Disease Description (Causes and Symptoms)
- Definition summary: Uremia is a condition in which kidney function is severely impaired (generally with a marked decrease in the glomerular filtration rate), causing uremic toxins and electrolyte·fluid imbalances to accumulate in the body and produce systemic symptoms.
- Main causes: Acute or chronic kidney injury (acute nephritis, acute pyelonephritis, hypertensive kidney injury, trauma·shock·toxins, drug-induced nephrotoxicity, etc.), progression of chronic kidney disease, and others.
- Pathophysiology summary: Reduced excretory and metabolic kidney function leads to the accumulation of urea, uremic toxins, and urea metabolism byproducts. Electrolyte (such as potassium) and acid–base imbalances, fluid overload, anemia (due to erythropoietin deficiency), and mineral and bone metabolism abnormalities may also occur, causing multisystem symptoms.
- Main symptoms (frequent): Fatigue, loss of appetite, nausea·vomiting, indigestion, sleep disturbance, headache, impaired memory·concentration, altered consciousness (stupor·coma), muscle weakness·seizures, skin pruritus (itching), skin hyperpigmentation, bleeding tendency (gum bleeding·nosebleeds), generalized edema, shortness of breath (due to fluid overload), increased risk of fractures (bone quality abnormalities), and increased susceptibility to infection.
Treatment Methods
- Core principle: Treat the underlying disease and preserve or replace kidney function (when necessary)
- Conservative treatment (early/moderate kidney function impairment)
- Management of the underlying disease (blood pressure·diabetes control, treatment of infections, discontinuation of causative medications, etc.)
- Dietary therapy: Adjust protein·sodium·potassium·phosphorus intake; restrict fluid intake (in cases of edema·hypertension)
- Medication adjustment: Treat individual problems such as hyperkalemia·acidosis·anemia·hyperphosphatemia (potassium binders, oral·intravenous sodium bicarbonate, phosphate binders, active vitamin D, etc.)
- Adjust medication doses and avoid nephrotoxic drugs (e.g., NSAIDs, some antibiotics, contrast media, etc.)
- Replacement therapy (end-stage renal disease)
- Hemodialysis: Standard replacement therapy for acute uremic symptoms or chronic end-stage renal disease
- Peritoneal dialysis: May be selected when home treatment·quality of life are considered
- Renal transplantation: A long-term treatment option depending on the indications
- Medication treatment by symptom
- Anemia: Erythropoietin (EPO) preparations and iron supplementation
- Hyperphosphatemia: Phosphate binders (calcium-based·non-calcium-based)
- Bone metabolism disorders: Active vitamin D derivatives and calcium regulation
- Hyperkalemia·metabolic acidosis: In emergencies, intravenous calcium·insulin plus glucose·sodium bicarbonate, etc.
- Precautions and risk of complications
- Be alert for infection, hypotension, electrolyte imbalance, and access-related complications before·after dialysis
- Bleeding risk must be managed because of the bleeding tendency (uremic platelet dysfunction)
- Check medication doses·contraindications (dose adjustment according to kidney function is essential)
- Self-care summary
- Strictly follow medication·diet·fluid plans; monitor weight·blood pressure·urine output and report signs of infection immediately
- Avoid smoking·limit alcohol intake, and avoid nephrotoxic drugs (especially NSAIDs and some antibiotics)
Outpatient Visit Checklist (Preparation and Example Questions)
- Items and information to prepare
- List of medications currently being taken (including prescription drugs·OTC medicines·herbal medicines·supplements)
- Records of allergies and past adverse drug reactions
- Recent test results (blood tests: creatinine·eGFR·BUN, electrolytes, CBC, Ca/P, albumin, etc.; urinalysis results)
- Records of weight changes and urine output (urination frequency·nocturia, etc.), and photos or records of edema
- Self-measured blood pressure·blood glucose records (if available)
- Timing and course of symptoms (nausea·vomiting·dizziness·altered consciousness, etc.)
- Key information to tell the doctor during the outpatient visit (examples)
- Submit recent blood test results, if available
- Whether you are receiving dialysis or have a history of dialysis (if so, the method·frequency)
- Transplant-related information (previous transplant, availability of a donor)
- Supplements·herbs and other products currently being taken
General Example Questions to Ask the Doctor
- What are the expected effects and major side effects of this medication (or treatment)?
- What is the current status of my kidney function (creatinine, eGFR), and what is the prognosis?
- What are the criteria for starting dialysis? How soon should I prepare given my current condition?
- What should I change first in my lifestyle (diet·fluid intake·exercise)?
- What are the complications before·after dialysis or transplantation, and how can they be prevented?
Examples of Disease-Specific Questions
- What are my recent creatinine·eGFR·electrolyte levels? Are these levels at the point where dialysis should be started?
- Which would be more suitable for my lifestyle, vascular access (intravascular catheter·arteriovenous fistula) or peritoneal dialysis (comparison of advantages and disadvantages)?