What Are the Causes of Azotemia in Uremia

Azotemia is a common manifestation in Uremia. It refers to the levels of creatinine, uric acid and other non-protein nitrogen levels rise obviously above the normal levels. If uncontrolled, azotemia can cause serious adverse effects for the patients with Uremia. Therefore, it is very important to prevent azotemia. Primarily, it is essential for the patients with Uremia to know the causes of azotemia.

In Uremia, as the kidneys are damaged seriously, the renal blood flow and glomerular filtration rate (GFR) decline obviously, which can affect the excretion function of kidneys. As a result, the nitrogen accumulates in blood stream resulting in azotemia.

Also the complication gastrointestinal hemorrhage of Uremia can aggravate the primary azotemia. On one hand, it can cause the systemic blood volume to decrease thus leading to renal ischemia and affecting the excretion function of kidneys. If the patients can blood flow insufficiency can be corrected in time, the symptoms of azotemia can relive to some extent. On other hand, gastrointestinal hemorrhage can lead to renal tubular necrosis and aggravate the primary kidney damage thus aggravating azotemia.

However, in some cases, if the patients have too much protein at a time. The kidneys can not discharge the metabolic product nitrogen thus leading to transient azotemia. Once they adjust their diet, the patients will recover normal. Therefore, the patients with Uremia should limit the protein intake strictly.

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Why Patients with Uremia Suffer from Muscle Twitching

Muscle twitching is a common complication in Uremia patients. It is mainly caused by hypocalcemia. To avoid muscle twitching, the patients with Uremia should elevate blood calcium level. Therefore, it is very essential for the patients with Uremia to know the causes of hypocalcemia.

※ Diet: The patients with Uremia need to strict their daily diet resulting in insufficient vitamin D supplement.

※ Metabolic disorder of vitamin D: As the patients with Uremia lack 1α- hydroxylase，it can hinder the production of active vitamin D3 which can promote the absorption of calcium by intestines and stomach. As the vitamin D3 level decreases, the patients may suffer from hypocalcemia.

※ Hyperphophatemia: In Uremia, the patients’ glomerular filtration rate (GFR) declines. As a result, the phosphorus can not be secreted from blood normally resulting in high phosphorus level in blood. To keep the product of calcium and phosphorus stable, the calcium level in blood will decline.

Hypocalcemia can increase the neuromuscular excitability. If hypocalcemia is not serious, the patients only have numb, stabbing pain without obvious muscle twitching. If the calcium level can not be corrected, it will lead to serious hypocalcemia. In that case, the patients often have cramp in skeletal muscle and smooth muscle. For the patients with acidosis, although their serum calcium level declines, the free calcium level is not low, which can decrease the neuromuscular irritability. Therefore, although the blood calcium level decreases, the patients may not have muscle twitching. However, after the acidosis is corrected, muscle twitching may occur suddenly. Therefore, the patients should keep the calcium supplement when correcting acidosis.

There are various causes of muscle twitching in patients with Uremia. The patients should find the cause of the problem and then take relative treatment.

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Informations of Uremia

What is uremia?

Uremia is a state in which the blood urea nitrogen level, an indicator of nitrogen waste products, is elevated. In uremia, the kidneys’ failure to filter nitrogen waste properly leads to excessively high levels of nitrogen wastes in the bloodstream. Uremia is life-threatening because too much nitrogen in the blood is toxic to the body. Symptoms of uremia include confusion, loss of consciousness, low urine production, dry mouth, fatigue, weakness, pale skin or pallor, rapid heart rate (tachycardia), edema (swelling), and excessive thirst. Uremia may also be painful.

Uremia is reversible if treated quickly; however, permanent damage to the kidneys may occur. Kidney failure may also result from the underlying processes that cause uremia.

Treatment for uremia frequently requires hospitalization. It begins with treating the cause of the kidney injury so that nitrogen waste will not continue to build up in the blood. Treatment may require dialysis, which filters the waste out of the blood. Fluid therapy, blood transfusions, and blood pressure medications may also be administered. Ongoing treatment after the acute symptoms of uremia have been addressed may include medication, dialysis, or dietary modification.
General symptoms of uremia

Some of the symptoms of uremia may be generalized. These are serious symptoms, and when present with other symptoms of uremia, should be evaluated in a medical setting.

General symptoms of uremia include:

• Abdominal pain
• Confusion or loss of consciousness for even a brief moment
• Dry mouth and nose
• Edema (swelling)
• Excessive thirst
• Fatigue
• Low blood pressure (hypotension)
• Pale skin or pallor
• Rapid heart rate (tachycardia)
• Weakness (loss of strength)

In some cases, uremia can be life threatening. if you, or someone you are with,
have any of these life-threatening symptoms including:

• Confusion or loss of consciousness for even a brief moment
• Low urine output
• Renal causes of uremia
• Uremia may arise from any condition that damages the kidney including:
• Certain medications, such as high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) or intravenous contrast material
• Injury to the kidney
• Kidney damage from hypertension or diabetes
• Kidney disease (includes any type of kidney problem, such as kidney stones, kidney failure and kidney anomalies)
• Renal artery embolism or occlusion (blockage of blood flow to the kidney)
• Surgery

Other causes of uremia

Uremia may also arise from a number of other conditions that cause low blood volume or decreased blood flow including:

• Burns
• Congestive heart failure (deterioration of the heart’s ability to pump blood)
• Dehydration (loss of body fluids and electrolytes, which can be life threatening when severe and untreated)
• Excessive bleeding
• Excessive diarrhea
• Excessive vomiting
• Shock

What are the risk factors for uremia?

• A number of factors increase the risk of developing uremia. Not all people with risk factors will get uremia. Risk factors include:
• Low blood pressure (hypotension)
• Recent infection
• Recent injury
• Recent surgery
• Taking certain medications, such as nonsteroidal anti-inflammatory drugs or intravenous contrast material