UREMIA

toxic effects of abnormally high concentrations of nitrogenous substances in the blood as a result of the kidney's failure to expel these waste products by way of the urine. The end products of protein metabolism accumulate in the blood but are normally filtered out when the blood passes through the kidneys. Uremia can result from any disorder that impairs the functioning of the kidneys or that hinders the excretion of urine from the body. The symptoms of uremia are diverse. Fatigue, lassitude, and a loss of mental concentration are among the first signs. The patient may experience persistent itching sensations, along with muscle twitching or other involuntary movements. The skin becomes dry, flaky, and turns yellowish to tan. The mouth has a dry metallic taste, and the breath has a distinct ammonialike odour. Loss of appetite progresses to nausea and vomiting, and episodes of diarrhea and constipation are common. In the more serious stages of uremia, the buildup of waste products in the bloodstream and tissues causes a wide-ranging derangement of the nervous, cardiovascular, and respiratory systems and can lead to hypertension, convulsions, heart failure, and death. The chief cause of uremia is damage to the kidneys, whether because of Bright's disease (glomerulonephritis), hypertension (high blood pressure), diabetes mellitus, or some other disorder that impairs kidney function. Blockages of the flow of urine due to urinary stones or, in males, enlarged prostate glands can also cause uremia. The treatment of uremia rests on the identification and treatment of the disorder that is the underlying cause. Patients whose kidneys are diseased and who are waiting for kidney transplants often suffer varying degrees of uremia. In these cases uremia, along with other syndromes due to renal insufficiency, is best treated by dialysisi.e., the artificial filtering of the blood by a machine outside the body.