Uremia is a syndrome in which kidney function declines to the point that symptoms may develop in multiple body systems
Manifestations of uremia vary among patients according to the cause of the kidney disease, co-morbid conditions, age, and degree of adherence to the prescribed medical regimen
Cultural and ethnic health disparities
Chronic kidney disease (CKD) has a high incidence in minority populations, especially African Americans and Native Americans.
Hypertension and diabetes mellitus are also more common in African Americans and Native Americans.
African Americans
The risk of CKD as a complication of hypertension is significantly increased in African Americans.
African Americans have the highest rate of CKD, nearly four times that of whites.
Native Americans
Native Americans have a rate of CKD twice that of whites.
The rate of CKD is six times higher among Native Americans with diabetes than among other ethnic groups with diabetes.
Hispanics
The rate of CKD in Hispanics is 1.5 times higher than in non-Hispanic whites.
Urinary system
In the early stages of CKD, patients usually do not report any change in urine output
Since diabetes is the primary cause of CKD, polyuria may be present, but not necessarily as a consequence of kidney disease
As CKD progresses, patients have increasing difficulty with fluid retention and require diuretic therapy
Anuria may develop after a period on dialysis
Metabolic Disturbances
Waste Product Accumulation.
As the GFR decreases, the BUN and serum creatinine levels increase.
The BUN is increased not only by kidney disease but also by protein intake, fever, corticosteroids, and catabolism.
For this reason, serum creatinine clearance determinations (calculated GFR) are considered more accurate indicators of kidney function than BUN or creatinine.
Significant elevations in BUN contribute to development of nausea, vomiting, lethargy, fatigue, impaired thought processes, and headaches.
Altered Carbohydrate Metabolism.
Defective carbohydrate metabolism is caused by impaired glucose metabolism, resulting from cellular insensitivity to the normal action of insulin.
Mild to moderate hyperglycemia and hyperinsulinemia may occur.
