uremia Uremia refers to the late stage of acute or chronic kidney failure, generally indicating stages 4 and 5 of chronic kidney disease. At this point, the patient's kidneys are unable to function properly, leading to disturbances in water, electrolyte, acid-base balance, as well as endocrine dysfunction. Additionally, there is a buildup of metabolic waste products and toxic substances in the body, resulting in a series of symptoms and signs, thereby causing uremia.

Uremia refers to the late stage of acute or chronic renal failure, generally referring to stages 4 and 5 of chronic kidney disease. At this stage, the kidneys are unable to function normally, leading to disturbances in water, electrolyte, and acid-base balance, as well as endocrine dysfunction. Additionally, there is an accumulation of metabolic end products and toxic substances in the body, resulting in a series of symptoms and signs, ultimately leading to uremia.

The causes of uremia can be categorized into primary, secondary, and genetic kidney diseases.

Primary kidney diseases include chronic glomerulonephritis, arteriosclerosis of the renal arteries, and chronic pyelonephritis.

Secondary kidney diseases result from systemic diseases affecting the kidneys, such as diabetic nephropathy, hypertensive nephropathy, allergic purpura nephritis, and lupus nephritis.

Genetic kidney diseases include hereditary nephritis and autosomal dominant polycystic kidney disease.

Progressive factors contributing to uremia development include high blood sugar, hypertension, proteinuria, hypoalbuminemia, smoking, anemia, hyperlipidemia, aging, malnutrition, and accumulation of uremic toxins.

Acute exacerbating factors include disease relapse or exacerbation affecting the kidneys, inadequate effective blood volume, sudden reduction in local renal blood supply, uncontrolled severe hypertension, nephrotoxic drugs, urinary tract obstruction, severe infection, hypercalcemia, liver failure, and heart failure.

Restriction of protein intake is a crucial aspect of treatment to alleviate symptoms and related complications. Recommended protein intake is 0.6g/(kg·d), which should be reduced to below 0.6g/(kg·d) for diabetic nephropathy patients. Emphasis should be placed on high-quality proteins such as eggs, lean meat, fish, and milk.

Limiting salt intake is essential, with a general recommendation of not exceeding 6-8g/d. Those with significant edema or hypertension should restrict salt intake to around 5g/d.

Restricting potassium intake and reducing consumption of high-potassium foods, such as bananas, is necessary.

Preparation for long-term hemodialysis or peritoneal dialysis is crucial. Patients opting for hemodialysis should prepare vascular access 1-3 months in advance and make arrangements with a dialysis center for long-term treatment. Patients preparing for peritoneal dialysis should make peritoneal preparations 2-4 weeks in advance.

Without treatment, uremia, as the terminal stage of renal failure, poses a high risk of mortality, particularly from cardiovascular disease. The following outlines complications related to dialysis and kidney transplantation.

Complications of Hemodialysis

The most common complications are thrombosis, catheter-related infections, excessive fluid removal leading to hypotension, as well as long-term complications such as anemia, malnutrition, and cardiovascular disease.

Complications of Peritoneal Dialysis

The primary complication is peritonitis, with other complications including the formation of hernias, hyperglycemia, and hyperlipidemia.

Complications of Kidney Transplantation

The most common complication is rejection, which can occur during transplantation, in the early post-transplant period, or later.

Lifestyle: Adequate rest and good sleep are essential, and patients should avoid engaging in strenuous activities.

Diet: Patients should consult a doctor when unsure about certain foods and should maintain disciplined eating habits, as diet is crucial for uremia treatment.

Dietary Recommendations:

Moderate intake of high-quality, low-protein foods such as eggs, dairy, fish, and soy.

Ensuring sufficient energy intake while controlling protein intake.

Dietary Restrictions:

Low-sodium diet: Avoid high-sodium foods such as instant noodles.

Low-phosphorus diet: Limit high-phosphorus foods, including certain beverages, nuts, canned foods, etc.

Low-potassium diet: Limit consumption of high-potassium foods such as potatoes, pumpkin, and tomatoes.

Low-fat diet: Patients should consume less meat.

Early diagnosis, effective treatment of primary diseases, and removal of factors leading to renal function deterioration are essential.

Regular screening is recommended for the general population, aiming for early diagnosis.

For those with existing kidney diseases or conditions that may cause kidney damage, timely and effective treatment is necessary, along with regular urine and kidney function tests at least twice a year to detect chronic kidney disease early.

For patients diagnosed with chronic kidney disease, various measures should be taken to delay, stop, or reverse the progression of chronic renal failure. Effective control of hypertension, blood sugar, and proteinuria can delay the progression of chronic kidney disease and prevent it from developing into uremia.