urinemia

uremia [u-re´me-ah]

1. an excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acid metabolism; more correctly referred to as azotemia.

2. in current usage, the entire complex of signs and symptoms of chronic renal failure. As the glomerular filtration rate falls in either acute tubular necrosis or chronic renal failure, serum urea (usually expressed as blood urea nitrogen content or BUN) and creatinine rise to very high levels. However, BUN and creatinine measurements are only roughly correlated with uremic symptoms. Other nitrogenous compounds present in small amounts may produce most of the toxic effects. Some uremic symptoms are due to losses of kidney function that do not involve uremia (azotemia). adj., adj ure´mic.

Patient Care. A major activity of care is assessment of health status and learning needs on an ongoing basis throughout the course of the illness. The systemic effects of uremia involve virtually every system of the body and present problems related to dysfunction of each system. Maintaining adequate nutrition is a very real challenge for the patient with this condition. The cooperative efforts of nutritionists and other health care professionals are needed to meet the goals of minimizing uremic toxicity, maintaining acceptable electrolyte levels, controlling hypertension, providing sufficient calories, and maintaining adequate nutritional status. Because of buildup of nitrogenous wastes from protein metabolism, dietary intake of protein may be severely limited. If any protein foods are allowed they should be of high quality; for example, eggs, milk, and cheese provide all of the essential amino acids in relatively small quantities.



Potassium restriction may also be indicated because of inability of the kidney to excrete it. This complicates the problem, however, because foods rich in potassium also are high-quality protein foods. These same foods also contain phosphorus, which may be restricted. A sodium-free diet usually is prescribed, but this can pose problems in regard to food selection and patient compliance.

Patients in the terminal stage of uremia will require special mouth care; measures to prevent pressure ulcers; protection from injury due to altered levels of consciousness; monitoring and protection from deleterious effects of excessive bleeding related to lack of renal hormone erythropoietin and bone marrow depression; and interventions appropriate to psychological and emotional support for the patient and family members during a terminal illness.

Systemic effects of uremia.

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urinemia

uremia.