Uremia

Question 1

What are the signs and symptoms of uremia?

Answer 1

Anorexia, fatigue, itching, pruritus, nausea, coagulability.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 342.

Question 2

What causes uremic syndrome?

Answer 2

It results from the body’s inability to perform its regulatory and
excretory functions. It is not certain whether or not accumulated
levels of urea cause the symptoms, but the blood urea nitrogen
(BUN) level is a good indicator of the severity of the problem.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 342.

Question 3

What is the usual treatment of uremic syndrome?

Answer 3

Dietary protein restriction which is aimed at reducing protein
catabolism and urea production.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 342.

Question 4

What is uremic bleeding?

Answer 4

Uremic bleeding is a decrease in coagulability that occurs in
patients with renal failure.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 343.

Question 5

What is the treatment for uremic bleeding?

Answer 5

DDAVP or cryoprecipitate are used in the treatment of uremic
bleeding. Both cryoprecipitate and DDAVP/desmopressin
increase the circulating levels of the factor VIII-von Willebrand
Factor complex and decrease the bleeding time. Platelet
dysfunction in common in patients with uremia due to the
accumulation of succinic acid and hydrophenolic acid which
interfere with the platelet’s ability to expose it’s phospholipid
surface. These substances, however, can be removed via
dialysis and coagulability improves following treatment.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 343.

Question 6

How are coagulation studies affected in uremic

bleeding?

Answer 6

The platelet count, prothrombin time, and partial thromboplastin
time are normal, but the bleeding time is prolonged.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 343.