Nutrition and Appetite Regulation in Children and Adolescents with End-Stage Renal Failure
Victor R. Preedy in Handbook of Nutrition and Diet in Palliative Care, 2019
Uremia describes the accumulation of a multitude of substances that are normally excreted by the kidneys. Apart from well-known parameters like urea or creatinine and the hormones previously depicted, many substances are unidentified (Chazot 2009). Sufficient elimination of uremic toxins by dialysis has been shown to be of major importance, as it is associated with improved clinical outcome and growth (Fischbach et al. 2010). Complications of uremia that contribute to inappetence include nausea, gastric emptying delay, peptic ulcers and Helicobacter pylori infections. A loss of taste also may contribute to reduced nutrient intake in patients with ESRD (Armstrong et al. 2010). Consequently, the intake of protein and energy progressively decreases with deteriorating renal function. On the molecular level, amino acid imbalance increases the transport of free tryptophan across the blood-brain barrier, creating a hyperserotoninergic state resulting in activation of the anorexigenic melanocortin receptor 4. Accumulating inflammatory cytokines also suppress appetite. Hemodialysis supports the inflammatory state because of recurring contact to extrinsic, potentially allergenic surfaces. Peritoneal dialysis leads to distension of the abdomen and an increased glucose load, which both are satiety signals (Rees and Shaw 2007; Chazot 2009).
Kidney Function and Uremia
Sirshendu De, Anirban Roy in Hemodialysis Membranes, 2017
The precursor to toxin buildup in the human body is kidney malfunction, and this clinical syndrome is referred to as uremia resembling systemic poisoning. There is an overall decline in the performance of various organs of the human body. This can manifest itself through decline in the performance of the cardiovascular system (hypertension, hypotension, etc.), the nervous system (loss of memory, sleep disorders), the hematological system (anemia, bleeding), and the immunological system (susceptible to cancer and infection). Various other complications such as bone diseases (amyloidosis, osteoporosis), skin diseases, gastrointestinal diseases (gastritis, nausea), weight loss, and hypothermia can also arise due to uremia.
Uremia/Uremic Syndrome
Charles Theisler in 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.
Neurologic conditions and disorders of uremic syndrome of chronic kidney disease: presentations, causes, and treatment strategies
Published in Expert Review of Clinical Pharmacology, 2019
The normal kidney functions to regulate body fluids volume and electrolytes, maintain pH, concentrate urine above plasma, secrete important hormones (erythropoietin [EPO] and renin), control blood pressure, and excrete waste products, metabolites, toxins, and drugs. Kidney failure is defined as inadequate excretory, regulatory, and endocrine function of the kidneys that cannot be explained by extracellular volume derangements, inorganic ion concentrations, or lack of known renal synthetic products. Uremia or uremic syndrome is a term used to describe the clinical, metabolic, and hormonal abnormalities accompanying kidney failure. Uremic syndrome is diagnosed when renal glomerular filtration rate (GFR) becomes equal or less than 15 ml/min. In end stage kidney disease (ESKD), the GFR is equal to or less than 7% of the normal value which necessitates renal replacement therapy by regular dialysis or kidney transplantation. Because uremia is mostly a consequence of kidney failure, its signs and symptoms often occur concomitantly with other signs and symptoms of kidney failure [1]. The Uremia or uremic syndrome of chronic kidney disease (CKD) is frequent and worldwide rapidly growing public health problem particularly with ESKD, with an estimated prevalence of 13–35% [2]. Diabetic nephropathy is the commonest CKD in developed countries [2] whereas in the developing world, inflammatory diseases of the kidney, particularly glomerulonephritis and tubulointerstitial nephritis, remain also on the top of the commonest causes of CKD in addition to diabetes [3].
Neutrophil/lymphocyte ratio elevation in renal dysfunction is caused by distortion of leukocyte hematopoiesis in bone marrow
Published in Renal Failure, 2019
Satoyasu Ito, Yoshiya Ohno, Toshiyuki Tanaka, Shuhei Kobuchi, Kazuhide Ayajiki, Eri Manabe, Tohru Masuyama, Sakamoto Jun-Ichi, Takeshi Tsujino
It is thought that uremia symptoms are caused by uremic toxins accumulated in the body of renal disorder patients. IS is the most studied substance as a representative of uremic substances among about 90 uremic substances. In patients with CKD, the total mortality rate and the CVD mortality rate were high in the serum IS high-level group [21]. In other words, IS was involved in high morbidity and mortality of CVD in patients with CKD. IS has been reported to activate NADPH oxidase, induce reactive oxygen species (ROS), and promote CKD progression [22–25]. Oxidative stress is deeply involved in pathogenesis of inflammation [26–28], which accelerates the progression of CKD [28,29]. In order to examine how IS is involved in NLR elevation, we focused on leukocyte hematopoiesis in bone marrow.
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.
Related Knowledge Centers
- Azotemia
- Kidney Failure
- Protein Metabolism
- Urea
- Urine
- Amino Acid
- Creatinine
- Assessment of Kidney Function
- Glomerular Filtration Rate
- Kidney Dialysis