Uremic syndrome

 Uremic syndrome. The uremic syndrome consists of symptoms and signs that result from toxic effects of elevated levels of nitrogenous and other wastes in the blood.

(Uremic syndrome) Symptoms. Uremic patients commonly become nauseated and often vomit soon after awakening. They may lose
their appetite such that the mere thought of eating makes them feel ill. They often feel fatigued, weak, and/or cold.
Their mental status is altered; at first, only subtle changes in personality may appear, but eventually, the patients become confused and, ultimately, comatose.

(Uremic syndrome) Signs. The classic uremic physical findings of a sallow coloration of the skin due to accumulation of urochrome
pigment (the pigment that gives urine its yellow color) and of an ammonia-like or urine-like odor to the breath are rarely seen unless the degree of uremia is severe. A pericardial friction rub or evidence of pericardial effusion with or
without tamponade reflects uremic pericarditis, a condition that urgently requires dialysis treatment. Foot- or wrist-drop may be evidence of uremic motor neuropathy, a condition that also responds to dialysis. Tremor, asterixis,
multifocal myoclonus, or seizures are signs of uremic encephalopathy. Prolongation of the bleeding time occurs and can be a problem in the patient requiring surgery.

(Uremic syndrome) Signs and symptoms: uremia versus anemia. Several of the symptoms and signs previously ascribed exclusively to uremia may be partially due to the associated anemia. For example, when the anemia of dialysis
patients is corrected with erythropoietin, they experience a marked decrease in fatigue and a concomitant increase in sense of well-being and exercise tolerance. The bleeding time may also improve, and there may be improvement in
angina pectoris and a reduction in left ventricular hypertrophy. There are improvements in cognitive function as well.

(Uremic syndrome) Relationship between uremic syndrome and creatinine clearance. The uremic syndrome predictably develops
when the creatinine clearance falls below 10 mL per minute per 1.73 m 2 . Diabetic individuals appear to be especially suscep-tible and frequently require earlier initiation of chronic dialysis (e.g., when creatinine clearance falls to 15 mL per minute per 1.73 m 2 ). However, in chronic renal failure, decreased spontaneous protein intake, anemia, and derangements in Ca/PO 4 /PTH homeostasis are already demonstrable when clearance is still 30–40 mL per minute per 1.73 m 2 .  (Uremic syndrome)