Definitions of Azotemia and Uremia
© 1997 Andrew Lundin, M.D.
All rights reserved. Reproduced with permission.
If I am going to use medical terms, I should
define them for you. I would ask you to say when something is
not clear, but medical students often do not remember what uremia
means and are afraid to ask for fear of public embarrassment.
1. Azotemia (nitrogen in blood):
One major role of a healthy kidney is to get
rid of the byproducts of nitrogen metabolism (from protein). Azotemia
occurs when the kidneys are damaged and can no longer efficiently
get rid of these metabolites. BUN (blood urea nitrogen) and creatinine
are just two easily measured markers of nitrogen accumulation.
When their levels are increased one can be said to have renal
dysfunction. Eight five to 90% of kidney function can be lost
(if gradual) before one notices any obvious symptoms. For those
who visit a doctor regularly and have blood drawn, kidney dysfunction
can be detected by accident. For others, diagnosis comes when
they develop symptoms at a late stage, and may require dialysis
in the short term. The possible advantage of knowing early is
applying the possible interventions that might slow progression
and the ability to prepare psychologically (if that is possible).
2. Uremia (urine in blood):
The end stage of "kidney failure"
when one begins to get symptoms of increasing severity as the
kidney fails further. Such symptoms include:
- 1. Progressive loss of energy - decreased
- 2. Progressive loss of interest in life and
- 3. Decrease of appetite, some weight loss
(may be masked by fluid retention
- 4. Loss of appetite with nausea and vomiting
marks a serious turn for the worse
- 5. Uremic pericarditis (inflammation of the
outside lining of the heart), lethargy, confusion, coma indicate
a progression of the final stages of uremia to death.
Intervention with dialysis or transplant early
in the course can prevent later complications. However, some patients
have to become ill before appreciating what dialysis can do.
Peter Lundin, M.D
*This symptom is a description of reactive
depression, a normal reaction to an adverse life event. In detail it is
best discussed by a psychologist or psychiatrist. However, when
one's body is failing as
with uremia or other disease, whether overtly
sensed or not, depression
can follow. Depression can recur with under
dialysis or can persist in
those who have not accepted the loss of a
previous life style and the
intrusion of dialysis. Getting good dialysis,
support from family
friends, professionals and fellow patients
with shared experiences all
help. Having the desire and ability to get
on with living is also
essential. If the feelings persist despite
the above, medication can be
helpful. I have seen some patients take up
to several years to accept
their new life, and when it happens it is
often like the light bulb
going on as depicted in a cartoon. The sudden
realization that life can
go on. For this to happen, however, life
cannot be full of " other shoes dropping".
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