Urämie – Wikipedia Wikipedia

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The word Educate (from Latin urine , German ‘urine’, and ancient Greek blood Ha , German ,Blood’ ) means “urine in the blood”, ie the increased occurrence of urinary substances in the blood due to the lack of or insufficient kidney function (renal insufficiency).
The consequence of this inadequate cleaning of the blood is urinary poisoning due to harmful urine components (uremiet oxins, nephrotoxins). [2] One also speaks of the Retention uremia and when the end products of the nitrogen metabolism predominated from the Azotemic uremia . [3]

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The clinical full screen of an uremia can occur acutely (5–10 days after acute kidney failure) or chronically (developed for years in chronic kidney failure).

When Pseudouidy In the past, cerebral disorders in chronic arterial hypertension were referred to with confusion (as with cerebral sclerosis) even without kidney insufficiency. [4]

A renally conditioned uremia can occur on two ways: If the glomerular filtration decreases, too little plasma is cleaned by the ugly fabrics. Your serum level increases. On the other hand, if the tubular reversal resorption increases, the plasma level of the ugly -liable substances also increases. A decrease in Glomerular filtration rate can therefore like an increase in tubular reversal rate lead to an uremia.

Not every kidney disease leads to uremia. Not every uremia is based on kidney disease. Here is the Extra -Nerve syndromes to think after Wilhelm Nonnenbruch, i.e. kidney insufficiency even without kidney disease. Cardianal syndrome and hepator syndrome are worth mentioning, for example. Nun fracture described the in 1949 Extrarenale Urämie Even in patients with an anuria. [5] In 1953 in the German edition of ICD-6 (international statistical classification of diseases and related health problems) the Extrarenale Urämie encrypted with N 899. [6] Today it is classified in the ICD-10 with R 39.2. [7]

In addition, with certain metabolic disorders, a pathologically increased formation of uremia oxins, regardless of kidney function, also leads to an uremia ( Overproductionalemia ). [8]

Carl Anton Ewald was unable to bring the individual symptoms of uremia in the real encyclopedia of the entire medicine in 1898 in accordance with the individual “retained metabolic products”. [9] As early as 1888, he wrote: “The uremia results from the retention of metabolic production. The Uremic appearances are most difficult, where the retention is greatest. ” [ten]

In 1900 Isidor Albu wrote a six -sided essay on the “urination”. At that time they speculated through auto intoxication through the urine components. In numerous attempts, rabbits were infused by rabbits to calculate a “urotoxic coefficient of the urine”. A transferability of such animal test results on humans was not subordinate. There was no information about the harmfulness of the individual urinary lifts, urotoxins, uremia lifts or kidney toxins. [11]

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Even today, detailed tables are missed in the current specialist literature on the concentration -dependent undesirable effects of the individual kidney toxins.

Clinically, the focus is on a therapy -resistant itching ( Uremic pruritus [twelfth] ) as well as the signs of enterocolitis. This often goes hand in hand with problems of the gastrointestinal tract such as nausea, vomiting and bleeding through gastric mucosal inflammation (gastritis) and intestinal inflammation (colitis). Uremia can cause a pericardium, which can cause a perican truck audible with the stethoscope. As a complication, heart failure (heart failure) can arise. In the further course of the disease, hyperkalaemia (consumption of potassium) can arise with subsequent cardiac arrhythmias. Lung edema (“water in the lung”) with shortness of breath and central cyanosis (violet to bluish discoloration of the skin, the mucous membranes, lips and/or fingernails) occurs in some cases.

Since urea can damage nerves in higher concentrations, it can lead to neurological disorders such as the Uremic encephalopathy [13] (Salicous changes in the brain) come, which can range from personality changes, sleep disorders, excessiveness and a slowdown to a coma. Peripheral nerves can also be disturbed, which is clinical as polyneuropathy (disease of the entire external nervous system). Hematopoiesis (blood formation) is also disturbed, which leads to anemia (anemia). The smell of the breathing air according to urine is striking ( Foetor Uremicus ) – But it only appears when urea -containing bacteria are located in the mouth.

Uremia as a clinical picture usually consists of chronic renal failure in stage IV, the treatment of which serves to improve the uremia. Therapeutically, the focus is on improving kidney function. In chronic renal failure, ACE inhibitors, AT1 antagonists and other antihypertensives such as calcium antagonists and beta blockers are used.

The popularly known as “blood laundry” and for the first time in 1924 in Gießen by Georg Haas on humans [14] Performed dialysis (as hemodialysis, hemofiltration or peritoneal dialysis [15] ) represents a therapy option for advanced renal insufficiency and is established at the creatinine value, the urea concentration in the serum, the serum potassium, calcium and phosphate and the clinical symptoms.

In addition, a strict diet has been prescribed so far. B. to avoid an excessive protein, potassium (by fruit juices, fruit) and phosphate wear (by cola, pizza). However, current studies provide both the value of a strict restriction of the protein intake [16] as well as the value of a low -phosphate diet [17] In question.

In the The extra scenery Urämie As an alternative to kidney replacement therapy, in addition to the treatment of the underlying diseases, the use of diuretic means (diuretics) is also possible. All diuretics reduce the tubular reversing resorption and thus enlarge the education rate of the secondary harp with the appropriate excretion, also of uremy oxins.

In the event of a pathologically increased formation of uremia oxins, an attempt must be made to reduce this overproduction by a corresponding diet, with medication or with other procedures.

  • Walter H. Hörl: Uremia – what is that . In: Nephro-News . No. 5/10 , 2010, S. 1–8 ( Medicom.cc ).
  1. ↑ Alphabetical directory for the ICD-10-WHO version 2019, Volume 3. German Institute for Medical Documentation and Information (Dimdi), Cologne, 2019, p. 912
  2. ↑ Franz persevere: The double -sided hematogenic kidney diseases (Brighte disease) . 1st edition. Springer-Verlag, Berlin / Heidelberg 1918, 576 pages plus attachment, imprint from L. Mohr, Rudolf Staehelin (ed.): Handbook of internal medicine . 3. Band, irb. 978-3/662-42272-4, P .. 168-258.
  3. ↑ H. Straub, K. Beckmann: General pathology of water and salt metabolism and urine preparation . In: Textbook of internal medicine . 2nd volume. 4th edition. Verlag of Julius Springer, Berlin 1939, p. 50.
  4. ↑ H. Straub, K. Beckmann: General pathology of water and salt metabolism and urine preparation , in: Textbook of internal medicine , 4th edition, Springer-Verlag, 2 volumes, Volume 2, Berlin 1939, p. 51.
  5. ↑ Wilhelm Nonnenbruch: The double -sided kidney diseases – Brightii’s disease , Ferdinand Enke Verlag, Stuttgart 1949, p. 128.
  6. ↑ Handbook of international statistical classification of diseases, health damage and causes of death , Editor: Federal Statistical Office, Wiesbaden 1953, Volume 3: Detailed German systematics , Pp. 76 and 96.
  7. ↑ Bernd Graubner: German Institute for Medical Documentation and Information (Dimdi): Alphabetical directory ICD-10-GM 2013 , 10th revision, version 2013, Deutscher Ärzte-Verlag, Cologne 2013, ISBN 978-3-7691-3509-1, p. 1206.
  8. ↑ Franz persevere: The double -sided hematogenic kidney disease . In: Gustav von Bergmann, Rudolf Staehelin (ed.): Handbook of internal medicine , 2nd edition, Springer-Verlag, Berlin, Heidelberg 1931, Volume 6, pp. 195 and 723.
  9. ↑ Carl Anton Ewald: Keyword Kidney inflammation , in: Real-Encyclopedia of the entire medicine, publisher Urban & Schwarzenberg, 3rd edition, Volume 17, Vienna/ Berlin 1898, p. 214.
  10. ↑ Carl Anton Ewald: Keyword Kidney inflammation , in: Real-Encyclopedia of the entire medicine, publisher Urban & Schwarzenberg, 2nd edition, Volume 14, Vienna/ Leipzig 1888, p. 386.
  11. ↑ Isidor Albu: Keyword “Harling” in Volume XXXI of the Real-Encyclopedia of the entire medicine, Verlag Urban & Schwarzenberg, 9th year of the Encyclopedic yearbooks , Berlin/ Vienna 1900, pp. 171–176.
  12. ↑ Gerd Herold: Internal medicine 2020 , Self-published, Cologne 2019, ISBN 978-3-9814660-9-6, p. 642.
  13. ↑ Gerd Herold: Internal medicine 2020 , Self-published, Cologne 2019, ISBN 978-3-9814660-9-6, p. 642.
  14. ↑ Jost bless: The early history of the artificial kidney. In: Ains. Anesthesiology intensive medicine emergency medicine pain therapy. Band 38, Nr. 11, November 2003, S. 681-688.
  15. ↑ Amitava Majumder, Anne Paschen: Medical working techniques. In: Jörg Braun, Roland Preuss (ed.): Intensive care of the clinic guide. 9. Edition. Elsevier, Munich 2016, ISBN 978-3-437-23763-8, pp. 29–93, here: pp. 62–66 ( Dialysis procedure ).
  16. ↑ Bruno Cianciaruso, u. a .: Effect of a low- versus moderate-protein diet on progression of CKD: follow-up of a randomized controlled trial . In: American Journal of Kidney Diseases . Band 54 , No. 6 , December 2009, ISSN 1523-6838 , S. 1052–1061 , doi: 10.1053/j.ajkd.2009.07.021 , PMID 19800722 .
  17. ↑ Steven M. Brunelli: The Association between Prescribed Dietary Phosphate Restriction and Mortality among Hemodialysis Patients . In: Cjasn . Electronic publication before printing; December 2010, 2011 ( Article ).
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