Uremia - Information and Specialists

Uremia refers to the poisoning of the blood by substances normally excreted in the urine, such as urea, creatinine, and uric acid.

Uremia occurs primarily in cases of:

• Kidney damage
• End-stage renal disease
• Acute kidney failure

Uremia leads to progressive blood poisoning caused by uremic substances @ Pepermpron /AdobeStock

Uremia can be chronic or acute.

In acute uremia, extensive edema develops because the dysfunctional kidneys can no longer excrete fluid. This causes blood pressure to rise. As a result, patients with acute uremia often suffer from high blood pressure.

Chronic uremia is characterized by chronic kidney damage. Kidney function continues to decline, causing waste products to accumulate more and more in the blood.

Uremia manifests through a wide range of symptoms and affects virtually the entire body. Since uremia is usually the result of kidney failure, many symptoms overlap with those of kidney damage.

In the nervous system, uremia leads to:

• severe drowsiness (somnolence)
• disorientation
• amnesia
• cerebral edema, or
• sensory disturbances due to polyneuropathy

Symptoms in the digestive system include:

• Malaise
• Nausea and vomiting
• Abdominal fluid accumulation (ascites) or
• uremic inflammation

Ascites refers to a pathological accumulation of fluid in the abdominal cavity @ donikz /AdobeStock

In the blood, the toxins lead to:

• Dysfunction of platelets and blood clotting
• Impaired immune defense due to damage to white blood cells.

In the cardiovascular system, the following are observed in uremia:

• High blood pressure (hypertension)
• Uremic inflammation of the heart, as well as
• heart failure

The respiratory system is usually also affected, as it is closely linked to the cardiovascular system.

This leads to the following in the lungs:

• Edema (fluid accumulation)
• Inflammatory reactions and
• Kussmaul breathing: usually resulting from blood acidification (acidosis) 

However, these are all symptoms that usually develop invisibly inside the body.

In addition to open-mouth breathing caused by acidosis, uremia also leads to characteristic skin manifestations that indicate uremia. 

These include:

• Severe itching (pruritus)
• A grayish-yellow skin color (“café au lait spots”) as well as
• General pigmentation disorders

Uremia associated with renal insufficiency can be diagnosed based on blood test results. To do this, the doctor draws a small sample of blood—similar to a complete blood count—which is then analyzed by a laboratory. 

Of particular interest in uremia are the retention levels for:

• Urea
• creatinine, and
• uric acid

If these levels are elevated in the blood, doctors diagnose uremia—an accumulation of substances normally excreted in the urine in the blood.

Uremia itself cannot be treated directly, as it is the result of kidney disease. For this reason, the primary focus must be on treating kidney failure in order to alleviate uremia.

The treatment of choice is usually immediate dialysis (blood cleansing) to filter the high concentration of waste products out of the blood—a function normally performed by the kidneys in healthy individuals.

Depending on the patient’s age and any pre-existing conditions, attempts may be made to restore kidney function through treatment.

However, a kidney transplant may also be considered as a long-term solution.

Treatment for uremia consists of immediate dialysis to cleanse the blood of harmful substances @ Tyler Olson /AdobeStock

The following measures can be used as adjunctive therapy, particularly to improve or maintain kidney function:

• a low-protein but high-calorie diet, since a lower protein intake also results in less urea production
• balanced fluid intake to reduce the strain on the kidneys
• taking diuretics to support the excretion of electrolytes and water

Uremia, or blood poisoning, is a life-threatening condition if left untreated. However, immediate medical treatment can save the patient’s life. Nevertheless, dialysis is necessary in the long term, and in many cases, a kidney transplant is also required.

Due to the need for dialysis in cases of kidney failure, patients’ daily lives and quality of life are severely limited. Only a successful kidney transplant improves the living conditions and overall health of those affected.

The kidney is the most commonly transplanted organ @ Iryna /AdobeStock

The best way to protect yourself from kidney failure with uremia is to have any signs of kidney damage evaluated by a specialist. 

In addition, as a patient, you should ensure that:

• You undergo regular checkups if you have existing kidney weakness
• You monitor your fluid intake and urine output, and 
• avoid medications and substances that can damage the kidneys

This usually helps slow down or even completely halt further kidney damage.

Since uremia results from kidney disease, it falls within the scope of nephrology. Specialized kidney centers or nephrologists will make the diagnosis and plan further treatment steps with you. 

Urology also performs kidney transplants as a surgical treatment. In state-of-the-art centers in Germany, this surgery is now possible with the assistance of robots.