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Uremia/Uremic Syndrome
Published in Charles Theisler, Adjuvant Medical Care, 2023
Uremia is defined as elevated concentrations of urea, creatinine, and other nitrogenous end products of metabolism in the blood that are normally excreted by the kidneys into the urine. It is a serious condition and when left untreated can lead to death. Uremia occurs after the kidneys are damaged (chronic kidney disease) and cannot filter the blood normally. Symptoms include itchy skin, nausea, loss of appetite, weight loss, leg cramps, and fatigue. Common causes of chronic kidney disease are hypertension, polycystic kidney disease, diabetes (DM1 and DM2), glomerulitis, some cancers, and recurrent kidney stones or infections. Complications of untreated uremia can be seizures, coma, bleeding, cardiac arrest, and death.
Disorders of Consciousness
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Uremia: May have asterixis (i.e. flapping tremor) and fetid breath odor.EEG may reveal prominent frontal triphasic waves.
Measurement of Transmembrane Potential in the Study Of Systemic Disease*
Published in Richard C. Niemtzow, Transmembrane Potentials and Characteristics of Immune and Tumor Cell, 2020
J. Hamilton Licht, Hardin Jones
Welt et al. observed high intracellular sodium and chloride in erythrocytes from uremic individuals and the term “sick cells” was subsequently coined.12 In part to determine whether the “sick cell” syndrome applied to skeletal muscle cells in severely ill patients, Cunningham et al.20 examined normal and severely ill subjects, eight of whom had uremia. They measured skeletal muscle Em and intracellular electrolytes and observed that in uremic individuals muscle cells have high intracellular sodium and chloride concentrations and low Em. In other studies of skeletal muscle in uremia, low intracellular potassium was also observed.27 The fundamental cell membrane defect(s) was not identified in these studies, but inferences were made. Both groups noted a disparity between Em calculated using the Goldman Equation (Equation 1) and measured Em. This disparity may have been due either to enhanced permeability of the cell membrane to sodium or to decreased activity of membrane sodium- potassium-ATPase.20, 27 The latter hypothesis is supported by in vitro studies of erythrocytes from uremic individuals and ATPase preparations from uremic brains.2, 36, 37
Restless leg syndrome in patients with chronic kidney disease: a hospital-based study from Upper Egypt
Published in International Journal of Neuroscience, 2023
Sherifa Ahmed Hamed, Samir Kamal Abdulhamid, Ali Farrag El-Hadad, Mohamed Fawzy, Mohamed Ahmed Abd-Elhamed
This study included 520 adults with CKD. The majority had low/very low SES (88.46%). They had mean age of 50.45 ± 3.63 years and duration of uremia of 6.44 ± 1.65 years. Four hundred (77%) had ESKD (GFR: <30-<15 mL/min) and on regular hemodialysis (three times per week, 2.5–4 h/session) for duration of 4.43 ± 1.26 years. The remaining (n = 120, 23%) had CKD3D (GFR: 30-59 mL/min) and were on dietary control and supportive treatments. None had history of kidney transplantation and none received erythropoietin therapy but nearly all had history of frequent use of iron, calcium, vitamin D and vitamin B complex supplementations. The commonest causes/comorbid conditions of uremia were nephritis (66.15%), diabetic nephropathy (22.31%) and hypertension without or with ischemic heart disease (11.54%). Nearly 33.85% had history of uremic encephalopathy. Manifestations of uremic encephalopathy included disturbed level of consciousness, disorientation, astrexis and myoclonus. Astrexis and myoclonus were observed in every patient with ESKD. Sensory/sensorimotor peripheral neuropathies were found in neurological examination of 55.38%. The most prominent biochemical abnormalities with CKD were hypocalcemia (54.62%), anemia (53.08%), hyperparathyroidism (24.62%), hypoalbuminemia (16.15%) and hyperphosphatemia (13.85%). Hyponatremia, hyperkalemia and hypomagnesaemia were found in 13.85%, 8.46%, 7.69% and 4.23%, respectively. Hyperparathyroidism was found in 78.57%. Inadequate dialysis (URR: ≤45%) was found in 66.35% (p = 0.0001).
The roles of hydrogen sulfide in renal physiology and disease states
Published in Renal Failure, 2022
Jianan Feng, Xiangxue Lu, Han Li, Shixiang Wang
H2S plays diverse roles in the onset and development of kidney disease. Acute kidney injury (AKI) is the clinical syndrome caused by a rapid decline in renal function due to a number of causes, which can occur in patients without kidney disease or on the basis of original kidney disease. The main features of this type of injury are a rapid decrease in GFR, an increase in serum creatinine, oliguria and even anuria. Approximately 20% of hospitalized patients experience AKI, although among critically ill patients, the percentage can reach 50%. AKI is divided into different types according to etiology and stage, and the prognoses and treatments differ among the types. However, the main complications include volume overload, uremia complications and electrolyte disorders. AKI causes 2 million deaths a year, placing huge burdens on society and the medical system [33,34].
Prognostic implications of predialysis patients’ symptoms in peritoneal dialysis patients
Published in Renal Failure, 2021
Fang-Yu Wang, Zhuan Cui, Chun-yan Su, Tao Wang, Wen Tang
Anorexia (58%) was the most common symptom in the present cohort, followed by insomnia (32.7%), fatigue (27.6%), syndromes of heart failure (27.6%), and nausea (20.5%). These results are different from the previous study that the most common symptoms were fatigue (44%), nausea (24%), and anorexia (22%) at the dialysis initiation [6]. Nausea and anorexia are major uremic symptoms and a frequent indication for starting dialysis [14]. The higher present of anorexia and nauseas may reflect a relatively late start of dialysis in the present predialysis patients. Interestingly, we found that nausea is a more powerful predictor for patients’ short-term (6 and 12 months) mortality than anorexia after adjusting other confounding factors, which indicated that for patients with symptoms of nausea, more intensive treatment may be needed to ameliorate the symptom and thus to improve patients short-term outcome.