The Uremic Syndrome

Pericardial effusion Pericardial effusion, occasionally with tamponade, has occurred in approximately 3% of treated patients not on dialysis, especially those with inadequate or compromised renal function. Many cases were associated with connective tissue disease, the uremic syndrome, CHF or fluid retention, but were instances in which these potential causes of effusion were not present. Observe patients closely for signs of pericardial disorder. Perform echocardiographic studies if suspicion arises. More vigorous diuretic therapy, dialysis, pericardiocentesis, or surgery may be required. If the effusion persists, consider drug withdrawal. 

W. H. Horl, Genesis of the Uremic Syndrome Role of Uremic Toxins(Editorial), Wien Klinik Wochenschrift 110 (1998) 511-520. 

Diseases of the kidney that are discussed in this section include (1) the uremic syndrome, (2) chronic kidney disease, (3) end-stage renal disease, (4) diabetic nephropathy, (5) hypertensive nephropathy, (6) glomerular diseases, (7) interstitial nephritis, (8) polycystic Iddney disease, (9) polycystic kidney disease, (10) toxic nephropathy, (11) obstructive uropathy, (12) tubular diseases, (13) renal calculi, and (14) cystinuria. In addition, this section also includes discussions on (1) prostaglandins and NS AIDS in kidney disease, (2) monoclonal light chains and kidney disease, and (3) urinary osmolality. 

In addition to the consequences of reduced excretory, regulatory, and endocrine function of the kidneys, the uremic syndrome has several systemic manifestations—among them pericarditis, pleuritis, disordered platelet and granulocyte function, and encephalopathy— that have been difficult to explain. 

Bakir A, Wilhams RH, Shaykh M, Dunea G, Dubin A. Biochemistry of the uremic syndrome. Adv Clin Chem 1992 29 61-120. 

Siddiqui, J., Freeburger, R., and Freeman, R. M., Folic acid, hypersegmented polymorphonuclear leukocytes and the uremic syndrome. Am. J. Clin. Nutr. 23, 11-16 (1970). 

Many investigators, indeed, have objected to the very concept of a specific toxin, arguing that the uremic syndrome represents the sum total of all the perturbations caused by renal failure. Increasingly clinicians have come to appreciate... 

Urea is a waste product, so after it is produced by the liver the kidneys must excrete it. Whenever there is impairment of urine excretion or formation, urea will accumulate in the patient s blood, leading to uremia. The blood nitrogen levels are of considerable importance in medicine, not only because their determination is invaluable for the diagnosis and prognosis of renal insufficiency, but also because they indicate the presence of the uremic syndrome. 

Congestive heart failure often occurs in conjunction with uremia. A number of factors—such as hypertension, arteriosclerosis, and anemia—may contribute to the heart failure, but more specific to the uremic syndrome is the increased intravascular volume and plasma volume that appear in uremics. Whether blood urea accumulation causes metabolic alterations of the heart muscles and results in myocardial malfunction remains to be established. 

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