Acute kidney failure can trigger a condition called uremia, which is urine poisoning. This occurs when urine backs up in the urinary tract and triggers a variety of symptoms. Treatment of the underlying condition promises a good chance of recovery, but dialysis may still be necessary.
What is uremia?
Dialysis is a blood purification procedure used as part of renal replacement therapy for kidney failure. Acute or chronic kidney failure with urinary toxicity, medically called uremia, is the end stage of kidney failure. The kidneys are no longer able to perform their task of cleansing the blood of the body’s own uremic substances, for example urea, and exogenous toxins, such as drugs. These substances can no longer be filtered and excreted. The concrete characteristics of uremia are disturbed excretion of water and electrolytes, combined with a disturbance of the acid-base balance. The life-threatening effects of such a disorder include dizziness or coma. Furthermore, the breakdown of urea and creatinine is disturbed. Creatinine is a breakdown product of muscle substances, urea is a waste product of the transformation of urea and protein. Disruption of hormone balance is the third feature, which affects blood pressure, cooking and blood formation.
Causes
The difference between acute and chronic uremia lies in the time of onset: chronic uremia develops over years, while acute uremia occurs five to a maximum of ten days after acute renal failure. Accordingly, the causes of renal failure with urinary toxicity lie in inadequate or failure to treat the renal failure. Complete or partial renal failure is triggered by [[poisoning]s, inflammation, insufficient blood flow to the kidneys, or urinary stasis. Kidney failure itself is mostly the result of inadequately treated kidney disease. These are triggered by a variety of factors, including poorly controlled diabetes, years of high blood pressure, repeated kidney infections, congenital cysts, and diseases of the renal blood vessels. Abuse of alcohol and medications can also cause kidney disease and subsequently uremia.
Symptoms, complaints, and signs
Uremia is a very serious disease of the kidneys that leads to a variety of symptoms. It is acute or chronic kidney failure due to urinary toxicity. The main symptoms are intestinal inflammation in addition to therapy-resistant itching all over the body. Therefore, there is nausea, vomiting and often bleeding from the stomach and intestinal tract. Furthermore, pericarditis may develop, often leading to severe heart failure later on. Cardiac arrhythmias are also possible, again based on hyperkalemia. Pulmonary edema with severe respiratory problems and cyanosis is also sometimes observed. Accumulation of water in the abdomen (ascites or abdominal dropsy) may also occur. Furthermore, disorders of the immune system and anemia also occur. The breath may smell of urine (ammonia). However, this is only the case if urea-degrading bacteria are present in the patient’s mouth. The increased concentration of urea in the blood also leads to neurological symptoms, because urea can damage nerves depending on the concentration. Thus, personality changes, agitation states, amnesia, abnormal sleepiness or even coma may occur. Furthermore, peripheral nerves are often damaged. As a result, polyneuropathy with worsening sensory disturbances, gait disturbances, paralysis, and skin changes may develop. Muscle twitching in whole muscles or muscle groups such as trunk and extremity muscles is also possible.
Diagnosis and course
Medical diagnosis in suspected uremia includes a detailed history and thorough physical examination. This includes analysis of urine and blood for abnormalities, such as the amount or substances contained. A kidney ultrasound is also one of the standard methods. Imaging procedures with the administration of contrast media are only performed in exceptional cases to protect the kidneys. In some cases, puncture of the kidney may be necessary. If left untreated, kidney failure with urinary toxicity is fatal.The prognosis of acute uremia is good if medical help is sought in good time and the underlying disease is easily treatable. Chronic uremia, on the other hand, requires permanent renal replacement therapy. Complications, such as cardiovascular disease and a high susceptibility to infection, are common.
Complications
If left untreated, renal failure with urinary toxicity leads to patient death. Chronic uremia necessitates renal replacement therapy by dialysis. This method of treatment is usually considered very stressful by patients. Dialysis usually involves three treatments per week, each lasting four to five hours. During treatment, the blood is cleansed of toxic substances and excess fluids, and acid-base and electrolyte balances are restored to normal. A number of complications can occur during or as a result of dialysis. Circulatory problems are particularly common. Dehydration during blood washing reduces blood volume, and blood pressure, or fluid pressure in the vessels, drops. If the lack of fluid in the bloodstream can no longer be compensated, this usually results in a very sharp drop in blood pressure, which can even lead to unconsciousness. Even in less extreme reactions, the drop in blood pressure is associated with a number of unpleasant symptoms for the patient, including in particular nausea, vomiting, severe dizziness and temporary visual disturbances. In addition, dialysis patients frequently experience infections of the shunt, i.e., the surgically placed vascular access, or tunnel infections on the catheter that is permanently anchored in the abdominal wall.
When should you see a doctor?
If the affected person suffers from symptoms such as nausea, vomiting, or a strong feeling of illness, a physician should be consulted. If there is bleeding, pain, or a general feeling of malaise, medical attention is needed. Since without adequate medical care, the premature demise of the affected person is imminent, a visit to the doctor is recommended at the first irregularities. Inflammation, fever, a loss of performance level or persistent itching must be examined and treated. If the complaints spread or increase in intensity, a doctor should be consulted. Disturbances in cardiac activity, dizziness or sensory abnormalities must be clarified. Excessive sensitivity, numbness or an inner restlessness are cause for concern. Increased fatigue, interruptions of sleep or gait unsteadiness are further indications of a present disease. A doctor must be consulted, as the complaints indicate a disease progression that needs to be treated. If there is paralysis or unstoppable twitching of the muscle fibers, action is required. If there is a change in the state of consciousness or an acute health-threatening situation, an ambulance should be alerted. General dysfunctions, irregularities of the gastrointestinal tract or convulsions should be presented to a physician. In case of changes in skin appearance, abnormalities in behavior or persistent agitation, a visit to a doctor is necessary. If the personality of the affected person is perceived as unusual by people in the close environment, a doctor should be consulted.
Treatment and therapy
Treatment distinguishes between chronic and acute uremia. Chronic uremia requires renal replacement therapy by dialysis. This usually takes place three times a week. During the four- to five-hour treatment, toxins and excess fluid are filtered from the blood and disturbances in the acid-base and electrolyte balance are balanced. Accompanying diseases must be treated accordingly. In addition, the conservative measures used in acute uremia are used. These include treatment of the underlying kidney disease, for example, improved blood glucose control in diabetics. Regular medical check-ups are also a matter of course. Diuretics, which are used to support the excretion of electrolytes and urea, are taken after careful consideration of the risks and side effects. Patients must adjust the amount they drink to the excretory capacity of their kidneys. A change in diet is also recommended: the amount of urea is reduced with a diet low in protein and potassium but high in calories. Avoiding phosphates is also recommended.Although recent studies in the U.S. question the success of a change in diet, it remains the state of the art in medicine.
Outlook and prognosis
Renal failure with urinary toxicity is a potential threat to human life. Without immediate professional medical care, therefore, the sudden demise of the affected person is imminent. If medical care is provided as quickly as possible, the patient’s survival can be ensured. Therapies are initiated immediately that lead to a stabilization of the organism’s ability to function. However, the treatment approaches are highly stressful for the patient as well as his or her social environment. In addition, side effects can occur that are difficult for many to cope with. In most cases, regular dialysis is required to ensure survival. This method leads to severe limitations in coping with everyday life. In the case of an unfavorable course, there is the threat of a psychological secondary illness due to the emotional stress experienced. This significantly worsens the well-being of the patient and can in turn have an equally negative effect on the further physical condition. For a large number of patients, a donor organ is needed to provide lasting relief from the symptoms and improve the quality of life. Although organ transplantation is associated with numerous complications and side effects, it is often the last and only resort. If the surgical procedure can be performed without further complications, a significantly improved health situation can be expected afterwards.
Prevention
To prevent uremia, patients with kidney weakness should have it treated. If renal impairment is already present, regular medical examinations and adherence to special precautions, especially self-monitoring, are essential. Patients at risk should check their weight daily, monitor urine output and volume, avoid drugs and substances that damage the kidneys, support the immune system, and comply with prescribed measures.
Follow-up
With regard to the symptom of the disease, sufferers should give high priority to their follow-up care. Finally, organ failure requires intensive medical care. With follow-up care that is consistently tailored to the patient, the patient can learn to cope with the accompanying symptoms. The self-responsible measures are based a priori on regular examinations, dialysis appointments and, if possible, the use of rehabilitation measures and self-help groups. The exchange with like-minded people or in the context of psychotherapeutic sessions can help to find courage as well as to understand the complexity of the disease and to maintain one’s standard of living. Patients with uremia receive an intensive exchange of information during their medical treatment and should not be afraid to address open questions and other treatment options in addition to medication. Many patients experience the change in diet in particular as a break. Some of those affected find this vital circumstance easier than others. However, knowing that they will have to follow a diet that is high in calories but low in fat, protein and potassium, as well as phosphate-free, is already a big step towards accepting the disease. At the same time, the amount of drinking must be adjusted to the kidneys’ ability, and body weight must be monitored and recorded daily. In the lifelong aftercare process, it should be the concern of the affected person himself to deal with his symptoms as positively as possible, to be enthusiastic about beautiful hobbies, and thereby to maintain a stable mental life.
This is what you can do yourself
With this health condition, there are hardly any self-help options. The organ failure needs intensive medical care. Therefore, the affected person should accept the help and support of medical professionals under all circumstances. There are no self-responsible measures that could bring about relief from the symptoms. This is a life-threatening condition in which the affected person usually has little room for maneuver. Adequate information about the possibility of kidney failure with urine poisoning should be exchanged in advance. Normally, the sufferer is already undergoing medical treatment due to a diagnosed kidney disease. In this treatment, open questions, upcoming changes and a possible further course of the disease should be discussed.In addition, open questions can be answered through research in medical literature, special forums on the Internet or participation in self-help groups. In many cases, the exchange with other affected persons is perceived as supportive and strengthening. Despite all adversity, a fundamentally positive attitude toward life is helpful in coping with the existing complaints. As far as possible, relatives should encourage the patient, be there for him or her, and encourage a zest for life. A stable and healthy psyche is elementary in dealing with the overall situation. Conversations, shared laughter and humor have a positive effect.
