What causes uremia?

Written by Wang Li Bing

Intensive Care Medicine Department

Updated on September 15, 2024

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Uremia is very common in clinical practice. It is mainly caused by abnormal kidney functions, leading to abnormalities in glomerular filtration, as well as in the reabsorption and secretion functions of the renal tubules, which results in a series of symptoms. Once uremia occurs, it can disrupt the internal environment of the body, cause electrolyte abnormalities, and even lead to life-threatening arrhythmias. Uremia is very dangerous in clinical practice and often requires regular hemodialysis treatment. Therefore, once uremia occurs, medical attention must be sought promptly.

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The precursors of uremia

The so-called uremia refers to the end result of chronic kidney disease causing long-term damage to the kidneys in patients. Patients with uremia often have long-standing conditions, as it takes time to progress from mild kidney failure to uremia. Before the onset of uremia, patients may experience symptoms related to kidney failure, such as swelling of the limbs and face, reduced urine output, proteinuria which leads to foamy urine, and visible blood in the urine due to hematuria. Patients are also prone to developing high blood pressure. These symptoms can be precursors to uremia, although other diseases can also cause similar symptoms.

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How to diagnose uremia

Uremia primarily refers to high levels of creatinine in the blood. Generally, a creatinine blood test can be used to evaluate kidney function, thus diagnosing whether the kidneys are in a compensatory stage, in a chronic stage, or during a period of uremia. Renal insufficiency, which causes uremia, has specific causes. It is essential to determine whether the causes are renal or post-renal by performing routine urinary system CT scans to identify any obstructions, stones, or space-occupying lesions that may lead to hydronephrosis and a decline in renal function. Other internal medical diseases, such as chronic nephritis syndrome and kidney disease, can also lead to increased creatinine levels. In such cases, renal biopsy and pathology are necessary to confirm the diagnosis. Once an individual reaches the uremic stage, the overall condition tends to deteriorate, characterized by fatigue, anorexia, and weight loss. Additional issues include toxin accumulation in the body leading to anemia and various other problems, including gastrointestinal issues and reduced digestive capacity resulting in loss of appetite. When the aforementioned symptoms occur, there generally are only two treatment options: dialysis to filter out the toxins or, if an appropriate kidney source is available and economically feasible, kidney transplantation can be considered.

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How is uremia caused?

Uremia, also known as end-stage renal disease, is actually the late stage of chronic renal failure development, capable of causing long-term chronic damage to the kidneys. There are many reasons for this, and if these causes persist over a long period, continuously harming the kidneys without effective removal or control, it could eventually lead to severe renal failure, ultimately causing uremia. The causes that can chronically harm the kidneys mainly include diabetes, hypertension, chronic nephritis, polycystic kidney, urinary system stones, tumors, and other such conditions.

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Precursors of uremia

The kidneys have a very strong compensatory ability. When kidney function is slightly impaired, they can generally still handle the basic physiological functions of the human body through compensation, so patients may feel that everything is normal. Despite the fact that the occurrence and development of uremia is a long and gradually worsening process, which can sometimes be very severe, it is still possible to detect early signs of uremia if one actively seeks them out early on. Early indications of uremia can be identified in time by going to the hospital for urine and blood tests. The early signs of uremia often manifest as general fatigue, which is the symptom most easily overlooked. Other symptoms of early uremia include edema, especially noticeable swelling of the eyelids and facial area after waking up in the morning. If it develops into systemic or persistent edema, the condition is already very serious. Additionally, early-stage uremia patients may also experience an increase in the frequency of nocturnal urination and more foam in the urine, as well as increased blood pressure, and even dizziness, headaches, and a lack of appetite. These are all early signs of uremia.

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Is high creatinine uremia?

High creatinine levels do not necessarily indicate uremia. High creatinine often implies that the patient is experiencing renal failure, which can be classified into acute renal failure and chronic renal failure based on factors such as the patient's medical history and course of the disease. Uremia is the final state of chronic renal failure. Thus, even if high creatinine levels suggest the possibility of chronic renal failure, it does not necessarily mean that the patient has reached the final stage. Uremia, also known as end-stage renal disease, generally requires a patient's blood creatinine to exceed 707 µmol/L. Additionally, patients often simultaneously present with clinical manifestations such as renal anemia, disorders of calcium and phosphorus metabolism, and reduction in kidney size.