Differences Between Azotemia and Uremia

Will is a 68-year-old male with a history of hypertension. Eight months ago, he started regular dialysis therapy for ESRD. Before that, his physician was closely monitoring his condition because he had polyuria and nocturia. Soon it became difficult to manage his hypertension. He also lost his appetite, became weak, easily fatigued, and had edema around his ankles. Will debated with his physician about starting dialysis, but she insisted, before the signs and symptoms of uremia increased, the treatment was absolutely necessary (Chapter 34, Learning Objectives 1 to 4).

1. What is the difference between azotemia and uremia?
2. Two years ago, Will’s physician told him to decrease his protein intake. In spite of what the physician ordered, Will could not stop having chicken, beef, pork, or eggs at least once a day. Why did his physician warn him about his diet?
3. Will’s feelings of weakness and fatigue are symptoms of anemia. Why is he anemic?
4. Knowing what you do about Will’s history, why is left ventricular dysfunction a concern for his physician?

Instructions:

1. Your primary post should be at least 200 words long and should include reference to the textbook or another course resource using APA 7th edition format.

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Answer

Differences Between Azotemia and Uremia

Azotemia and uremia are related to the buildup of nitrogenous wastes in the blood due to kidney dysfunction, but they differ in severity and symptom presentation. Azotemia is an early stage where there is an accumulation of nitrogen waste products, like blood urea nitrogen (BUN) and creatinine, in the blood, with minimal or no symptoms. Uremia is a more advanced stage, indicating severe kidney failure, where waste accumulation leads to a range of symptoms, including fatigue, nausea, anorexia, and cognitive changes (McCance & Huether, 2019).

Importance of Protein Restriction

Will’s physician advised him to limit his protein intake due to his kidney disease. High-protein diets increase the production of nitrogenous waste, which can exacerbate kidney workload and worsen renal function in individuals with ESRD. Excessive protein intake increases urea production, which the kidneys struggle to filter efficiently, leading to greater retention of waste products. Reducing protein intake helps manage symptoms of uremia and delays kidney disease progression (McCance & Huether, 2019). Differences Between Azotemia and Uremia

Anemia in Kidney Disease

Will’s weakness and fatigue are symptoms of anemia, which is common in patients with ESRD. Healthy kidneys produce erythropoietin, a hormone that stimulates red blood cell production in the bone marrow. As kidney function declines, erythropoietin production decreases, resulting in reduced red blood cell counts and anemia. Dialysis does not replace erythropoietin production, so anemia persists unless treated with synthetic erythropoietin (Levey et al., 2017).

Concern for Left Ventricular Dysfunction

Left ventricular dysfunction is a significant concern for Will’s physician due to the relationship between kidney disease and cardiovascular health. In patients with ESRD, hypertension, fluid overload, and anemia increase the workload on the heart, leading to left ventricular hypertrophy and dysfunction. This can eventually progress to heart failure, a leading cause of mortality in ESRD patients (McCance & Huether, 2019). Monitoring and managing Will’s cardiovascular health is crucial to improving his overall prognosis.

References

McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier.

Levey, A. S., Coresh, J., & Balk, E. (2017). National Kidney Foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Annals of Internal Medicine, 139(2), 137–147. https://doi.org/10.7326/0003-4819-139-2-200307150