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=uremia

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/11/07 10:52:57」(JST)

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Uremia or uraemia (see spelling differences) is a term used to loosely describe the illness accompanying kidney failure (also called renal failure), in particular the nitrogenous waste products associated with the failure of this organ.^[1] This is not to be confused with uricemia, or hyperuricemia, a build up of uric acid in the blood.

In kidney failure, urea and other waste products, which are normally excreted into the urine, are retained in the blood. Early symptoms include anorexia and lethargy, and late symptoms can include decreased mental acuity and coma. Other symptoms include fatigue, nausea, vomiting, cold, bone pain, itch, shortness of breath, and seizures. It is usually diagnosed in kidney dialysis patients when the glomerular filtration rate, a measure of kidney function, is below 50% of normal.^[2]

Azotemia is another word that refers to high levels of urea, but is used primarily when the abnormality can be measured chemically but is not yet so severe as to produce symptoms. Uremia can also result in uremic pericarditis. There are many dysfunctions caused by uremia affecting many systems of the body, such as blood (lower levels of erythropoietin), sex (lower levels of testosterone/estrogen), and bones (osteoporosis and metastatic calcifications). Uremia can also cause decreased peripheral conversion of T4 to T3, producing a functionally hypothyroid state.

Physical signs, symptoms, and laboratory findings

Neural and muscular

Fatigue^[3]
Peripheral neuropathy^[3]
Decreased mental acuity^[3]
Seizures^[3]
Anorexia^[3]
Nausea^[3]
Decreased taste and smell^[3]
Cramps^[3]
Restless legs,^[3] potentially due to decreased muscle membrane potential^[3]
Sleep disturbance^[3]
Coma^[3]

Encephalopathy

Endocrine and metabolic

Amenorrhea^[3]
Sexual dysfunction^[3]
Reduced body temperature^[3]
Altered levels of amino acids^[3]
Bone disease by hyperphosphatemia, hyperparathyroidism, and vitamin D deficiency^[3]
Reduced basal metabolic rate^[3]
Insulin resistance^[3]
Increased muscle protein catabolism^[3]

Other

Serositis, including pericarditis^[3]
Itching^[3]
Hiccups^[3]
Oxidative stress^[3]
granulocyte and lymphocyte dysfunction^[3]
Platelet dysfunction^[3]

Because uremia mostly is a consequence of kidney failure, its signs and symptoms often occur concomitantly with other signs and symptoms of kidney failure, such as hypertension due to volume overload, hypocalcemic tetany, and anemia due to erythropoietin deficiency.^[3] These, however, are not signs or symptoms of uremia.^[3] Still, it is not certain that the symptoms currently associated with uremia actually are caused by excess urea, as one study showed that uremic symptoms were relieved by initiation of dialysis, even when urea was added to the dialysate to maintain the blood urea nitrogen level at approximately 90 mg per deciliter (that is, approximately 32 mmol per liter).^[3]

Laboratory findings in various platelet and coagulation disorders
Condition	Prothrombin time	Partial thromboplastin time	Bleeding time	Platelet count
Vitamin K deficiency or warfarin	Prolonged	Normal or mildly prolonged	Unaffected	Unaffected
Disseminated intravascular coagulation	Prolonged	Prolonged	Prolonged	Decreased
Von Willebrand disease	Unaffected	Prolonged	Prolonged	Decreased and/or Rejected
Hemophilia	Unaffected	Prolonged	Unaffected	Unaffected
Aspirin	Unaffected	Unaffected	Prolonged	Unaffected
Thrombocytopenia	Unaffected	Unaffected	Prolonged	Decreased
Liver failure, early	Prolonged	Unaffected	Unaffected	Unaffected
Liver failure, end-stage	Prolonged	Prolonged	Prolonged	Decreased
Uremia	Unaffected	Unaffected	Prolonged	Unaffected
Congenital afibrinogenemia	Prolonged	Prolonged	Prolonged	Unaffected
Factor V deficiency	Prolonged	Prolonged	Unaffected	Unaffected
Factor X deficiency as seen in amyloid purpura	Prolonged	Prolonged	Unaffected	Unaffected
Glanzmann's thrombasthenia	Unaffected	Unaffected	Prolonged	Unaffected
Bernard-Soulier syndrome	Unaffected	Unaffected	Prolonged	Decreased or unaffected
Factor XII deficiency	Unaffected	Prolonged	Unaffected	Unaffected

Causes

Besides renal failure, the level of urea in the blood can also be increased by:

increased production of urea in the liver, due to:
- high protein diet
- increased protein breakdown (surgery, infection, trauma, cancer)
- gastrointestinal bleeding
- drugs (e.g. tetracyclines and corticosteroids)

decreased elimination of urea, due to:
- decreased blood flow through kidney (e.g. hypotension, cardiac failure)
- urinary outflow obstruction
- bladder rupture

dehydration
chronic infection of the kidney such as chronic pyelonephritis

References

^ "uremia" at Dorland's Medical Dictionary
^ Meyer TW and Hostetter, TH (2007). "Uremia". N Engl J Med 357 (13): 1316–25. doi:10.1056/NEJMra071313. PMID 17898101.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t ^u ^v ^w ^x ^y ^z ^aa ^ab ^ac Meyer, T. W.; Hostetter, T. H. (2007). "Uremia". New England Journal of Medicine 357 (13): 1316–1325. doi:10.1056/NEJMra071313. PMID 17898101. edit [1]

UpToDate Contents

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English Journal

Is peritoneal dialysis still an equal option? Results of the Berlin pediatric nocturnal dialysis program.

Thumfart J1, Hilliger T, Stiny C, Wagner S, Querfeld U, Müller D.
Pediatric nephrology (Berlin, Germany).Pediatr Nephrol.2015 Jul;30(7):1181-7. doi: 10.1007/s00467-015-3043-4. Epub 2015 Jan 27.
BACKGROUND: Peritoneal dialysis (PD) or conventional hemodialysis (HD) are considered to be equally efficient dialysis methods in children and adolescents. The aim of our study was to analyze whether an intensified, nocturnal HD program (NHD) is superior to PD in an adolescent cohort.METHODS: Thirte
PMID 25877914

Evaluation of hemoglobin A1c measurement by Capillarys 2 electrophoresis for detection of abnormal glucose tolerance in African immigrants to the United States.

Zhao Z1, Basilio J1, Hanson S2, Little RR2, Sumner AE3, Sacks DB4.
Clinica chimica acta; international journal of clinical chemistry.Clin Chim Acta.2015 Jun 15;446:54-60. doi: 10.1016/j.cca.2015.03.025. Epub 2015 Apr 8.
BACKGROUND: Hemoglobin A1c (HbA1c) is used to monitor long-term glycemic control in individuals with diabetes, guide therapy, predict the risk of microvascular complications, and more recently to diagnose diabetes. An automated liquid-flow capillary electrophoresis method was recently developed to m
PMID 25861848

Activation of nuclear factor of activated T cells 5 in the peritoneal membrane of uremic patients.

Kitterer D1, Latus J1, Ulmer C2, Fritz P3, Biegger D4, Ott G3, Alscher MD1, Witowski J5, Kawka E6, Jörres A6, Seeger H7, Segerer S7, Braun N8.
American journal of physiology. Renal physiology.Am J Physiol Renal Physiol.2015 Jun 1;308(11):F1247-58. doi: 10.1152/ajprenal.00617.2014. Epub 2015 Apr 1.
Peritoneal inflammation and fibrosis are responses to the uremic milieu and exposure to hyperosmolar dialysis fluids in patients on peritoneal dialysis. Cells respond to high osmolarity via the transcription factor nuclear factor of activated T cells (NFAT5). In the present study, the response of hu
PMID 25834072

Japanese Journal

Impact of pulse pressure on degree of cardiac hypertrophy in patients with chronic uraemia

BRAHIMI M.
J Hypertens 14, 1645-1650, 2000
NAID 30018867204

Identification of system y^+L as the high-affinity transporter for L-arginine in human platelets: up-regulation of L-arginine influx in uraemia

MENDES Ribeiro AC
Pflugers Arch 438, 573-575, 1999
NAID 30002005576

Double Filtration Plasmapheresis for Extracorporeal Immunomodulation in Treatment of Rapidly Progressive Glomerulonephritis(Workshop1-12)

Srivastava Rakesh
日本アフェレシス学会雑誌 16(1), 97-100, 1997-02
… 14 cases of RPGN treated by double filtration plasmapheresis (DFPP) presenting with oligoanuria, fluid overload and severe uraemia for 2-10 weeks were studied. …
NAID 110009721196

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