Azotemia

Notes
  • This is the accumulation of nitrogenous waste products (mainly Blood Urea Nitrogen, BUN) in the body as a result of loss of excretory functions of the kidneys

## Epidemiology and Statistics:

  • Normal range for BUN - 8 to 20mg/dL
  • Normal range for serum creatinine - 0.7 to 1.4 mg/dL

## Pathophysiologic states in azotemia are:

  • Prerenal azotemia (elevated BUN and creatinine levels due to problems in the systemic circulation that reduce renal flow e.g. shock, burns, severe diarrhea, severe bleeding, severe vomiting, severe dehydration, CHF, and renal artery embolism /occlusion). If prerenal azotemia is not corrected fast enough it can result to acute tubular necrosis and acute renal failure. It is the most common form of renal failure in hospitalized patients globally.
  • Intrarenal azotemia (elevated BUN and creatinine levels due to problems in kidneys e.g. Acute renal failure)
  • Postrenal azotemia (elevated BUN and creatinine levels due to obstruction in the collecting system)
Symptoms
  • Confusion
  • Fatigue
  • Pale skin color
  • Asterixis or flapping tremor
  • Thirst
  • Uremic frost
  • Elevated serum BUN and creatinine levels
  • Collapsed neck veins
  • Xerostomia
  • Oliguria or anuria
  • Hypotension
  • Bradycardia
  • Hypovolemia
  • Tachycardia
  • Low pulse pressure
Diagnosis
  • Clinical evaluation
  • Blood creatinine and BUN
  • Urinalysis
Differential
  • Consideration of various underlying causes
Prevention
  • Prevention and control of underlying cause(s)
Management
  • Treatment of the underlying cause(s)
  • Dialysis
  • Diet review
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