Uremic syndrome - medical article, news, lecture

Uremia
(Latin uraemia; other Greek οὖρον - urine and αἷμα - blood; synonyms:
urinary tract
) is a syndrome of acute or chronic autointoxication that develops with severe renal failure as a result of retention in the body of nitrogenous metabolites (azotemia) and other toxic substances, disorders of water-salt, acid-base and osmotic homeostasis, accompanied by secondary metabolic and hormonal disorders, general tissue degeneration and dysfunction of all organs and systems. The term “uremia” was proposed in 1840 by P. A. Piorri[en] and D. Leritier[1].

Uremia: causes of the disease

There are many reasons for the appearance of this disease. This may be renal failure (acute), which occurs due to shock, disruption of the circulatory system, as well as injuries, frostbite, severe burns or poisoning. Uremia also occurs as a result of a disorder of acid-base, water-salt and osmotic homeostasis, accompanied by secondary hormonal and metabolic disorders, dysfunction of all systems, organs and general tissue degeneration.

In most cases, acute renal failure is reversible. Most often it occurs abruptly. In this case, the disease is accompanied by sudden anuria or oliguria, in which the bladder fills slightly or urine does not enter it at all.

The most common cause of uremia is self-poisoning of the body with nitrogenous compounds such as uric acid, urea, indican and creatinine. In addition, this disease can manifest itself as a result of acidosis and changes in electrolyte balance in the human body.

Forecast

Uremia in acute renal failure is characterized by rapid development and almost complete reversibility with adequate treatment, with the exception of the most severe cases. Without dialysis treatment, it is fatal in the vast majority of cases. If the period of anuria extends to 5-7 days or more, death may occur from hyperkalemia, acidosis, or overhydration. When using extrarenal cleansing methods, primarily dialysis, it is possible to save the lives of 65-95% of patients, most of whom return to a full life.

During chronic uremia, conservatively curable and terminal stages are distinguished. The latter is characterized by a decrease in glomerular filtration to 10 milliliters/minutes or lower, with the exhaustion of the possibilities of adaptation to impaired renal function. Varying life expectancy of persons with untreated chronic uremia is observed mainly in the conservative stage or in the intermittent course of uremia, observed in patients suffering from loss of water and salt, tubular acidosis, infection, and impaired urodynamics. High arterial hypertension, circulatory failure, and pericarditis significantly aggravate the course and worsen the prognosis.

The terminal stage of uremia indicates the proximity of death. The only way to prolong the life of a patient at this stage is regular dialysis. Among the causes of death in patients with uremia, the most common are cardiovascular disorders (including pericarditis with cardiac tamponade), hyperkalemia, associated infectious diseases (pneumonia and others), sepsis, hemorrhagic complications, uremic coma. With regular hemodialysis treatment, the life expectancy of patients with chronic uremia can be significantly extended. The known maximum life expectancy on maintenance treatment with hemodialysis is 22 years, and with peritoneal dialysis - 12 years.

What are the different forms of uremia?

Diseases of the kidneys and urinary tract can occur in chronic and acute forms. Chronic uremia, unlike acute uremia, develops very slowly. Often it becomes a consequence of processes (irreversible) of extinction of the parenchymal tissues of the kidneys.

It should be noted that nephrosclerosis, which underlies the development of chronic renal failure, is also often the cause of uremia. In addition, this disease can also begin against the background of blockage of kidney vessels, chronic nephritis and urinary tract obstruction, which are blocked by an overgrown tumor or stone.

Stages

Acute uremia develops almost instantly and is not divided into clear stages in the medical literature. Chronic poisoning occurs more slowly and can take several months or years, and at first the patient will not even realize that he is sick.

Experts distinguish three stages of development of chronic uremia:

1. Conservative-curable (hidden).
2. Terminal.
3. Uremic coma (sometimes considered a complication of uremia).

In some sources, the stages of uremia coincide with the stages of chronic renal failure: stage 1 - latent (hidden), stage 2 - compensated, stage 3 - intermittent and stage 4 - terminal.

Kidney diseases leading to chronic renal failure

Kidney diseases, which become a common cause of chronic renal failure, often include:

• pyelonephritis;
• glomerulonephritis;
• congenital nephritis;
• the formation of many cysts in the kidneys;
• kidney stone disease.

The cause of uremia can also be diabetes mellitus or prostate adenoma.

Famous people who suffered from uremia

• Tycho Brahe
• Stefan Batory
• Peter I
• Jean-Jacques Rousseau
• Napoleon III
• Alexander III
• Michael Bulgakov
• Solovyov, Vladimir Sergeevich
• Jack London
• Louis Pasteur
• Christiane Vulpius (Goethe's wife)
• Dale Carnegie
• Sturmer, Boris Vladimirovich
• Jean Harlow
• Yuan Shikai
• Sarah Bernhardt
• Romanov, Dmitry Pavlovich
• Yuri Andropov
• Ostwald, Wilhelm Friedrich
• Emperor Meiji
• Novgorodov Semyon Andreevich

Main symptoms of the disease

As a rule, inflammatory kidney diseases are accompanied by volumetric urine discharge that is almost white in color. At the same time, urine has a low specific gravity. It should also be noted that large diuresis is often accompanied by retention of urea and chlorides, released in small quantities.

As the disease progresses, the volume of urine may decrease, and nitrogenous metabolic products may accumulate in the body, increasing their concentration in the blood.

For several weeks, the patient usually experiences a precomatose state. Subsequently, it can easily cause uremic coma. Its first harbingers are disorders of the gastrointestinal tract. So, the patient’s appetite decreases, and later he completely refuses food and drink. Urea accumulates in the patient's saliva. This has a direct impact on the appearance of bitterness in the mouth. The urea is subsequently broken down by oral bacteria, resulting in the release of ammonia. This is what causes the unpleasant odor.

Pathogenesis

The leading role in the pathogenesis of uremia, both acute and chronic, is played by intoxication with metabolic products that are normally excreted in the urine. It has been proven that the body of patients with uremia accumulates a lot of organic substances, especially products of protein metabolism, many of which are toxic. In addition to urea, in particular, ammonia, cyanate, creatinine, guanidines, uric acid, β2-microglobulin, β2-glucoprotein, peptides of average molecular weight, amino acids, pyridine derivatives, aliphatic and aromatic amines[en], polyamines, indole, phenols accumulate. , myoinositol, mannitol, acetone, lipochromes, cyclic AMP, glucuronic and oxalic acids, a number of hormones, some enzymes and others.

How to recognize the disease?

As mentioned above, kidney disease (symptoms and treatment are described in detail in this article) can be easily identified by problems with the gastrointestinal tract. Accumulating in gastric juice, urea causes uremic colitis and gastritis. Thus, the symptoms of the disease include vomiting after eating, nausea, and diarrhea mixed with blood.

Among other things, kidney disease in men, women and children is accompanied by disorders of the central nervous system. The patient may experience weakness and apathy, and get tired quickly. The patient often feels stiff in his movements, constantly feels drowsy, and his head seems incredibly heavy.

As the illness progresses, the desire to sleep begins to combine with insomnia. Against this background, confusion occurs, the eye and other muscles twitch.

Clinical picture

At the first stage of uremia, no characteristic symptoms are observed. All unpleasant sensations at this stage are provoked by the toxic effects of urea, ammonia and creatinine on the blood vessels, nervous and digestive systems. Patients feel weak, overwhelmed, complain of drowsiness and irritability. Sleep suffers, problems with memory and attention begin, and sometimes speech disorders. Appetite may disappear, the person often feels sick, and constipation occurs regularly.

The terminal stage is often called the borderline 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 higher than 35ºC);
• heavy and uneven breathing;
• colitis and abdominal pain (uremic gastritis);
• pale skin with a yellowish tint (due to liver failure);
• deterioration of vision (up to complete loss);
• hemorrhages in different parts of the body;
• low pressure;
• white residue of urea crystals on the face (uremic frost);
• bad breath (urine or ammonia).

Impaired breathing, uremic powder and bad breath are already symptoms of an incipient uremic coma. At this stage, the patient is delusional and hallucinates.

There are usually no differences in the symptoms of this disease in children and adults. In infants and small children, acute poisoning develops faster, so all the symptoms appear more clearly. Uremia against the background of chronic renal failure can cause growth retardation in children even at the conservative stage.

Signs of uremic coma

This condition can be determined by certain breathing movements. So, the patient begins to breathe very noisily, occasionally taking deep breaths and then exhaling briefly.

After the onset of the terminal phase, breathing may periodically completely disappear. This occurs due to a decrease in the excitability of the respiratory center.

The body temperature of patients with this problem almost never rises above 35 degrees. Also, symptoms of uremia often appear on the skin. Released through the integument, urea and other waste products cause itching, inflammation, dryness, trophic ulcers and leave a white coating.

Symptoms of impaired renal filtration function

If filtration is impaired, the amount of the above substances becomes excessive, which causes the following symptoms of uremia:

• General intoxication of the body. High levels of urea in the blood lead to intoxication. It causes the greatest harm to the heart muscle, which can manifest itself in the form of disturbances in the rhythm and contractility of the heart.
• Depression of the nervous system. Urine contains ammonia, which is a neurotoxin. Ammonia concentrations higher than normal in the blood cause disturbances in consciousness. In severe cases, it causes uremic coma. The severity of the manifestations is directly proportional to the concentration of ammonia. Azotemic uremia may be accompanied by convulsions, as well as disturbances of peripheral innervation.

• Dyspeptic phenomena. The appearance of nausea, vomiting, and diarrhea almost always accompanies the state of uremia. These symptoms occur due to the harmful effects of creatinine.
• Increased breathing. The appearance of frequent respiratory movements is the result of several pathological processes. Firstly, the body compensatoryly tries to increase breathing speed in order to remove toxic substances from the body. In this case, the patient's breath takes on the characteristic odor of ammonia. Secondly, breathing increases due to irritation of the vasomotor center, which is located in the medulla oblongata, by toxins.
• Tendency to bleed. High concentrations of toxins in the blood lead to impaired platelet formation. Their deficiency reduces the clotting ability of the blood, which leads to the development of bleeding. It is worth noting that with chronic kidney disease this symptom is more pronounced.

The state of uremia causes disturbances in the functioning of almost all systems, which can cause multiple organ failure.

How to eat?

Proper nutrition for kidney disease is of great importance. This is due to the fact that along with food, unnecessary substances enter the human body, which can significantly worsen the patient’s already difficult condition.

So what should you eat if you have kidney disease? When diagnosing this disease, doctors are required to prescribe a special diet to their patient. As a rule, it consists of significantly reducing the amount of protein food consumed. To do this, it is recommended to exclude meat and dairy products from your diet. Although some experts still advise leaving some of them, since proteins are very important for the human body (especially a growing one).

Diagnostics

If uremia is suspected, a biochemical blood test should be immediately performed to determine the level of creatinine and urea. A general urine test is also done. This analysis helps to determine the true causes of the development of uremia (it is important to prescribe the correct treatment). For example, if the analysis shows an increased amount of salts, then this suggests that the cause is urolithiasis. If bacteria are found in the urine, then the cause of uremia is complicated pyelonephritis. An effective method for diagnosing uremia is ultrasound examination of the kidneys.

Treatment methods for uremia

Now you know what diet you should have if you have kidney disease. However, it is not enough just to choose the right diet to alleviate the patient’s condition and relieve him of the above-mentioned ailment. That is why doctors additionally prescribe appropriate medications. Thus, patients with uremia are often injected into a vein about 50 ml of 40% glucose. In order to significantly reduce the concentration of toxic substances in the blood, as well as lower blood pressure, when treating the above-mentioned ailment, bloodletting is often performed (up to about 400 ml of blood).

To restore the amount of chlorine and other minerals that are excreted from the human body along with vomit and loose stools, they are restored through intravenous administration of sodium chloride (about 20 ml of a 10% solution). In addition, regular table salt may be added to the patient's food.

If the main symptoms of kidney disease (uremia) are accompanied by a deviation such as heart failure, then the patient must be prescribed a solution of the drug “Strophanthin”. Itching of the skin, which is inherent in this disease, is relieved with sodium bromide. As for muscle cramps and twitching, calcium chloride is used to get rid of them.

If a patient develops uremic coma, it should be treated only in a hospital. For this, the patient must be hospitalized immediately at the first symptoms.

Complications

With uremia, the brain suffers greatly. The patient experiences disturbances in attention, sleep, memory, and concentration. Hallucinations may develop. Gradually, the symptoms of uremia become so severe that uremic encephalopathy develops. Its main manifestations:

• complete apathy;
• increased anxiety (the patient is in an excited state);
• sensory disturbance;
• asterixis;
• instability is observed while walking;
• speech is disrupted;
• A characteristic symptom is muscle twitching.

The most severe complication of uremia is uremic coma . It develops if the patient was not provided with qualified medical care in a timely manner (in the first stages of the development of the disease). Its symptoms may develop gradually as kidney tissue dies. The patient complains of general weakness and loss of appetite. The amount of urine produced decreases, and swelling increases. These symptoms are accompanied by diarrhea and vomiting. Quite often, patients complain of pain in the heart area. Their shortness of breath increases, hemorrhages appear in the skin, mucous membranes and in the brain. One of the main symptoms for diagnosis is a pronounced smell of ammonia from the mouth. If treatment is not carried out in a timely manner, stupor and uremic coma will occur.

This condition requires immediate emergency care. The first thing that needs to be done in case of uremic coma is to remove from the body substances that the kidneys are not able to remove. For this purpose, the intestines are washed and solutions are administered intravenously.

Disease prevention

In preventing the development of this disease, the issue of preventing renal dysplasia is very important. Thus, it is necessary to create all the necessary conditions during monitoring of a pregnant woman, protecting the embryo and fetus from any teratogenic effects.

It is also important to search for markers of a heterozygous carrier of the pathology. In addition, antenatal diagnosis of the development of malformations of the genitourinary system is required.