Uremia Clinical Manifestations and Pathophysiology

Pathophysiological Mechanisms

• The accumulation of globotriaosylceramida in the vascular endothelium leads to ischemia and infarction, particularly in the kidney, heart, and brain 1

Clinical Manifestations

Gastrointestinal Symptoms

• Nauseas, vomiting, and anorexia are frequent manifestations that significantly affect dietary intake 2
• Uremia affects gastric emptying, compromising food tolerance 2
• Diarrhea, anorexia, and gastrointestinal symptoms appear early in the course of the disease 3

Neurological Manifestations

• Neurological symptoms include confusion, lethargy, dizziness, hypotonia, headache, tremors, ataxia, dysarthria, seizures, hemiplegia, and coma 4

Cardiovascular and Respiratory Manifestations

• Serositis (pleuritis, pericarditis) is characteristic of acute uremia 5
• Edema, volume overload, congestive heart failure, and cardiac arrhythmias are common 3

Hematological Manifestations

• Platelet dysfunction predisposes to bleeding 5

Metabolic and Endocrine Manifestations

• Insulin resistance and increased catabolism occur in uremic patients 5
• Protein-energy wasting is a common complication 5
• Amenorrhea occurs in women with uremia 5
• Reduced core body temperature is observed in uremic patients 5

Other Manifestations

• Persistent hypoxia 5
• Somnolence 5
• Seizures or altered seizure threshold 5
• Hipo 5

Specific Complications

Dialysis Disequilibrium Syndrome

• Children with hemolytic-uremic syndrome develop seizures, hemiparesis, aphasia, and visual field defects 6
• Coma at presentation and elevated protein in cerebrospinal fluid predict poor prognosis in hemolytic-uremic syndrome 6

Indications for Renal Replacement Therapy

• Consider initiating dialysis when the weekly renal Kt/Vurea falls below 2.0, especially if uremic symptoms persist 2
• The decision to initiate dialysis should be based on the assessment of signs and symptoms associated with uremia, not just on the level of glomerular filtration 5
• Providers should be diligent in seeking reversible causes of symptoms before initiating dialysis, especially in the elderly and patients with polypharmacy 5