Uremia

Uremia is heavy intoxication resulting from the failure of the kidneys. Uremia is caused by metabolic disorder, alkaline-acid balance, with the accumulation in the blood of toxic metabolic products that disrupts the function of all organs and body systems.
There are acute and chronic uremia.
Acute uremia occur due to acute renal failure: in case of poisoning by mercury, lead, barbiturates, and some other poisons, massive hemolysis in a transfusion of blood incompatible, with the trauma of the kidney, acute severe infection (fever, cholera and other), with sepsis different etiology, burns, shock.
In the event of a severe kidney failure, the consequence of which is uremia, is set acute impairment of renal blood circulation, as well as direct damage toxic substances elements of the nephron.
Chronic uremia is the final stage diffuse diseases of buds: chronic diffuse glomerulonephritis, pyelonephritis, arteriolosclerosis wrinkled buds with hypertension , etc.
For acute uraemia, and acute renal failure, characterized by several stages (see Renaldisease).
The first signs of chronic uremia are lethargy, apathy, headache, poor sleep, memory loss. In the study of blood detect the increased content of nitrogen products: nitrogen (a rate of 20-40 mg%), urea (a rate of 20-40 mg%), creatinine (normal 1-2 mg%).
In the later period of urea and other nitrogen containing substances that accumulate in the blood, begin hard to stand out the skin, mucous and serous membranes, irritating them. Consequently symptoms uremic gastritis (anorexia, nausea, vomiting), colitis (diarrhea), laryngotracheitis, pleurisy, pericarditis (usually already in terminal period).
Due to intoxication are violated liver, bone marrow, growing anemia, thrombocytopenia, you receive a tendency to bleed, disturbed vision (uremic neiroretinit). In further developing uremic coma - patient loses consciousness, there is a noisy deep breath (the breath of Kussmaul), rarely observed breathing type Chein - Stokes equations (see Breath, pathological), from patient comes the strong smell of ammonia, eyes narrowed.
To differentiate uremic who have with coma other origin: harpanahalli, diabetes, liver and other (see Noma).
Forecast serious, but chronic uremia, despite the irreversible decline of kidney function, may be sometimes for years. Patients may long to be in a relatively satisfactory condition.

uremia
Fig. 1. Uraemic "powder". Fig. 2. Swelling of the entrance to the larynx with uremia. Fig. 3. Fibrinous focal pneumonia in uremia. Fig. 4. Fibrinous gastritis with uremia.


Speaking about uremia, referring mainly poisoning of the body soplease in the blood and tissues urea and other nitrogenous waste products - indican, creatinine, uric acid.
Normally the content of urea in the blood is 20 - 35 mg%, and residual nitrogen-20-45 mg%, uremia level increases up to 200-300 mg% and even more. However, not one of this fact caused the clinical picture uremia, as in some cases with high content of nitrogen products in the blood signs of uremia are absent, in others they are observed at relatively low azotemii. A great role in the uremic condition plays dehydration and acidosis.
In urological practice uremia in most cases, is associated with impaired renal function on the soil of the difficulty of urine outflow. Adenoma prostate, urethral stricture, stones of kidneys and ureters mostly violate the process of urinary tract gradually, which explains the slow development of uremia in these diseases. Increased pressure in urine-diverting ways caused by the stagnation of urine is passed then the kidney parenchyma, primarily on the tubular system. The tubular epithelium flattens, violated its main function is the reabsorption of water, which leads to increased urine output with 1-1,5 to 2-3 liters of urine and the corresponding lack of fluid in the tissues. Dehydration long offset by increased fluids, so the clinical symptoms of dehydration (dry tongue, thirst) appear only in the late stages of uraemia, when the increased need for water cannot be satisfied abundant drinking.
The harmful effects of high pressure gradually affects the blood supply to the kidney. This often joins the destructive influence of urinary infections in the form of chronic pyelonephritis. Violated all the functions of the kidney, including the synthesis of ammonia. Instead, for the neutralisation of acid metabolism products are drawn from the blood plasma of other alkali ions, such as sodium, potassium. Lowering alkaline valences blood leads to the fact that the carbonic acid, usually communicates with sodium and excreted in the urine in the form Na2СО3, remains free and causes a decrease in the pH of the blood (acidosis).
Clinical symptoms of uremia develop gradually. Initially marked fatigue, lack of appetite, thirst, headache, nausea, which later joined some sluggishness, twitching of muscles is the result of deep Central nervous system toxicity. In a later stage uremia appear persistent vomiting, diarrhea as manifestations of gastritis, enterocolitis caused by the compensatory toxic ingredients of urine through the gastrointestinal tract. The allocation of toxins salivary glands and mucous membranes of the trachea leads to hard stomatitis and tracheitis (the smell of urine from the mouth, hoarse voice). Intoxication respiratory centre accumulated in the blood of free carbonic acid disturbs the rhythm of the breath, it becomes a deep, loud, e uneven pauses (kosmulska breathing). Patients fall into unconsciousness and die from uremic coma.
Treatment uremia is to remove barriers to the flow of urine, the restriction of protein foods, the appointment of the bases for combat disorders, the bloodletting substitution blood transfusions, intravenous or subcutaneous injection 5% glucose solution or physiological solution. The importance of daily stomach to remove excess waste, compensatory secreted by the gastric mucosa. In respect of the intestine so is having mechanized enema.
As the peritoneum has huge absorption and excretion capacity, with the aim of detoxification wash the abdominal cavity weakly alkaline solutions, the so - called peritoneal dialysis.
In the peritoneal cavity introduce two drainage through an incision in the abdominal wall. One of them - leading - connects to a vessel filled with a sterile liquid special composition, the second - discharge - with the handset sucking.
For the estimation of patients from state uremia is also applied apparatus "artificial kidney" (Fig. 8). The principle of operation it is based on the ability of a number of low-molecular compounds present in the blood (electrolytes, urea, uric acid, creatinine, and other nitrogenous compounds), to penetrate into force of diffusion and osmosis through a semipermeable membrane in a salt solution, due to the release of blood from toxins. The main item of artificial kidneys are semi-permeable membrane from plastic, bakelite. Testimony to the use of artificial kidney is acute renal failure after blood transfusion, poisoning, severe burns postabortne sepsis.

Fig. 8. Apparatus "artificial kidney" design NIIHAU.

Treatment of acute uremia is the same as acute renal failure (see Renal disease). Patients with chronic uremia appoint geroglifico a diet consisting of meat dishes, potatoes, rice, animal and vegetable fats, which do not restrict. Nausea, vomiting food is served in the form of purees and pastes, pureed soup, jelly, jelly. The intake of salt limited to 3-4 grams per day and protein - up to 18-22,5 g per day. If no inclination to swelling useful excessive drinking. Depending on features of violations of water-salt metabolism, the doctor may prescribe individual diet. It is complemented by the b vitamins (especially B1 and B6) and ascorbic acid.
For suppression of the processes of putrefaction in the intestines appoint tetracycline, oletetrin in individual doses, and lactic acid products: kefir, sour milk, acidophilus. When uremic gastritis, colitis, and for additional body purification from nitrogen slag spend stomach and intestines 1% solution of sodium bicarbonate. More effective methods of struggle against uremic intoxication are hemodialysis (see artificial Kidney) and peritoneal dialysis (see), but irreversible chronic kidney damage these methods, without eliminating the cause of uraemia, allow only a few prolong the life of patients.
Patients with uremia is necessarily also symptomatic therapy: rezerpinom with high blood pressure, iron supplementation and transfusions erythrocyte mass in patients with severe anemia. Medical treatment of the basic diseases (nephritis, pyelonephritis, and so on), if it is observed aggravation. Treatment of heart failure at uremia cardiac glycosides (strofantin, drugs digitalisa in strictly individual doses) should be done very carefully taking into account violated the withdrawal of these drugs affected kidneys.