Uremic end stage renal disease is not an independent kidney disease but the final stage of chronic renal failure. End stage uremic renal disease is characterized by the accumulation of uremic wastes and toxins in the patients’ body as well as a series of metabolic disorders due to severely damaged kidney functions.
In this stage, more than 85% kidney functions have been lost and patients will develop a series of typical symptoms.
End stage kidney disease will have the accumulation of wasteful substances from protein metabolism which is called azotemia. These metabolic wastes and toxins include creatinine, urea, guanidio compounds, amino, indole, phenols as well as middle molecules and macromolecular wastes and toxins.
Elevated creatinine can cause hyperkalaemia, hyperuricemia, hyperlipidemia, hypoalbuminemia and metabolic acidosis, etc.
High urea can cause fatigue, loss of appetite, vomiting, difficulty in concentration, low body temperature, bleeding tendency, etc.
Under normal circumstances, arginine will be decomposed into urea, creatinine and guanidine acetic acid in the liver. The accumulation of urea and creatinine in ESRD will cause arginine being decomposed into methyl guanidine and guanidine arginine. Methyl guanidine is the most toxic small molecular substance and it can be 70-80 times higher than the normal value. It can cause loss of body weight, shorted life span of red blood cells, anemia, vomiting, diarrhea, drowsiness, etc.
Amine, fatty amine
They can cause flapping tremor, muscle cramps and hemolysis, etc.
Polyamines (spermine, cadaverine and putrescine)
They can cause loss of appetite, nausea, vomiting, proteinuria, etc. They can also promote erythrocytolysis, inhibit the secretion of erythropoietin resulting in and worsening renal anemia. They can also cause pulmonary edema, ascites and cerebral edema, etc.
Besides, end stage uremic renal disease patients will have a series of metabolic imbalances of sugar and fat as well as water, electrolytes and acid-base.
Low-protein diets are important for ESRD patient with uremic states. It can help alleviate uremic toxins in the body, improve nutritional state, slow down illness progression and protect residual kidney functions.
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