The Pathophysiology of Uremia

Meyer, Timothy W.; Hostetter, Thomas H.

doi:10.1016/b978-1-4160-6193-9.10053-3

Cited by 6 publications

(5 citation statements)

References 277 publications

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“…At moderate serum urea levels (21.4 mmol/L) these factors do not appear to elicit ureamic symptoms in isolation from severely impaired kidney function [13]. …”

Section: Discussionmentioning

confidence: 99%

An isolated elevation in blood urea level is not ‘uraemia’ and not an indication for renal replacement therapy in the ICU

Mackenzie

Chacko

2017

Crit Care

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The decision to initiate renal replacement therapy (RRT) and the optimal timing for commencement is a difficult decision faced by clinicians when treating acute kidney injury (AKI) in the intensive care setting. Without clinically significant ureamic symptoms or emergent indications (electrolyte abnormalities, volume overload) the timing of RRT initiation remains contentious and inconsistent across health providers. Current trends of initiating RRT in the ICU are often based on isolated blood urea levels without clear guidelines demonstrating an upper limit for treatment. Although the appropriate upper limit remains unclear, it is reasonable to conclude that a blood urea level less than 40 mmol/L is not in itself an indication for RRT, especially in the absence of supporting evidence of kidney impairment (anuria, elevated serum creatinine), presenting a welcome reminder to treat the patient and not a number.

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“…At moderate serum urea levels (21.4 mmol/L) these factors do not appear to elicit ureamic symptoms in isolation from severely impaired kidney function [13]. …”

Section: Discussionmentioning

confidence: 99%

An isolated elevation in blood urea level is not ‘uraemia’ and not an indication for renal replacement therapy in the ICU

Mackenzie

Chacko

2017

Crit Care

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“…Gut dysbiosis itself plays a role in CKD progression and it is starting to be recognized as a nontraditional factor for CV risk in CKD patients [31]. For example, gut microbiome-produced metabolic compounds, such as indoxyl sulfate, p-cresol sulfate, and trimethylamine N-oxide (TMAO), are associated with the promotion of CV events [3,18,[83][84][85][86]. Uremia is also associated to immune dysfunction characterized by immunodepression in CKD patients, contributing to a high prevalence of infections, increased inflammation and CV risk; for a review see [87].…”

Section: The Microbiome In Ckdmentioning

confidence: 99%

The microbiome in chronic kidney disease patients undergoing hemodialysis and peritoneal dialysis

Simões-Silva

Araújo

Pestana

et al. 2018

Pharmacological Research

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Chronic kidney disease (CKD) is associated with an imbalanced human microbiome due not only to CKD-associated factors such as uremia, increased inflammation and immunosuppression, but also to pharmacological therapies and dietary restrictions. End-stage renal disease patients require renal replacement therapies commonly in the form of hemodialysis (HD) or peritoneal dialysis (PD). HD implies the existence of a vascular access, such as an arteriovenous fistula/graft or a venous catheter, whereas PD implies a long-term peritoneal catheter and the constant inflow of peritoneal dialysate. Also, dietary adaptations are mandatory in both therapies. This revision explores the impact of HD or PD therapies on human microbiome. HD and PD appear to be associated with different changes in the gut microbiome, for example a decrease in Proteobacteria relative abundance in HD patients and increase in PD patients. Both therapies may also have an impact on the human microbiome beyond the gut, leading to increased relative abundance of specific bacteria in the blood microbiome of HD patients and increased relative abundance of other bacteria in the peritoneal microbiome of PD patients. HD and PD catheter biofilms may also play an important role in the changes observed in these microbiomes. A more interdisciplinary approach is needed to further clarify the role of microbial groups other than bacteria in all body habitats to allow the complete understanding of the impact of HD or PD on the microbiome of CKD patients. Moreover, strategies that promote a healthy balance of the human microbiome on these patients should be explored.

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“…It has also been suggested that indoxyl sulfate is toxic to renal tubular cells, while increased indoxyl sulfate levels accelerate the progression of renal disease [ 17 ]. Thus, the produced physiologically active metabolites may be linked to the patient’s altered mental state during bacteriuria.…”

Section: Discussionmentioning

confidence: 99%

Purple Urine Bag Syndrome in a Home-Dwelling Elderly Female with Lumbar Compression Fracture: A Case Report

et al. 2023

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Purple urine bag syndrome (PUBS) is an uncommon, but usually benign, underrecognized clinical condition with the distressing presentation of purple, blue or reddish discoloration of a patient’s catheter bag and tubing in the setting of catheter-associated urinary tract infections (UTIs). PUBS is the result of the complex metabolic pathway of the dietary essential amino acid tryptophan. Its urinary metabolite, indoxyl sulfate, is converted into red and blue byproducts (indirubin and indigo) in the presence of the bacterial enzymes indoxyl sulfatase and phosphatase. The typical predisposing factors are numerous and include the following: female gender, advanced age, long-term catheterization and immobilization, constipation, institutionalization, dementia, increased dietary intake of tryptophan, chronic kidney disease, alkaline urine, and spinal cord injury (SCI). Here, we present a case of PUBS in a home-dwelling elderly female patient with a history of long-term immobility after a pathological spinal fracture, long-term catheterization, constipation, and malignant disease in remission. Urine culture was positive for Proteus mirabilis. This state can be alarming to both patients and physicians, even if the patient is asymptomatic. Healthcare professionals and caregivers need to be aware of this unusual syndrome as an indicator of bacteriuria in order to initiate proper diagnostics and treatment.

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The Pathophysiology of Uremia

Cited by 6 publications

References 277 publications

An isolated elevation in blood urea level is not ‘uraemia’ and not an indication for renal replacement therapy in the ICU

An isolated elevation in blood urea level is not ‘uraemia’ and not an indication for renal replacement therapy in the ICU

The microbiome in chronic kidney disease patients undergoing hemodialysis and peritoneal dialysis

Purple Urine Bag Syndrome in a Home-Dwelling Elderly Female with Lumbar Compression Fracture: A Case Report

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