What is urinary poisoning?
Urinary poisoning, also called uremia, is a build-up of toxic substances in the body that are normally excreted in the urine. It usually occurs as a result of acute or chronic kidney failure. The accumulation of these urinary, poisonous substances can lead to a large number of complaints as they can be deposited in all organs. Therapy consists primarily in treating the cause.
Also read the article on the topic: Urosepsis
In most cases, uremia occurs as a result of acute or chronic kidney failure. One or both kidneys can no longer function fully and cannot filter the urinary substances from the body into the urine. The concentration of these substances increases in the blood and is ultimately deposited in the various organs.
Read more on the topic: Chronic renal failure
Injuries to the kidney or tumors that cause the kidneys to lose their ability to produce urine can also lead to uremia. If several organs fail (multiple organ failure), for example in sepsis, urine poisoning often occurs. Even drugs that damage the kidneys can, in the worst case, lead to renal insufficiency and thus to uremia.
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The diagnosis of urinary poisoning is made by the doctor. In most cases, uremia is suspected based on the symptoms or previously known renal insufficiency. Blood is drawn from the patient to reinforce the suspicion. This is primarily a collection of urinary substances such as creatinine, urea, serum proteins, etc.
There is also a change in the composition of the electrolyte, i.e. the salts in the blood. Uremia leads to an increase in potassium and phosphate with a simultaneous decrease in calcium. In the case of severe uremia, there is also a change in the pH value, as the blood becomes more acidic. The pH value decreases, which is called acidosis.
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Urine poisoning can be recognized by these symptoms
Urine poisoning occurs gradually in most cases. A healthy patient does not suddenly suffer from urinary poisoning; most of the time, the patients are sick beforehand and have other symptoms. At the beginning of uremia, patients often complain of general symptoms such as tiredness, loss of appetite or headaches. These are the consequences of the deposition of urinary substances in the central nervous system. More typical signs of uremia are a uremic odor, similar to that of urine.
There may also be spots on the skin, so-called café-au-lait spots. These usually show up as grayish-yellow, irregularly limited discoloration all over the body, similar to that of a mole. One also speaks of a "dirty skin color". Another typical symptom is frequent itching of the skin. The deposition of the substances in the skin leads to unpleasant itching, the pruritus. The patients often show scratches.
Uremia can also trigger many other symptoms, depending on the organ in which the substances are deposited. It can lead to disorders of the eye function and deposits in the gastrointestinal tract, which cause nausea, vomiting or abdominal pain. Fluid retention (pulmonary edema) or inflammation (pleurisy) in the lungs can result. In the heart, inflammation of the pericardium (pericarditis) or high blood pressure (hypertension) are common consequences. It can also attack the cells in the blood and lead to an immune deficiency.
Find out more about the topic: Acute kidney failure
Treatment / therapy
The therapy of uremia consists in the first sense of treating the cause, i.e. in most cases renal insufficiency.
In acute renal insufficiency, medication can lead to rapid healing. These include in particular diuretics, which lead to increased excretion of water. With the water, urinary substances, such as urea and excess salts, are excreted. It is also important to protect the kidneys from damaging influences and, for example, to lower high blood pressure with antihypertensive drugs.
A low-protein, high-calorie diet can also be helpful. Urea is produced by the breakdown of proteins in the body. If less protein is consumed, less urea is formed. In addition, care should be taken to ensure a high fluid intake, but with careful control of the fluid balance. The absorbed fluid should also be excreted in similar quantities, as otherwise water retention (edema) can occur.
Immediate dialysis is the treatment of choice for severe urinary poisoning. The patients are connected to a machine through which all urinary substances are filtered out of the blood. If the uremia results in acidosis in the blood, the administration of bicarbonate is indicated. In very serious cases, a kidney transplant may be necessary if the kidney is permanently damaged.
In all cases, however, it is also true that the most important therapy is to avoid risk factors. In addition, the consumption of tobacco and the intake of kidney-damaging drugs as well as obesity should be reduced in order to prevent chronic kidney disease.
Duration / forecast
Uremia associated with acute or chronic renal insufficiency is a serious illness and can be life-threatening if left untreated. Immediate intensive therapy is indicated to prevent any consequences. As a rule, treatment also requires close monitoring in the hospital.
In young patients, good treatment can quickly cure kidney failure. Older or chronically ill patients usually require lifelong therapy and, in the end, often only kidney transplantation helps, but it often takes months to years to find a suitable donor kidney.
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