Uremia - Revision history

Elcatracho: /* See Also */

2021-02-21T03:04:23Z

Elcatracho: /* Anion Gap Metabolic AcidosisAngus S. Uremic Acidosis. University of Connecticut, 2006. http://fitsweb.uchc.edu/student/selectives/TimurGraham/Uremia.htmlNickson C. Renal Tubular Acidosis and Uraemic Acidosis. LITFL. http://lifeinthefastlane.com/ccc/...

2021-01-24T15:39:24Z

/* Anion Gap Metabolic AcidosisAngus S. Uremic Acidosis. University of Connecticut, 2006. http://fitsweb.uchc.edu/student/selectives/TimurGraham/Uremia.htmlNickson C. Renal Tubular Acidosis and Uraemic Acidosis. LITFL. http://lifeinthefastlane.com/ccc/...

← Older revision		Revision as of 15:39, 24 January 2021
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	**Bone demineralization - bone buffers H+, releasing calcium from bone, leads to osteopenia		**Bone demineralization - bone buffers H+, releasing calcium from bone, leads to osteopenia
	*Treatment: PO [[sodium bicarbonate]] 1 mEq/kg/day		*Treatment: PO [[sodium bicarbonate]] 1 mEq/kg/day

			==See Also==
			[[AKI]]

	==References==		==References==
	<references/>		<references/>
	[[Category:Renal]]		[[Category:Renal]]

ClaireLewis at 17:49, 19 September 2019

2019-09-19T17:49:57Z

← Older revision		Revision as of 17:49, 19 September 2019
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	==Clinical Features and Management==		==Clinical Features and Management==
	===Neurologic===		===Neurologic===
	*Uremic encephalopathy		*Uremic [[encephalopathy]]
	**Diagnosis of exclusion		**Diagnosis of exclusion
	**Cognitive defects, memory loss, decreased attentiveness, slurred speech		**Cognitive defects, memory loss, decreased attentiveness, [[dysarthria\|slurred speech]]
	**Asterixis, seizure, coma		**Asterixis, [[seizure]], [[coma]]
	**Improves with dialysis		**Improves with [[dialysis]]
	*Dialysis dementia		*Dialysis [[dementia]]
	**Similar to uremic encephalopathy except progressive, no improvement with dialysis		**Similar to uremic encephalopathy except progressive, no improvement with dialysis
	**EEG findings can differentiate uremic encephalopathy from dialysis dementia		**EEG findings can differentiate uremic encephalopathy from dialysis dementia
	*[[CVA]]		*[[CVA]]
	**Cerebrovascular disease, trauma, bleeding dyscrasias, anticoagulant, hypertension		**[[Stroke\|Cerebrovascular disease]], trauma, [[coagulopathy\|bleeding dyscrasias]], anticoagulant, hypertension
	*[[Subdural hematoma]]		*[[Subdural hematoma]]
	**10 times more likely than in general population		**10 times more likely than in general population
	**Platelet dysfunction		**Platelet dysfunction
	**Headache, focal neurologic deficits, seizure, coma		**[[Headache]], [[focal neurologic deficits]], [[seizure]], [[coma]]
	*Peripheral neuropathy		*Peripheral neuropathy
	**Occurs in 60-100% of dialysis patients		**Occurs in 60-100% of dialysis patients
	**Paresthesias, impaired proprioception, weakness		**[[Paresthesias]], impaired proprioception, [[weakness]]
	**Autonomic neuropathy (postural dizziness, gastroparesis, bowel dysfunction)		**Autonomic neuropathy (postural [[dizziness]], [[gastroparesis]], bowel dysfunction)

	===Cardiovascular===		===Cardiovascular===
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	*Mortality from cardiovascular disease is 10-30 times higher in dialysis patients than general population		*Mortality from cardiovascular disease is 10-30 times higher in dialysis patients than general population
	*hypertension is common		*hypertension is common
	*Uremic cardiomyopathy		*Uremic [[cardiomyopathy]]
	**Diagnosis of exclusion		**Diagnosis of exclusion
	**Circulating digitalis-like substances have been implicated		**Circulating digitalis-like substances have been implicated
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	***Constitutional symptoms, such as fever, are more common than in uremic pericarditis		***Constitutional symptoms, such as fever, are more common than in uremic pericarditis
	**Treatment		**Treatment
	***Dialysis		***[[Dialysis]]
	*[[Tamponade]]		*[[Tamponade]]
	**Presents with altered mental status, hypotension, dyspnea		**Presents with [[altered mental status]], [[hypotension]], [[dyspnea]]
	***Rarely present with classic signs of Beck's triad		***Rarely present with classic signs of Beck's triad
	**Pericardiocentesis should only be attempted if hemodynamically unstable		**[[Pericardiocentesis]] should only be attempted if hemodynamically unstable
	*[[Pulmonary Edema]]		*[[Pulmonary Edema]]
	**Commonly ascribed to fluid overload; also consider MI		**Commonly ascribed to fluid overload; also consider MI
	***Treat similar to non-ESRD patient		***Treat similar to non-ESRD patient
	****~~Lasix~~ 80mg IV may be effective even if minimal urine output (pulmonary vasodilation)		****[[Furosemide]] 80mg IV may be effective even if minimal urine output (pulmonary vasodilation)
	***Preload reduction can be accomplished via:		***Preload reduction can be accomplished via:
	****Induced diarrhea (sorbitol)		****Induced [[diarrhea]] (sorbitol)
	****Phlebotomy - withdrawal of as little as 150 mL is safe and effective		****Phlebotomy - withdrawal of as little as 150 mL is safe and effective
	*[[CHF]]		*[[CHF]]
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	*Bleeding diathesis ([[Uremic bleeding syndrome]])		*Bleeding diathesis ([[Uremic bleeding syndrome]])
	**Increased risk for of bleeding (GI, ICH, liver hematoma) due to impaired platelet function		**Increased risk for of bleeding (GI, ICH, liver hematoma) due to impaired platelet function
	**Treatment = desmopressin, cryoprecipitate, conjugated estrogen, EPO, dialysis<ref>Hedges SJ et al. Evidence-based treatment recommendations for uremic bleeding. Nature Clinical Practice Nephrology (2007) 3, 138-153.</ref>		**Treatment = [[desmopressin]], [[cryoprecipitate]], conjugated estrogen, EPO, dialysis<ref>Hedges SJ et al. Evidence-based treatment recommendations for uremic bleeding. Nature Clinical Practice Nephrology (2007) 3, 138-153.</ref>

	===GI===		===GI===
	*Anorexia, [[nausea/vomiting]]		*Anorexia, [[nausea/vomiting]]
	*Increased incidence of GI bleeding, diverticular disease, ascites		*Increased incidence of [[GI bleeding]], diverticular disease, [[ascites]]

	===Dermatologic===		===Dermatologic===
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	*Metastatic calcification ([[calciphylaxis]])		*Metastatic calcification ([[calciphylaxis]])
	**When calcium-phosphate product (Ca x PO4) > 70-80, metastatic calcification can ensue		**When calcium-phosphate product (Ca x PO4) > 70-80, metastatic calcification can ensue
	**Symptoms of pseudogout, skin/finger necrosis (small vessel involvement)		**Symptoms of [[pseudogout]], skin/finger necrosis (small vessel involvement)
	**Life-threatening calcifications can occur in the cardiac and pulmonary systems		**Life-threatening calcifications can occur in the cardiac and pulmonary systems
	**Treatment = use of low-calcium dialysate and phosphate-binding gels		**Treatment = use of low-calcium dialysate and phosphate-binding gels
	*Hyperparathyroidism (osteitis fibrosa cystica)		*[[Hyperparathyroidism]] (osteitis fibrosa cystica)
	**Calciphylaxis + vitamin D3 deficiency results in depressed Ca, stimulation of PTH		**Calciphylaxis + vitamin D3 deficiency results in depressed Ca, stimulation of PTH
	**Leads to high bone turnover → weakened bones → increased fracture susceptibility		**Leads to high bone turnover → weakened bones → increased [[fracture]] susceptibility
	**Treatment = phosphate binding gels, vitamin D3 replacement		**Treatment = phosphate binding gels, vitamin D3 replacement
	*Vitamin D3 deficiency and aluminum intoxication (osteomalacia)		*[[Vitamin D deficiency\|Vitamin D3 deficiency]] and [[aluminum toxicity\|aluminum intoxication]] (osteomalacia)
	**Leads to osteomalacia (defect in bone calcification)		**Leads to osteomalacia (defect in bone calcification)
	**Symptoms similar to hyperparathyroidism (muscle weakness, bone pain)		**Symptoms similar to hyperparathyroidism (muscle weakness, bone pain)
	**Treatment = desferrioxamine		**Treatment = desferrioxamine
	*Amyloidosis		*[[Amyloidosis]]
	**Common in patients >50yo who have received dialysis for >10yr		**Common in patients >50yo who have received dialysis for >10yr
	**Complications: GI perforation, bone cysts with pathologic fracture, arthropathies		**Complications: GI perforation, bone cysts with pathologic fracture, arthropathies

	===Anion Gap Metabolic Acidosis<ref>Angus S. Uremic Acidosis. University of Connecticut, 2006. http://fitsweb.uchc.edu/student/selectives/TimurGraham/Uremia.html</ref><ref>Nickson C. Renal Tubular Acidosis and Uraemic Acidosis. LITFL. http://lifeinthefastlane.com/ccc/renal-tubular-acidosis/.</ref>===		===[[Anion gap acidosis\|Anion Gap Metabolic Acidosis]]<ref>Angus S. Uremic Acidosis. University of Connecticut, 2006. http://fitsweb.uchc.edu/student/selectives/TimurGraham/Uremia.html</ref><ref>Nickson C. Renal Tubular Acidosis and Uraemic Acidosis. LITFL. http://lifeinthefastlane.com/ccc/renal-tubular-acidosis/.</ref>===
	*Early chronic kidney disease associated with hyperchloremic normal anion gap metabolic acidosis		*Early chronic kidney disease associated with hyperchloremic [[non anion gap acidosis\|normal anion gap metabolic acidosis]]
	*Late stage disease causes anion gap		*Late stage disease causes anion gap
	**Failure to excrete acid anions, phosphate and sulfate		**Failure to excrete acid anions, phosphate and sulfate
	**Bone demineralization - bone buffers H+, releasing calcium from bone, leads to osteopenia		**Bone demineralization - bone buffers H+, releasing calcium from bone, leads to osteopenia
	*Treatment: PO sodium bicarbonate 1 mEq/kg/day		*Treatment: PO [[sodium bicarbonate]] 1 mEq/kg/day

	==References==		==References==
	<references/>		<references/>
	[[Category:Renal]]		[[Category:Renal]]

Mholtz: Text replacement - "->" to "→"

2017-02-09T02:12:57Z

Text replacement - "->" to "→"

← Older revision		Revision as of 02:12, 9 February 2017
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	***Loss of Vitamin D and erythropoietin		***Loss of Vitamin D and erythropoietin
	**Regulatory failure		**Regulatory failure
	***Uremic state produces excess free radicals -> atherosclerosis, amyloidosis		***Uremic state produces excess free radicals → atherosclerosis, amyloidosis

	==Clinical Features and Management==		==Clinical Features and Management==
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	*Hyperparathyroidism (osteitis fibrosa cystica)		*Hyperparathyroidism (osteitis fibrosa cystica)
	**Calciphylaxis + vitamin D3 deficiency results in depressed Ca, stimulation of PTH		**Calciphylaxis + vitamin D3 deficiency results in depressed Ca, stimulation of PTH
	**Leads to high bone turnover -> weakened bones -> increased fracture susceptibility		**Leads to high bone turnover → weakened bones → increased fracture susceptibility
	**Treatment = phosphate binding gels, vitamin D3 replacement		**Treatment = phosphate binding gels, vitamin D3 replacement
	*Vitamin D3 deficiency and aluminum intoxication (osteomalacia)		*Vitamin D3 deficiency and aluminum intoxication (osteomalacia)

Rossdonaldson1: Text replacement - "troponin " to "troponin "

2016-12-04T14:27:14Z

Text replacement - "troponin " to "troponin "

← Older revision		Revision as of 14:27, 4 December 2016
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	===Cardiovascular===		===Cardiovascular===
	*CK-MB and troponin are specific markers of MI even in patients undergoing regular dialysis		*CK-MB and [[troponin]] are specific markers of MI even in patients undergoing regular dialysis
	*Mortality from cardiovascular disease is 10-30 times higher in dialysis patients than general population		*Mortality from cardiovascular disease is 10-30 times higher in dialysis patients than general population
	*hypertension is common		*hypertension is common

Alvarez13 at 23:55, 20 November 2016

2016-11-20T23:55:53Z

← Older revision		Revision as of 23:55, 20 November 2016
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	*[[Subdural hematoma]]		*[[Subdural hematoma]]
	**10 times more likely than in general population		**10 times more likely than in general population
			**Platelet dysfunction
	**Headache, focal neurologic deficits, seizure, coma		**Headache, focal neurologic deficits, seizure, coma
	*Peripheral neuropathy		*Peripheral neuropathy

Rossdonaldson1: Text replacement - " CV " to " cardiovascular "

2016-09-24T12:12:47Z

Text replacement - " CV " to " cardiovascular "

← Older revision		Revision as of 12:12, 24 September 2016
Line 33:		Line 33:
	===Cardiovascular===		===Cardiovascular===
	*CK-MB and troponin are specific markers of MI even in patients undergoing regular dialysis		*CK-MB and troponin are specific markers of MI even in patients undergoing regular dialysis
	*Mortality from CV disease is 10-30 times higher in dialysis patients than general population		*Mortality from cardiovascular disease is 10-30 times higher in dialysis patients than general population
	*hypertension is common		*hypertension is common
	*Uremic cardiomyopathy		*Uremic cardiomyopathy

Neil.m.young: Text replacement - "Cr " to "creatinine "

2016-08-11T09:50:48Z

Text replacement - "Cr " to "creatinine "

← Older revision		Revision as of 09:50, 11 August 2016
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	*Uremia = clinical syndrome associated with end-stage renal disease		*Uremia = clinical syndrome associated with end-stage renal disease
	**Correlation exists between symptoms of uremia and low GFR (15-20% of nl)		**Correlation exists between symptoms of uremia and low GFR (15-20% of nl)
	**BUN/Cr are inaccurate markers of clinical syndrome of uremia		**BUN/creatinine are inaccurate markers of clinical syndrome of uremia
	*Contributing Factors:		*Contributing Factors:
	**Excretory failure		**Excretory failure

Rossdonaldson1: Text replacement - "HTN" to "hypertension"

2016-07-30T22:14:07Z

Text replacement - "HTN" to "hypertension"

← Older revision		Revision as of 22:14, 30 July 2016
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	**EEG findings can differentiate uremic encephalopathy from dialysis dementia		**EEG findings can differentiate uremic encephalopathy from dialysis dementia
	*[[CVA]]		*[[CVA]]
	**Cerebrovascular disease, trauma, bleeding dyscrasias, anticoagulant, ~~HTN~~		**Cerebrovascular disease, trauma, bleeding dyscrasias, anticoagulant, hypertension
	*[[Subdural hematoma]]		*[[Subdural hematoma]]
	**10 times more likely than in general population		**10 times more likely than in general population
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	*CK-MB and troponin are specific markers of MI even in patients undergoing regular dialysis		*CK-MB and troponin are specific markers of MI even in patients undergoing regular dialysis
	*Mortality from CV disease is 10-30 times higher in dialysis patients than general population		*Mortality from CV disease is 10-30 times higher in dialysis patients than general population
	*~~HTN~~ is common		*hypertension is common
	*Uremic cardiomyopathy		*Uremic cardiomyopathy
	**Diagnosis of exclusion		**Diagnosis of exclusion

Neil.m.young: Text replacement - "0 mg" to "0mg"

2016-07-21T09:16:05Z

Text replacement - "0 mg" to "0mg"

← Older revision		Revision as of 09:16, 21 July 2016
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	*Uremic frost		*Uremic frost
	*Generated from crystallized nitrogenous waste from sweat		*Generated from crystallized nitrogenous waste from sweat
	*Typically in BUN > ~~200 mg~~/dL		*Typically in BUN > 200mg/dL
	*Treatment is lowering BUN		*Treatment is lowering BUN

← Older revision		Revision as of 03:04, 21 February 2021
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	==See Also==		==See Also==
	[[AKI]]		*[[AKI]]

	==References==		==References==
	<references/>		<references/>
	[[Category:Renal]]		[[Category:Renal]]