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Uremia Clinical Presentation

  • Author: A Brent Alper, Jr, MD, MPH; Chief Editor: Vecihi Batuman, MD, FACP, FASN  more...
 
Updated: Feb 05, 2016
 

History

Uremia can occur once the creatinine clearance is below 10-20 mL/min. Clinically, it is heralded by the onset of the following signs and symptoms:

  • Nausea
  • Vomiting
  • Fatigue
  • Anorexia
  • Weight loss
  • Muscle cramps
  • Pruritus
  • Mental status changes
  • Visual disturbances
  • Increased thirst

Patients may report nonspecific symptoms, which become chronic and progressive over time because of the gradual onset of the disease. Making the diagnosis of uremia may be difficult in young children because of the nonspecificity of clinical symptoms.

Metabolic abnormalities such as anemia, acidemia, and electrolyte abnormalities are prominent.

Patients with diabetes may appear to be in better glycemic control but may tend to have more hypoglycemic episodes as renal function declines. This paradoxical improvement in glycemic control results from increased insulin secretion and insulin half-life, both of which occur as renal function declines.

Cardiovascular system

Cardiovascular abnormalities such as hypertension, atherosclerosis, valvular stenosis and insufficiency, chronic heart failure, and angina accelerate as renal function declines. These abnormalities may contribute to clinical manifestations of uremia if not treated appropriately.

Gastrointestinal system

Occult GI bleeding may occur. Nausea and vomiting are common in patients with severe uremia. Uremic fetor (ammonia or urinelike odor to the breath) also may be present.

Neurologic system

Clinical manifestations of uremic encephalopathy include fatigue, muscle weakness, malaise, headache, restless legs, asterixis, polyneuritis, mental status changes, muscle cramps, seizures, stupor, and coma. Amyloid deposits may result in medial nerve neuropathy, carpal tunnel syndrome, or other nerve entrapment syndromes.

Cutaneous

Fluid retention, pruritus associated with calcium phosphate deposition, and nail atrophy are common in persons with uremia.

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Physical Examination

Typical physical findings in persons with uremia are those associated with fluid retention, anemia, and acidemia. Severe malnutrition can contribute to muscle wasting, while electrolyte abnormalities may cause muscle cramping, cardiac arrhythmias, and mental status changes.

Skin

The classic skin finding in persons with uremia is uremic frost, which is a fine residue thought to consist of excreted urea left on the skin after evaporation of water. The skin may have a velvety appearance and feel, particularly in patients who are pigmented. Patients who are uremic also may have a sallow coloration of the skin due to urochrome, the pigment that gives urine its color. Patients may become hyperpigmented as uremia worsens (melanosis).

Eyes and mouth.

The sclera may become slightly icteric. Calcium deposition in the sclera can cause "red eye." In patients with chronic uremia, a broad range of oral lesions may be present, such as gingival hyperplasia, enamel hypoplasia, petechiae, or gingival bleeding.[19]

Cardiovascular system

Uremic pericarditis can be associated with a pericardial rub or a pericardial effusion. Increased fluid retention may result in pulmonary edema, peripheral edema, and severe hypertension. Valvular calcification may cause aortic stenosis or accelerate underlying disease.

Lungs

Fluid retention may result in pulmonary edema and corresponding crackles in the lungs. Pleural rubs occur in the setting of uremic lungs.

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Contributor Information and Disclosures
Author

A Brent Alper, Jr, MD, MPH Associate Professor of Medicine, Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine

A Brent Alper, Jr, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Hypertension, American Society of Nephrology, National Kidney Foundation, Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Bessie A Young, MD, MPH Associate Professor of Medicine, Division of Nephrology, University of Washington School of Medicine; Core Investigator, Seattle Epidemiologic Research and Information Center

Bessie A Young, MD, MPH is a member of the following medical societies: American College of Physicians, American Diabetes Association, International Society of Nephrology, National Kidney Foundation, American Society of Nephrology

Disclosure: Nothing to disclose.

Rajesh G Shenava, MD Former Assistant Professor of Medicine, Section of Nephrology and Hypertension, Department of Internal Medicine, Louisiana State University School of Medicine in New Orleans

Rajesh G Shenava, MD is a member of the following medical societies: American College of Physicians, American Society of Nephrology, National Kidney Foundation, Renal Physicians Association

Disclosure: Nothing to disclose.

Chief Editor

Vecihi Batuman, MD, FACP, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Renal Section, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, International Society of Nephrology

Disclosure: Nothing to disclose.

Acknowledgements

Eleanor Lederer, MD Professor of Medicine, Chief, Nephrology Division, Director, Nephrology Training Program, Director, Metabolic Stone Clinic, Kidney Disease Program, University of Louisville School of Medicine; Consulting Staff, Louisville Veterans Affairs Hospital

Eleanor Lederer, MD is a member of the following medical societies: American Association for the Advancement of Science, American Federation for Medical Research, American Society for Biochemistry and Molecular Biology, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Kentucky Medical Association, National Kidney Foundation, and Phi Beta Kappa

Disclosure: Dept of Veterans Affairs Grant/research funds Research

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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