Uremia and High Blood Pressure

As we all know, hypertension is one of the most common symptoms and complications of the disease of Polycystic Kidney Disease . And the worst prognosis of this disease is uremia. Many patients with this disease, however, don’t know that hypertension is one of the important factors for this disease to develop to uremia. So, what the patients should do to control the blood pressure and prevent uremia?

First, control the blood pressure on the ideal level

According to the general survey, more than half of patients with Polycystic Kidney Disease suffer from hypertension. Only less than 50 percent of patients, however, have realized they have hypertension. And among them, less than 12.5percent are taking medicine to treat the hypertension; and only 2.9percent of them can control the blood pressure in the ideal level. Therefore, we should spread the publicity of hypertension and it is extremely urgent to enhance the people′s cognition of the hazard of hypertension.

Second, take close examination of renal function

It is the precondition of preventing the damage of renal function to control the blood pressure in the ideal level. At the same time, we should take close examination of the renal function of the hypertension patients.

Third, choose therapeutic schedule and medicine reasonably

There are varieties of categories of antihypertensive drugs, which are suitable for different types of symptoms. The basic principle of choosing antihypertensive drugs is that the drugs do not contain the renal toxicity or even possess the function of renal protection. Research shows that ACEI, ARB, CCB, and βBRB can not only control the blood pressure but also can protect our kidney.

Uremia:Water and Dialysis

How much water to drink in dialysis? Water is the source of life, and under some occasions, water may become kind of poison. For uremia patients on dialysis, if they drink too much water under the state of oliguria or anuresis, it may cause acute heart failure and cause uremia heart diseases. The dehydration of dialysis patients is quick and big, and all these will increase the heart burden.

How much water is supposed to drink in dialysis? In order to control the water intake, the patients in dialysis should conduct healthy management: dialysis patients should check the weight everyday; it is normal to control the weight under a regulation around 5%. Patients with urine can properly loosen the control of water, but food rich in moisture content is not suggested. The dialysis patients can distribute the total water intake to different hours of a day.

Risk Factors that may Lead to Uremia

1.Chronic glomerulonephritis

For those patients who have been diagnosed with chronic glomerulonephritis, their kidney condition tends to aggravate at a higher rate if they have persistent proteinuria or their blood pressure is poorly controlled.

Also, the prognosis of the disease is also affected by the pathological classification and pathological stages. Some types of nephritis, such as MCD, light mesangial proliferation, would have good prognosis, while some types of nephritis, like mesangioproliferative glomerulonephritis, RPGN(rapidly progressive glomerulonephritis), would pose unfavorable prognosis. In some cases, patients would progress into uremia in a few months or weeks after the first attack.

2.Diabetic nephropathy

Once patients with diabetic nephropathy present clinical proteinuria, their kidney function would decline progressively. And almost one fourth of the patients with diabetic nephropathy would develop into uremia within six years once they present persistent proteinuria.

3.Hypertensive nephropathy

Patients with long-time medical history of hypertension and a poor control of their blood pressure would develop renal insufficiency apart from cardio-vascular diseases.

In addition, patients who had medical history of hypertensive crisis tend to develop damage to kidneys.

4.Bilateral hydronephrosis

Patients with bilateral hydronephrosis caused by kidney stones or other diseases would present bilateral hydronephrosis. If the obstruction could not lifted timely, kidney function would deteriorate in the long run, leading to uremia eventually.

5.Nephrotoxic medicines

Long-term intake of nephrotoxic medicines, such as certain antiobitics, pain-killers and chemotherapeutic drugs can also cause renal failure.

What is Hemolytic Uremia Syndrome

Hemolytic Uremia Syndrome mainly manifested as microangiopathic hemolysis, thrombocytopenia and acute renal failure; if accompanied with nervous system symptoms and noninfectious fever, it will be thrombotic thrombocytopenic purpura. Therefore, Hemolytic uremia syndrome and thrombotic thrombocytopenic purpura are similar in clinical manifestation and causes, and they both belong to thrombotic microangiopathy.

The causes of hemolytic uremia syndrome are still not very clear, and it may have relation with infection , inheritance and other factors. These factors lead to endothelial cells damage and broke negative charge brought by endothelial cells under physiology condition, decrease PGI2 and increase platelet adhesiveness; operated endothelial cells start blood clotting of white cells and plasma proteins, bring thrombopoiesis to happen, thus lots of blood cells are consumed and result in bleeding; hemolytic anemia will occur when red cells flow through vessels that is formed by microthrombus. Microembolization mostly occur in kidney, which may result in acute renal failure.

Why Uremia Patients Need to do Dialysis

Why do patients with kidney disease have to do Dialysis when enters into uremia stage?

Normally, kidney are the two “sewage treatment center” of human body, which are responsible for dispose of the wastes. Once kidneys have pathological changes and could not work as well, some of the wastes then could not be excreted out of the body and would build up. All of these wastes are the toxins that cause uremia, which’s life-threaten. The wastes can be divided into three major groups.

1.Small molecular toxins

These toxins’ relative molecular mass is below 500, which mainly include inorganic phosphorous, hydrogen ion, certain acid radicals, and urea, creatinine, uric acid, phenols and amines. Cyanate- metabolic product of urea- is neurotoxic. When creatinine reaches certain concentration, the life span of the cells would shorten, hemolysis would happen. Drowsiness and fatigue can also happen. Uric acid can cause gout. High-concentration polyamine can cause nausea, vomit and proteinuria, promotes the dissolution of red blood cells and restrain the production of EPO, resulting in anemia. Phenols can damage the nervous syImmunotherapy. Either excessive concentration of potassium ion or hydrogen ion can be life-threatening.

2.Middle molecular toxins

These toxins’ relative molecular mass is between 500 and 1000, which mainly are some peptides, which can cause peripheral nervous lesions, abnormal glucose tolerance, and also restrain the cell production, phagocytic activity of leucocytes, the growth of lymphocytes and fibrocytes.

3.Large molecular toxins

These toxins’ relative molecular mass is more than 1000, mainly containing some hormones, such as growth hormones, parathyroid hormone, corticotrophin, gastrin, insulin, which can cause central nervous syImmunotherapy dysfunction, calcification or necrosis of soft tissue, bone disease, pruritus, hyperlipemia, anemia, erectile dysfunction and secondary hyperthyroidism.

As listed, all of these toxins would lead to serious consequences if they are building up in the body. So the major task of the treatment of uremia is to get rid of the toxins. Dialysis, whether it is hemodialysis or peritoneal dialysis, can help clear the small and middle molecular toxins out of the body. So the kidney patients can sustain their lives.

What is Uremia

Uremia is a condition in which the body is unable to remove metabolic wastes and toxins from blood to maintain water, electrolyte, acid-base balance. Uremia usually refers to the severe renal failure. In the end-stage renal failure, GFR is less than 15. In most cases, damage many systems of the body.

Cardiovascular diseases:

Damaged kidneys lead to water retention or edema. High blood pressure is aggravated in end-stage renal failure. Also a sudden rise in potassium can increases the risk of cardiovascular disease. Retention, aggravated high blood pressure and rise of potassium increases the risk of cardiovascular diseases attack.

Respiratory diseases:

Short of breath is a symptom of respiratory disease. Pulmonary edema is very dangerous which may lead to death.

Sensory Effects：

Peripheral neuropathy may happen to patients with uremia that usually are in upper extremities. The manifestations of sensory problems include weakness and dizziness. Cerebral edema may cause metal confusion.

Sexual diseases:

Estrogen production and testosterones is reduced duet to effects of uremia toxins. Man with uremia may experience ED and has no desire of sexual life.

Metabolic System:

Impaired kidneys are unable to excrete medications or waste products. Medications and chemotherapy may cause severe toxicity problems. The kidneys are unable to maintain electrolyte balance.

Kidney Insufficiency and Uremia

Does renal insufficiency mean uremia?

Some people are confused about this question. Those who’re newly diagnosed with renal insufficiency may be scared and wonder.

In the clinical, chronic kidney disease can be divided into four stages. The four stages are compensation stage of renal insufficiency, discompensation stage of renal insufficiency, early stage of renal failure and advanced stage of renal failure (uremia).

In the compensation stage of renal insufficiency, chronic kidney disease patients can not feel any symptoms, and their creatinine level, GFR are all in normal range because of the compensation ability of the kidney. As we know, one important function of kidney is filtration. When some renal glomeruli are damaged and fail to work, the other healthy renal glomeruli will do more work to replace them. So creatinine and other toxins such as blood urea nitrogen, urea acid can be cleaned out of the body. In this stage, chronic kidney disease patients even do not have to limit the food which they take in. They do not have to limit water and keep low salt for the discharge of water is also normal.

In the discompensation stage of renal insufficiency, other renal glomeruli which do more work will also be tired and fail to work for a long time. In this stage, level of serum creatinine, blood urea nitrogen and urea acid may increase a little and chronic kidney disease patients can have symptoms such as anemia, fatigue, decreased body weight, and can not concentrate, and so on. These are usually ignored. If suffering from loosing water, infection, bleeding and so on, obvious symptoms will appear soon.

The third stage is early stage of renal failure. In this stage, renal function declines seriously. Chronic kidney disease patients in this stage can easily feel fatigue, weakness. Besides, anemia will become more obvious. Urine at night will also increase. In addition, blood urea nitrogen and serum creatinine also increase obviously. Acidosis can also be accompanied. So this stage can also be called azotemia stage.

The last stage is advanced stage of renal insufficiency(uremia). In this stage, chronic kidney disease patients have serious symptoms in clinic such as severe nausea, vomiting, little urine, edema, high blood pressure, serious anemia, itch in skin, and so on.

What Kind of Kidney Disease will Progress into Uremia

1.Chronic Glomerulonephritis

For those patients who have been diagnosed with chronic glomerulonephritis, their kidney condition tends to aggravate at a higher rate if they have persistent proteinuria or their blood pressure is poorly controlled.

Also, the prognosis of the disease is also affected by the pathological classification and pathological stages.

2.Diabetic Nephropathy

Once patients with diabetic nephropathy present clinical proteinuria, their kidney function would decline progressively. And almost one fourth of the patients with diabetic nephropathy would develop into uremia within six years once they present persistent proteinuria.

3.Hypertensive Nephropathy

Patients with long-time medical history of hypertension and a poor control of their blood pressure would develop renal insufficiency apart from cardio-vascular diseases.

Uremia Basics:Causes and Symtpoms

Causes of Uremia

1. Various kidney diseases account for the main cause.

2. Infection of urinary system or urinary tract infection.

3. Toxic side effects of some medications.

4. Approximately 30% of patients with Diabetes Mellitus may develop Uremia.

5. Uremia cases caused by HIV infection is in rising trend.

6. About 15% of high blood pressure will become Uremia.

Symptoms of Uremia

For uremia patients, the symptoms may include excessive thirst and reduced urination, nausea and vomiting, a drying mouth, swelling (edema of the entire body, hands, feet and face, etc.), abdominal pain, Confusion due to reduced mental alertness, pale color of the skin, tiredness, fatigue and increased irritability, increased pulse rate, tremors and seizures, fever and a low blood pressure, nocturnal urination, Anorexia and weight loss, inexplicable small bruise and pericarditis.

What are the differences between Nephritis and Uremia

Chronic nephritis is the early stage of uremia. If chronic nephritis can not be treated reasonably, it will progress into renal failure and even uremia at last. Then, what are the difference between nephritis and uremia?

According to the original causes, nephritis can be divided into primary glomerulonephritis and secondary glomerulonephritis. According to the time, nephritis is divided into acute glomerulonephritis and chronic nephritis, also known as chronic glomerulonephritis. Acute nephritis, chronic nephritis, nephrotic syndrome and iga glomerulonephritis belong to primary nephritis; secondary glomerulonephritis includes purpura nephritis, lupus nephritis, diabetic nephropathy and hypertensive nephropathy.

Uremia is caused by renal failure. And the causes of renal failure are various reasons forming into nephritis, such as acute glomerulonephritis, interstitial nephritis, diabetic nephropathy, polycystic kidney disease and severe high blood pressure. Severe hypertension can cause renal arteriolar sclerosis, renal blood flow reduction, renal function damage, lower urinary tract obstruction.

Because renal corpuscle is damaged, the kidneys of nephritis patients suffer from edema, high blood pressure and proteinuria. Nephritis is the most common disease among kidney diseases.

Uremia actually refers to the human body not be able to produce urine through the kidneys, the metabolic waste and excess moisture can not be excreted from the body, which causes poisoning.

Nephritis and uremia are two different things. But they can be said to the two different stages of a disease. Nephritis can not surely develop into uremia. Most nephritis patients can be cured after effective treatment .