Uremia is a clinical syndrome associated with fluid, electrolyte, and hormone imbalances and metabolic

abnormalities, which develop in parallel with deterioration of renal function. The term uremia, which literally
means urine in the blood, was first used by Piorry to describe the clinical condition associated with renal failure.
(See Pathophysiology.)[1]
Uremia more commonly develops with chronic kidney disease (CKD), especially the later stages, of CKD, but it
also may occur with acute kidney injury (AKI) if loss of renal function is rapid. As yet, no single uremic toxin has
been identified that accounts for all of the clinical manifestations of uremia. A number of toxins, such as
parathyroid hormone (PTH), beta2 microglobulin, polyamines, advanced glycosylation end products, and other
middle molecules, are thought to contribute to the clinical syndrome. [2] (See Pathophysiology and Workup.)

Complications
Severe complications of untreated uremia include seizure, coma, cardiac arrest, and death. Spontaneous
bleeding can occur with severe uremia and may include gastrointestinal (GI) bleeding, spontaneous subdural
hematomas, increased bleeding from any underlying disorder, or bleeding associated with trauma.
Cardiac arrest may occur from severe underlying electrolyte abnormalities, such ashyperkalemia, metabolic
acidosis, or hypocalcemia. (See Pathophysiology, Prognosis, Presentation, and Workup.)
Severe hypoglycemic reactions may occur in patients with diabetes if hyperglycemic medications are not
adjusted for decreased creatinine clearance in these individuals.
Renal failure associated bone disease (renal osteodystrophy) may lead to an increased risk of osteoporosis or
bone fracture with trauma.
Medication clearance is decreased in persons with renal failure and may lead to untoward adverse effects,
such as a digoxin overdose, an increased sensitivity to narcotics, and a decreased excretion of normal
medications.

Patient education
Patients should be seen by a nephrologist early for education regarding renal disease and renal replacement
therapy options and for evaluation and diagnosis of their underlying renal disease process. (See Treatment.)
Inform patients with diabetes about potential changes in insulin or oral hypoglycemic medication needs.
Educate patients and their families about dialysis to avoid the shock of emergent dialysis and the decreased
quality of life that can occur with uremia.
For patient education information, see Chronic Kidney Disease.