Uremia in a CKD patient
PATIENT
• 41 year old male
• Longstanding history of HPN and
diabetes
• Complaint:
- pruritus
- lethargy
- lower extremity edema
- nausea
- emesis
Vital Signs
BP = 180/110 mmHg
PR = 80 beats/min
RR = 24 breaths/min
T = 36.5 Celsius
Physical Examination
• Well developed
• Well nourished
• Moderate distress
• Body weight = 76.5 kg
• AV nicking - a small artery (arteriole) is
seen crossing a small vein (venule) in the
eye
• Cooper wiring - arteriosclerosis with
moderate vascular wall changes; thicking
and opacification of arteriolar walls
Physical Examination
• Cardiac exam: S1, S2, S4
• 2+ lower extremity edema - The pressure
leaves an indentation of 3–4 mm that
rebounds in fewer than 15 seconds
• Superficial excoriations of his skin from
scratching
Laboratory Data
Chemistry Normal Values Urinalysis
Sodium 133 136-146 mmol/L
Potassium 6.2 3.5-5.3 mmol/L
Chloride 100 98-108 mmol/L
Total CO2 15 23-27 mmol/L
pH 6.0
BUN 170 7-22 mg/dl Specific gravity 1.010
Creatinine 16.0 0.7-1.5 mg/dl Protein 1+
Glucose 108 70-110 mg/dl Glucose negative
Calcium 7.2 8.9-10.3 mg/dl Acetone negative
Phosphorus 10.5 2.6-6.4 mg/dl Occult blood negative
Alkaline Phosphatase 306 30-110 IU/L Bile negative
Parathyroid Hormone 895 10-65 pg/ml Waxy casts
Hemoglobin 8.6 14-17 gm/dl
Hematocrit 27.4 40-54 %
Mean cell volume 88 85-95 FL
Renal Ultrasound
• Right kidney 9 x 6.0 cm
• Left kidney 9.2 x 5.8 cm
• Both kidneys illustrate hyperechogenicity
and no hydronephrosis
Symptoms suggest…. UREMIA
• Uremia, or uremic syndrome, is a serious complication of chronic kidney disease
• It occurs when urea and other waste products build up in the body because the kidneys
are unable to eliminate them.
• These substances can become toxic to the body when they reach high levels
• Prolonged or severe fluid buildup may make the uremic syndrome worse
• Uremic neuropathy
• Weakness, exhaustion, confusion
• Nausea, vomiting, loss of appetite
Signs and Symptoms
• Changes in blood test
• Metabolic acidosis
• High blood pressure
• Edema
• Dry, itchy skin
Treatment
• Uremia is a medical emergency that
requires urgent treatment. People with
uremia may need to be hospitalized. It is
not possible to treat uremia at home.
• Most people with uremia will need
dialysis. Dialysis uses a machine to act as
an “artificial kidney” that filters the blood.
• A doctor might adjust a person’s
medications for certain autoimmune
diseases, or surgically remove a
blockage, such as a kidney stone. Blood
pressure medication and medication to
better control diabetes may also help.
Medications
• Drugs that have been used empirically to counteract toxic effects of uremia include
aspirin for antiplatelet and anti-inflammatory properties; antihypertensives such as
angiotensin-converting enzyme (ACE) inhibitors, beta-adrenergic blockers, and diuretics
to normalize blood pressure; statins to lower atherosclerotic cholesterol; phosphate
binders to lower phosphorous levels; and folic acid to reduce homocysteine levels.
Drug Recitation
[Link] - CALEJA, Joanne Marie [Link] Hydrochloride - GALUT, Kyla
Grace Camille
[Link] - ESTEVES, Marco [Link] - LUBIN, Hana Vida
[Link] - DE LOS REYES, Jeanelle [Link] - LEE, Sheniah Grace T.
Herbie
[Link] - ORATE, Krishamae
[Link] - GANIGAN, Therese
Olivia [Link] - RARAMA, Hershey Jane
Requirements
• NCP: 1 actual, 1 potential
• FDAR: for 3 days
• Pass your requirements on or before 8:30 am tomorrow
to your assigned head nurse/s
