Uraemia in chronic kidney disease

Kidney cartoon 4

 

Uraemia is a syndrome seen in late stage in chronic kidney disease, and caused by the accumulation of the breakdown products of protein metabolism. The symptoms include anorexia, nausea, vomiting, lethargy, confusion, muscle twitching, convulsions and coma. Although urea and creatinine are the substances we measure, the symptoms are most likely due to the accumulation of other toxic and products. These symptoms can lead to poor food intake and malnutrition. By the time uraemia becomes symptomatic, dialysis is typically indicated.

Management:

  1.  Dialysis should be commenced as soon as uraemic symptoms develop
  2.  If non-dialysis pathway is planned:
  • a low protein diet will help control gastrointestinal symptoms
  • fluid control should be strict to avoid pulmonary oedema
  • avoid unnecessary medications
  • anti emetics are of limited value
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