Talk:Uremia

Merge with azotemia?

According to Stedman's azotemia is a synonym for uremia.[1]

Since uremia is used much more commonly-- as suggested by Google (uremia=951,000 hits vs. azotemia=337,000 hits) and PubMed (uremia=22,139 hits vs. azotemia=1,764 hits) -- I think azotemia should be merged into uremia. Nephron  T|C 21:06, 1 January 2007 (UTC)

• SUPPORT - as per above. Nephron  T|C 21:06, 1 January 2007 (UTC)
• SUPPORT-absolutely-in fact both could redirect to renal failure, which is what they are both almost always used as synonyms for.Felix-felix 14:54, 2 January 2007 (UTC)
• I wouldnt merge them. All I know is that a nephrologist will jump down your throat if you use them interchangably. Uremia is the symptomatic manifestation of azotemia. —Preceding unsigned comment added by 75.180.4.194 (talk • contribs) 11:40, 16 January 2007 (UTC)

Speaking as a nephrologist, all the ones that I know quite happily interchange the terms, along with the more accurate term, renal failure.FelixFelix ^talk 23:14, 14 March 2007 (UTC)

• DO NOT SUPPORT-Agree with above. Azotemia is measured biochemically and uremia is a clinical diagnosis.65.95.117.45 16:19, 28 January 2007 (UTC)Ben
• DO NOT SUPPORT The two users above are correct, it is possible to be azotemic without any symptoms and therefore not uremic. —Preceding unsigned comment added by TheDoqtor (talk • contribs) 12:20, 30 January 2007 (UTC)
• DO NOT SUPPORT As said above.
• DO NOT SUPPORT Felix the nephrologist may use these terms interchangeably, but I know some nephrologists who would not be happy with the interchangeable use. User: Cteaton, a medical student.
• Support Granted, the two terms are not identical or to be interchanged, as discussed. However, I think that keeping the terms in the same article, possibly on the Renal failure page, would be the clearest way to address this (just my thoughts as I prepare to start a nephrology fellowship). —Gaff ^ταλκ 05:38, 4 June 2007 (UTC)

These are not synonymous terms. If they are merged into the same article, there must be CLEAR distinction. You will be misinforming people if these terms are used interchangeably.

Plan to close discussion & move

I did a longer search of the web for definitions of uremia and azotemia. I found four additional definitions that support the assertion that uremia and azotemia are the same: [2] [3] [4] [5]

Two sites suggest something a bit different-- something along the lines of:

"Azotemia: A higher than normal blood level of urea or other nitrogen containing compounds in the blood." [6] [7].

If one examines the etymology of azotemia it is: 'azote' = nitrogen + 'emia' = more [8]. Uremia likely has a similar etymology, i.e. urea + emia = uremia

It is my experience that the terms are used interchangably, in a clinical context (an assertion supported by Felix-Felix). Since, urea contains nitrogen it is fair to say that a uremia also constitutes an azotemia. Therefore, I think it would make sense to merge uremia into azotemia. (Technically speaking, I don't think merging in the opposite direction would be wrong (i.e. azotemia into uremia)-- as urea, AFAIK, is the body's way of packaging nitrogenous waste.)

I did NOT find anything to back-up the assertion made by Ben (65.95.117.45). Ben could you provide a reference for the above?

If no factual objection is presented to the above and Ben doesn't come forward with a reference I move to close the discussion in 10 days and merge (uremia into azotemia) on the basis of the above facts. Nephron  T|C 04:08, 15 March 2007 (UTC)

According to Kumar, Robbins and Cotrans Pathologic Basis of Disease 7th edition, "When azotemia becomes associated with a constellation of clinical signs and symptoms and biochemical abnormalities, it is termed uremia." With the exception of the #5 reference above, I don't feel that web dictionaries trump a medical textbook, and #5 is a website for patient information designed to make explanations of disease easier. Azotemia is distinct from uremia and it should be maintained as such on an encyclopedia site like this.TheDoqtor 14:06, 20 March 2007 (UTC)

I looked through Robbins & Cotrans; it suggests that azotemia is a biochemical abnormality whilst uremia is a biochemical abnormality + characteristic (clinical) symptoms. Interesting it that this contradicts some of the primary literature -- "THE KIDNEY IN CIRRHOSIS. I. CLINICAL AND BIOCHEMICAL FEATURES OF AZOTEMIA IN HEPATIC FAILURE." PMID 14128217. Robbins & Cotrans is a great book for pathology... but I'm not sure I'd crown it the authority on the terminology used by nephrologists and I, personally, have some reservations about how the section on renal pathology in the book is written. Nephron  T|C 23:10, 30 March 2007 (UTC)

The idea that imprecise terminology is prevalent does not render it correct. A great many physicians use the terms interchangably in many situations. Primary literature is indeed important, but while medical textbooks have the benefit of being edited many times over by a large body of contributors (7 editions for Robbins & Cotran), primary research articles are edited by a much more limited group, namely the scientists and physicians who did the study and their immediate associates. Furthermore, the purpose of the aformentioned study and many of the others previously cited is not to precisely define azotemia and uremia as is the case in an encyclopedia such as this site. I don't doubt that even many nephrologists use the terms interchangably as evidenced by FelixFelix above. However, the problem still remains that these terms are not exact synonyms. Ask any medical student who has recently taken a nephrology exam (or more preferably, the attending teaching that portion of the course) or resident who has used the term uremia and azotemia interchangably on the wards. Not every physician objects, but those that do, do so vehemently and have the accepted body of medical literature on their side. If doubt still remains in your mind, I will continue to cite more examples of why azotemia is not exactly the same as uremia, but the impeachement of Robbins and Cotran in favor of any primary research article whos purpose is not directly related to defining those two terms seems incorrect to me.TheDoqtor 23:35, 30 March 2007 (UTC)

According to Tintinalli's "Emergency Medicine," "Uremia should be viewed only as a clinical syndrome; no single symptom, sign, or laboratory test is reliable in diagnosing all aspects of uremia." The same book also specifies, "In 1840, Piorry was the first to use the term uremia, contamination of the blood with urine, to describe the clinical syndrome from ESRD. The concept that uremia is from an excretory failure resulting in toxin accumulation is reinforced by the continued use of the term azotemia, the buildup of blood nitrogen." Harrison's Internal Medicine states, "Azotemia refers to the retention of nitrogenous waste products as renal insufficiency develops. Uremia refers to the more advanced stages of progressive renal insufficiency when the complex, multiorgan system derangements become clinically manifest." We now have multiple medical texts differentiating azotemia and uremia. If more sources are needed, I will continue to find them. TheDoqtor 15:49, 31 March 2007 (UTC)

• I agree with you that uremia and azotemia are not synonymous. However, as it stands we have two rather stumpy stubs. Merging them together, incorporating the distinctions that you are drawing into the article text, may be the best way to make on good article rather than two stubs...I can tell that you feel strongly about clarifying the distinction between the two. I just wonder if it might not be better to have one article. —Gaff ^ταλκ 05:47, 4 June 2007 (UTC)

I support the merge into one article. Not because the terms are synonymous, but because they and the subject matter they describe are sufficiently close to be dealt with in one article (renal failure). I would also support differentiating the terms. In a sense both terms are wrong because uremia is a clinical diagnosis caused by a variety susbstances inadequately excreted in renal failure most of which are not measured directly but rather are correlated with elevated urea, ie why one patient may be clinically uremic and another not with the same plasma urea concentration. In the UK the term azotemia is in fact hardly used at all. A UK doctor82.42.229.254 19:55, 23 August 2007 (UTC)

add metallic taste

should be separate section for PE / Symptoms of uremia.

- also add metallic taste and please find reference. ty. 163.40.12.37 (talk) 23:44, 27 October 2010 (UTC)

Gout

The page on gout says it is sometimes a result of kidney failure, so for consistency shouldn't it be mentioned here? --zandperl (talk) 22:17, 17 November 2012 (UTC)

Tables and other additions

I'm just trying to get more on this page. Please don't just remove it. Try to make it fit. Starting to wonder if this page should be called uremic syndrome instead.Sion55 (talk) 20:59, 30 June 2014 (UTC)

GFR

The glomerular filtration rates units are listed as ml but I believe they should be in ml/min or ml/min/1.73m²

Outline

Sticking a brief outline below for guidance. Do what you will with it.Sion55 (talk) 19:40, 9 July 2014 (UTC)

• Introduction
• History-urea to when it was called that
• Signs and Symptoms
• Biochemical characteristics
  • solutes
  • toxins

(Its signs, symptoms, biochemical characterisics, solutes and toxins relate very closely. Would be nice if someone made them more streamline so they flow

• Causes
• Diagnosis