ISSN 2398-2950      

Uremia

ffelis

Synonym(s): Uremic syndrome


Introduction

  • Polysystemic toxic syndrome of decreased renal function and azotemia (increased non-protein nitrogenous waste in the blood).
  • Cause: acute or chronic renal failure or prolonged urinary tract obstruction.
  • Signs: vomiting, anorexia, lethargy/depression, anemia, weakness, hypothermia, oral ulcers, melena, muscle tremors, seizures.
  • Diagnosis: signs, blood biochemistry, urinalysis.
  • Prognosis: depends on severity of renal damage.

Pathogenesis

Etiology

Acute renal failure

Pre-renal
  • Tubular failure: due to dehydration, circulatory failure, hypovolemia, crush syndrome.
  • Vascular obstruction: with ischemia.
Intrinsic
Post-renal

Chronic renal failure

Predisposing factors

General

  • Fluid deprivation/dehydration in animal with compromized renal function.
  • Reduced pressure in renal artery in animal with compromized renal function, eg heart failure, hypovolemia, hemorrhage (or even normal animal if hypoxia severe and prolonged).
  • Post-renal obstruction, eg urethral calculi Urethra: obstruction.

Specific

  • Nephrotoxic drugs.
  • Toxins.
  • Post-renal failure - urinary tract obstruction.

Pathophysiology

Acute renal failure

  • Prerenal, renal or post-renal azotemia   →   decreased glomerular filtration   →   oliguria   →   retention of waste products   →   toxemia/uremia.

Chronic renal failure

  • Loss of functional nephrons   →   inability to concentrate urine   →   polyuria, polydipsia.
  • Retention of waste products   →   toxemia   →   anorexia and hypermetabolism   →   catabolism of body tissues.
  • Retention of phosphate and reduced activation of Vitamin D   →   increased [parathyroid hormone]   →   osteodystrophy and other signs of parathyroid hormone toxicity (anemia, CNS signs) and increased soft tissue and renal calcification Stomach: calcification due to renal failure - pathology .
  • Toxemia   →   oral and gastrointestinal ulceration   →   vomiting, diarrhea and anorexia.
  • Loss of functional nephrons   →   decreased GFR   →   increased phosphorus   →   decreased calcium   →   increased PTH   →   normalizes calcium and phosphorus but causes renal secondary osteodystrophy.

Timecourse

  • Acute or chronic.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Elliott  J, Barber P J (1998) Feline chronic renal failure - clinical findings in 80 cases diagnosed between 1992 and 1995. JSAP 39 (2), 78-85 PubMed.
  • Krawiec D R (1996) Managing gastrointestinal complications of uremia. Vet Clin North Am Small Anim Pract 26 (6), 1287-1292 PubMed.

Other sources of information

  • Schulman R L, Krawiec D R (2000) Gastrointestinal Complications of Uremia. In: Kirk's Current Veterinary Therapy XIII. Bonagura J D (ed). W B Saunders. pp 864-866.

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