Uremia
Summary
Uremia is a clinical syndrome from accumulation of uremic toxins when GFR drops below 10-20 mL/min, causing multi-organ dysfunction. Develops in advanced CKD/ESRD with cardiovascular, neurologic, hematologic, and GI complications.
Detail
Over 100 uremic toxins accumulate including urea, beta2-microglobulin, homocysteine, and indoxyl sulfate. Manifestations include nausea, fatigue, uremic encephalopathy (mental status changes, seizures), cardiovascular disease (leading cause of mortality), and platelet dysfunction causing easy bleeding. Management: slow progression with BP control and ACE inhibitors, treat complications (hyperkalemia, anemia, bone disease), and ultimately renal replacement therapy (dialysis or transplantation).
Sources
- First Aid for the USMLE Step 1
- Robbins Basic Pathology
- Harrison's Principles of Internal Medicine
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