Uremia (Uremic Syndrome): An Overview

Medically Reviewed by Jabeen Begum, MD on February 29, 2024
Written by Matt Smith, Kendall K. Morgan
7 min read

When you have uremia, your kidneys won't filter waste and extra fluid from your blood and get rid of them through urine the way they should. As a result, those things stay in your blood and can be toxic. This condition is sometimes called uremic syndrome because of all the effects it can have throughout your body.

Usually if you have uremia, it means that your kidneys are failing from chronic kidney disease or end-stage renal disease. This can happen because of a long-running health problem, like diabetes or high blood pressure, or because a severe injury or an infection damages your kidneys. You're more likely to get uremia if you don't start dialysis after your kidneys stop working. 

Uremia vs. uremic syndrome

These names are sometimes used interchangeably. But uremic syndrome refers to all the signs and symptoms that you may have when untreated chronic kidney disease leads to uremia. The wastes in your blood can affect other organs and your metabolism in many complex ways.

Uremia vs. hemolytic uremic syndrome

Hemolytic uremic syndrome happens when your small blood vessels get damaged and clots form in them. Those clots can hurt your kidney or other organs and lead to kidney failure. Different things can cause this, but it usually happens when young children get an infection with E. coli bacteria.

Uremia vs. azotemia

Both of these conditions affect your kidneys. When you have azotemia, you'll have too much nitrogen and other waste in your blood. It most often happens when there isn't enough blood flowing through your kidneys from blockages, blood loss, dehydration, heart failure, liver failure, or taking certain medicines. Treatment for azotemia depends on the cause, but it may include IV fluids or stents to restore blood flow to the kidneys. When you have uremia, you'll have too much waste in your blood also. But uremia most often happens when your kidneys stop working from chronic disease and not because of a problem with blood flow.

The first thing you'll probably notice is that you feel nauseated and may vomit. You won't feel like eating. It might be mild at first and then get worse. Or you may notice it only after you start eating. 

As waste and fluid build up in your blood, you might:

  • Feel nauseated
  • Feel itchy
  • Lose your appetite or taste for some foods
  • Have a taste in your mouth that reminds you of metal
  • Feel more tired than usual
  • Feel short of breath
  • Lose weight without knowing why
  • Have trouble concentrating, thinking, or remembering
  • Have swelling in the feet
  • Feel pain, numbness, or cramps in your legs or feet (caused by damage to your nerves)

If it’s not treated, uremia can also cause other problems, including:

  • Breath that smells like pee
  • Yellow-white crystals on your skin after you sweat
  • Chest pain from inflammation in your heart lining (pericarditis)
  • Seizures
  • Coma

Kidney failure is the main cause. Anything that makes your kidneys stop working can lead to uremia as waste builds up in your body. Two of the most common reasons this happens are that you have diabetes or high blood pressure. But you're also more likely to get uremia if you aren't getting the treatment you need after your kidneys stop working. This could happen because you have chronic kidney disease and kidney failure and don't know it or for other reasons.

If your doctor thinks you might have uremia, they may recommend that you see a kidney specialist, called a nephrologist. They can do a few tests to see how well your kidneys are working:

Blood tests. These measure certain things in your blood, including a chemical called creatinine and a waste product called urea. Based on how much creatinine is there, your doctor can use a formula to figure out your estimated glomerular filtration rate (eGFR). This will show how much blood your kidneys can clean every minute. The lower the number, the more damaged your kidneys are.

Urinalysis. Your doctor will take a sample of your pee to look for things like blood cells or proteins that shouldn’t be there if your kidneys are working well.

Imaging. If tests show your kidneys aren't working well or you have uremia, your doctor may order more tests to look at your kidneys and try to see why they aren't working. They'll check the size and shape of your kidneys and whether they're scarred. They also can look to see if anything is blocking your kidneys, such as kidney stones, or if your kidneys are injured.

You're more likely to have uremia if your kidneys aren't working and you aren't getting dialysis to filter waste out of your blood. Anything that increases your risk for chronic kidney disease and kidney failure will make uremia more likely. These include:

  • Diabetes
  • High blood pressure
  • Heart disease
  • Smoking
  • Obesity
  • Family history
  • Abnormal kidneys
  • Old age
  • Race or ethnicity
  • Taking medicines that can hurt your kidneys

When your kidneys are failing such that you have uremia, you'll need help getting waste out of your blood. The most common treatment is dialysis, which cleans your blood. You'll most likely have your blood pumped through a machine that filters it and sends it back into your body. It can take several hours, and most people who need the treatment need to have it done three times a week at a medical center. However, it can be done at home too. This type of dialysis is called hemodialysis.

About 10% of people who need dialysis use a different kind, called peritoneal dialysis. With this, the space around the organs in your belly is filled with a fluid that draws wastes out. The fluid is then drained out through a tube in your belly. This can be done at home but still needs to be done regularly.

If your problem is caused by end-stage kidney failure, you’ll probably need dialysis for the rest of your life, unless you get a kidney from a donor. You can get a kidney from someone who is living or deceased. Ask your doctor if a kidney transplant is something you should consider.

There's no medicine you can take for uremia. But your doctor may suggest treatments to help with its other effects or with related conditions, including anemia, bone disease, high blood pressure, or heart disease. 

Uremia can come with many complications affecting your:

  • Blood
  • Bones
  • Heart
  • Brain

Complications may include:

  • Anemia (low red cell counts)
  • Bleeding too much
  • Bone problems
  • Fluid around your heart
  • Inflammation in your heart lining
  • Changes in brain function (uremic encephalopathy)
  • Hiccups
  • Twitching or feeling restless
  • Seizures
  • Coma

In addition, uremia may make it harder for you to get pregnant. It can also keep you from getting enough nutrients, leading to malnutrition.

The best way to prevent uremia is to take steps to prevent worsening kidney disease or kidney failure, such as:

  • Seeing your doctors and following their advice
  • Managing other health problems, including high blood pressure and diabetes
  • Taking your medicine
  • Avoiding medicines, drugs, or alcohol that can hurt your kidneys
  • Eating a diet that's good for your heart and low in salt
  • Exercising
  • Sticking to a healthy weight
  • Not smoking

If you already have advanced kidney disease or kidney failure, you can prevent uremia by getting dialysis regularly or having a kidney transplant. 

Uremia happens when your kidneys can't filter waste from your blood anymore and you aren't getting dialysis to remove the wastes either. The extra wastes and toxins can cause lots of health problems and can even lead to coma or death when kidney failure is severe and untreated. If you are worried you have uremia or may be at risk for uremia, see a kidney specialist or nephrologist for testing and dialysis if needed to replace your lost kidney function.

  • What is my outlook if I have uremia?

If you have uremia, you'll need to see your doctor regularly for monitoring and treatment. You'll need dialysis to remove the wastes from your system that your kidneys no longer can. Without dialysis, uremia can cause many serious symptoms and can even be deadly.

  • How long can I live with uremia?

If you have uremia and get dialysis, you can live a long time. You may also consider a kidney transplant instead of regular dialysis. If your kidneys have failed and you don't get dialysis or a transplant, you could die within a week. Sometimes people may choose not to treat uremia if they have a fatal illness. In that case, your doctor can help you treat the symptoms.

  • What is uremic syndrome of the kidneys?

Uremic syndrome includes the uremia or increase in toxins and fluid in your blood along with its other effects throughout your body. This can include abnormal function in multiple organs. You may also have changes in your gut bacteria. Uremia can affect how your body absorbs medicines and breaks down food, among other changes.

  • What is the difference between uremia and uremic syndrome?

Uremia is the buildup of urea and other wastes in your blood that normally should get filtered out by your kidneys. Uremic syndrome includes all the many symptoms and changes throughout your body that can happen when you have uremia.