code is R39.2.
Reasons for
The immediate and main cause of uremia is renal failure, acute or chronic. Therefore, all the causes that lead to a violation of renal functions are also risk factors for uremia. In most cases, these causes coincide in people of different age and sex.
Acute uremia usually occurs against a background of shock - traumatic or toxic. Among the intoxications in the first places - food poisoning( here most risk children) and alcohol. A common cause is severe infections.
The causes of chronic uremia are more extensive:
- malignant tumors in the kidney;
- inflammatory processes( pyelonephritis, glomerulonephritis, etc.);
- urolithiasis;
- hereditary nephritis;
- prostate adenoma in men;
- extrarenal diseases: tuberculosis, diabetes, hypertension.
During pregnancy, uremia can occur late in life, when the uterus contracts the ureter and prevents the outflow of urine. In children, the developmental causes( urinary tracts), renal vein thrombosis( in infants) and other pathologies are added to the causes of uremia.
Stages of
Acute uremia develops almost instantaneously and in medical literature is not divided into distinct stages. Chronic poisoning is slower and can take several months or years, and at first the patient will not even guess that he is sick.
Specialists distinguish three stages of development of chronic uremia:
- Conservative-curative( latent).
- Terminal.
- uremic coma( sometimes seen as a complication of uremia).
In some sources, the stages of uremia coincide with the stages of chronic renal failure: 1 stage - latent( latent), 2-compensated, 3 -termittent and 4-terminal.
Clinical picture of
No characteristic symptoms are seen in the first stage of uremia. All the unpleasant sensations at this stage are provoked by the toxic effects of urea, ammonia and creatinine on the vessels, nervous and digestive systems. Patients feel weak, broken, complain of drowsiness and irritability. There is a dream, memory and attention problems begin, sometimes speech disorders. Appetite may disappear, a person often feels sick, constipation regularly occurs.
The terminal stage is often called the boundary between life and death. Its symptoms:
- vomiting and diarrhea( the body tries to get rid of toxins);
- excruciating thirst;
- weakness and cramps;
- low temperature( not above 35ºC);
- severe and uneven breathing;
- colitis and abdominal pain( uremic gastritis);
- pale skin with a yellowish tint( due to hepatic insufficiency);
- vision impairment( until complete loss);
- hemorrhage in different parts of the body;
- reduced pressure;
- white precipitate of urea crystals on the face( uremic frost);
- bad breath( urine or ammonia).
Broken breathing, uremic powder and smell from the mouth are already symptoms of the beginning uremic coma. At this stage, the patient raves, he is visited by hallucinations.
Differences in symptoms of this disease in children and adults are usually not observed. In infants and small children, acute poisoning develops faster, so all symptoms appear brighter. Uremia in the background of chronic renal failure can cause a child to lag behind in growth at a conservative stage.
Diagnosis
The diagnosis of "uremia" is made when the level of urea in the blood rises to 16 mmol / l and higher. The index of 16-20 mmol / l is uremia of moderate severity, up to 50 mmol / l - a severe degree. More than 50 mmol / l urea in the blood - a very severe uremia, the forecast in this case is unfavorable.
The very first analysis in the diagnosis of uremic syndrome is a biochemical blood test. It shows the level of creatinine and urea, these are the main markers of the disease.
To determine the cause of this condition, additional diagnostic procedures are prescribed:
- general urine analysis;
- kidney ultrasound;
- excretory( excretory) urography;
- computed tomography.
The general analysis of urine helps to identify pyelonephritis and urolithiasis, ultrasound scan of the kidneys shows a variety of diseases, including malformations and tumors. Excretory urography, like computed tomography, is performed to clarify the diagnosis of "urolithiasis".
Treatment of
The main task in the treatment of uremia - if possible, eliminate the cause of poisoning. In severe stages of uremia, it is often impossible, here the treatment is aimed at removing the symptoms and easing the patient's suffering as much as possible.
Medication treatment
Effective only in the early stages of uremia or when other methods of treatment for any reason are impossible. Includes rehydration( fluid replenishment) and detoxification( removal of poisons) therapy.
This physiological solution intravenously, glucose solution, the introduction of rheosorbylact and reopolyglucin. How to treat and in what proportions to introduce medicines is prescribed by a doctor.
Folk methods
In acute uremia and in the terminal stage of chronic syndrome, treatment with folk remedies is strictly prohibited. In this case, you urgently need to take the patient to the hospital, and not try to improve his condition with weeds.
But the mild forms of the disease can be completely corrected with the help of herbal remedies( only in consultation with the attending physician).Improve the function of the kidneys and prevent the poisoning of the body are capable of herbal collections of chamomile, dandelion roots, black currant leaves, juniper berries, etc.
An important point in the treatment of chronic uraemia is a diet. It is necessary to observe a sparing diet with a minimal load on the kidneys and an increased volume of fluid( up to 4 liters per day, if there are no contraindications).
Hemodialysis
The main method of treating uremia today is hemodialysis( "artificial kidney").In most cases, the patient only needs one procedure, after which the doctors are already beginning to treat the immediate cause of uremia.
In the terminal stage, regular hemodialysis is used, in particularly severe cases - kidney transplantation.
Forecasts
The prognosis for uremia depends on the form and stage of the disease. Acute uremia develops very quickly, but the outcome is quite favorable, if the patient was quickly taken to the hospital. But when the urine does not depart more than 5-7 days, uremic coma and death are possible.
If a patient is not hospitalized on time, it is likely that he develops a kidney or uremic coma, which often ends in a fatal outcome. But even if a person survives, the risk of mental retardation in the future is great because of brain damage - renal encephalopathy.