Azotemia

Azotemia is a serious renal condition marked by low urine flow, rapid heartbeat, vomiting and a host of other problems. Read on to know all about this disease, its possible causes, symptoms, treatment options and more.

Azotemia Definition

It is a disorder marked by the presence of unusually high level of compounds such as creatinine and urea that contain nitrogen.

Azotemia Types

Based on its origin or underlying cause, this disease is classified into three types. Although distinct, these types have a few features that are common.

The three main types of this condition are:

Prerenal Azotemia

It is marked by the presence of high amounts of nitrogen-containing compounds in the bloodstream resulting from limited flow of blood to the kidneys. It may also occur as a result of low blood pressure and irregular pumping action of the heart.

Primary Renal Azotemia

It is also referred to as Intra-renal Azotemia. It is characterized by an elevation in the level of nitrogen-rich compounds in blood, usually due to damaged kidneys. This type of the condition may also arise as a consequence of conditions like Pyleonephritis and diabetes.

This form has also been found to result from the use of some drugs, like Mitomycin, Cisplatin and Gentamycin. If taken in excessive amounts, these medications may cause degeneration and degradation of the linings of the kidney. This can automatically heighten the risk of development of this disorder.

Postrenal Azotemia

The disorder leads to an elevation in the level of nitrogen-rich compounds in blood due to obstruction in the pathways within the kidney. This obstruction may occur in the urethra or ureters. In some cases, the blockage may also be observed in the pathways through the bladder.

This type commonly arises due to kidney stones. Development of stones is the cause of obstruction in the kidneys. This form of the disorder also results from enlargement of the prostate gland (in men) and swelling of the kidneys (in both sexes).

All three types of this disorder can lead to a dangerous elevation in the amount of blood urea nitrogen (BUN) and various other compounds that are discharged into the urine.

Azotemia Causes

The disorder is mainly associated to inadequate filtering of blood from the body by the kidneys.  In healthy individuals, the kidneys expel waste products from the body in the form of urine and filter blood. However, in some people, the organs are unable to remove creatinine, urea and other nitrogenous compounds from the blood adequately. This improper functioning of the kidneys may arise as a result of:

• Low blood pressure
• Irregular cardiac pumping action
• Use of certain drugs
• Kidney stones
• Damage to the kidneys

Azotemia Symptoms

The nitrogenous compounds, the presence of which gives rise to this disorder, are quite toxic in form. Naturally, an accumulation of these substances in the body gives rise to a number of health issues in sufferers.

The symptoms of this condition tend to vary from one sufferer to another based on the type of the disorder that a person is having. Generally, an individual with any of the three forms of the disease suffers from problems like:

• Rapid heart rate
• Elevated blood pressure
• Fatigue, even during rest
• Frequent vomiting
• Loss of appetite
• Mental confusion
• Reddish or blackish urine
• Lightheadedness
• Reduced urinary output

There can also be paleness of skin and inflammation of joints. Some affected individuals experience pain and tenderness in the lower back and the abdomen. Inflammation near the elbows and the ankles can be an indication of excessive buildup of nitrogen-rich compounds in the bloodstream of patients.

The condition often has an acute onset. In other words, the symptoms arise all of a sudden although certain cases          tend to worsen progressively over a course of several weeks or even months.

Azotemia Diagnosis

A person experiencing more than one symptom mentioned above should get in touch with a physician without any delay. Doctors typically carry out a physical examination of suspected patients and also ask them about the health issues that they are experiencing. In most cases, blood and urine samples are collected and sent to laboratory for analysis. Detection of low levels of nitrogen in urine samples and high levels of BUN in blood samples can confirm the presence of Azotemia.

In some cases, imaging tests are conducted as a part of additional diagnosis. Such exams, like sonograms, can be assistive to physicians in pinpointing the underlying cause of problems in the kidney.

Azotemia Differential Diagnosis

The differential diagnosis of this disorder should aim at making sure that the symptoms experienced by patients are a consequence of Azotemia and not of other similar conditions like:

• Acute Tubular Necrosis
• Uremia
• Nephritis, Interstitial
• Obstructed Megaureter
• Glomerulonephritis, Chronic
• Chronic Renal Failure
• Glomerulonephritis, Acute

Doctors should also take other factors into consideration that can cause an increase in the levels of creatinine or BUN. These involve:

• Gastrointestinal hemorrhage
• Ketoacidosis
• Large protein meal
• Steroids
• Total parenteral nutrition

Azotemia Treatment

The disorder is commonly treated with the prescription drug Amifostine. This drug helps lower the ill-effects resulting from the use of Mitomycin and Cisplatin and thus, decreases the possibility of the development of Azotemia. However, this treatment option can only be useful when there is risk of development of Primary Renal Azotemia due to the usage of the medications mentioned above.

Other common treatment measures for this disease include use of insulin and administration of loop diuretic drugs. These are useful in preventing the buildup of nitrogenous compounds in the bloodstream of sufferers.

People affected with this disorder are often at risk of being dehydrated. This is countered by hospitalizing such individuals and administering them with intravenous fluids. If an Intrarenal form is detected, physicians should make use of a dialysis machine to take over the process of blood filtration temporarily (to compensate for the improper functioning of the kidneys) and assessing the underlying cause of the renal problems.

Azotemia Prognosis

Many individuals affected with prerenal and postrenal forms of Azotemia manage to recover with drugs that reduce swelling, regulate blood pressure and open narrowed blood vessels. In case medicines fail to remove an obstruction or if there is a complete impairment of the kidneys, operative procedures may be required.

Azotemia in Dogs

In dogs, this condition is manifested by symptoms like:

• Dehydration
• Weakness
• Uremic breath
• Stupor
• Hypersalivation
• Ataxia
• Poor quality of coat
• Uremic stomatitis

The outcome depends on the underlying cause of the disorder. Complete recovery is possible if pre-renal and post-renal forms are effectively managed. However, if acute enough or if left untreated for a long time, the conditions can cause permanent damage to the kidneys.

Azotemia Vs Uremia

Azotemia is often confused with Uremia, although the two are completely distinct conditions. Azotemia is characterized by an increase in the levels of serum creatinine and Blood Urea Nitrogen (BUN). Uremia, on the other hand, is marked by the abnormal retention of urine and other waste matters and nitrogenous wastes (urea) in the bloodstream.

Azotemia Complications

All three forms of this disorder can give rise to various complications, which can be life-threatening for sufferers. In the Prerenal form, conditions such as atherosclerosis may arise – characterized by reduced flow of blood to the kidneys. The Intrarenal form is basically kidney failure as the kidneys are impaired in themselves. The Postrenal form arises due to obstructed flow of urine following discharge of waste materials from the kidneys.

It is essential to visit a doctor and seek immediate professional medical care in case of manifestation of more than one symptoms of Azotemia. As aforesaid, this is a dangerous condition that can give rise to fatal complications in sufferers. Naturally, timely treatment and proper management is essential to cure this disorder in time and increase the chances of a swift recovery for patients.

References:

Organ Failure: Deaths from Organ Failure, Heart Failure, Renal Failure, Chronic Kidney Disease, Acute Liver Failure, Paul Tsongas by Books, LLC

The Washington Manual of Nephrology Subspecialty Consult by Steven Cheng and Anitha Vijayan.