Uremic gastroenteropathy

Uremic gastroenteropathy is one of the late symptoms of uremia (Herold 2020).

Etiologically, uremia is based on chronic kidney disease (CKD) in the final stage (Herold 2020).

Uremic gastroenteropathy is caused by the toxic effect of urinary substances in the blood (Kuhlmann 2015).

Nowadays uremic gastroenteropathy is hardly ever observed in our latitudes (Herold 2020).

In uremic patients often occur:

• Gastritis
• ulcer disease
• Mucous membrane ulcerations in the area of the entire gastrointestinal tract (Kasper 2015)
• Gastroparesis (especially in cases of concomitant diabetes mellitus)
• Tendency to diverticulitis (caused by constipation) (Kuhlmann 2015)

Under adequate dialysis treatment, the following can occur:

• Surface gastritis
• atrophic gastritis
• Mucosal Hypertrophy
• Duodenitis
• However, infections with Helicobacter bacteria are not more frequent than in the general population (Keller 2010)

The patients often complain about:

• nausea
• Vomiting
• abdominal pains
• gastrointestinal bleeding
• Constipation (can be worsened by iron and calcium substitution) (Kasper 2015)
• Diarrhoea (cellar 2010)
• Anorexia
• Dysgeusia (metallic taste sensation through the decomposition of urea) (Kasper 2015)

Inspection: Foetor uraemicus (results from the decomposition of urea to ammonium in saliva) (Kasper 2015)

Bio-impedance method: The bio-impedance method (BIA) is used to estimate the fat-free mass in relation to the extracellular volume. This method is used particularly in Germany. In other countries the so-called "Dual- energy- x- ray- absorptiometry" (DEXA) is often used. (Kasper 2015)

Endoscopic diagnostics according to the symptoms

• CBC (normochromic, normocytic anemia) (Herold 2020).
• FGF 23 (Kassumeh 2016)
• Blood glucose determination and if necessary HbA1c- value
• Serum creatinine
• Calculate eGFR
• Iron
• Ferritin
• Transferrin saturation
• Vit. B 12
• Folic acid
• Blood gas analysis (metabolic acidosis may occur in advanced CKD)
• Potassium (risk of hyperkalemia)
• Chloride (risk of hyperchloremia, this can occur in early stages) (Kasper 2015)
• Calcium
• Serum phosphate determination (often there is hyperphosphatemia)
• Parathormone (possibly elevated)
• Vitamin D (Weckmann 2019)

• Urinalysis:
  • Proteinuria (Weckmann 2019)
  • Albuminuria (albuminuria is the most important risk factor for progression of CKD and for the development of cardiac risk [Herold 2020])
  • Hematuria (Weckmann 2019).
  • Protein determination in 24 h urine (Woolliscroft 2013)

Very rarely visceral amyloidosis can occur in long-term dialysis patients. This is beta2- microglobulin induced (Kuhlmann 2015).

The occurrence of uremic gastroenteropathy is an indication for dialysis or for optimizing the dialysis dose (Kasper 2015).

Dietetically, the restriction of protein can be helpful, especially with regard to nausea and vomiting. However, in order to avoid protein deficiency due to protein restriction, the patient should be advised by a dietician (Kasper 2015).

Patients with chronic kidney disease (CKD) should avoid ulcerogenic drugs such as:

• NSAID
• Steroids
• ASS (basement 2010)

1. Herold G et al (2020) Internal medicine. Herold Publisher S 642
2. Kasper D L et al (2015) Harrison's Principles of Internal Medicine. Mc Graw Hill Education S 2426
3. Kasper D L et al (2015) Harrison's Internal Medicine. Georg Thieme Publisher S 2234
4. Kassumeh S et al (2016) Nephrology and Rheumatology. Urban and Fischer Publishing House S 46 - 51
5. Keller C K et al (2010) Practice of nephrology. Springer Publishing House S 212 - 213
6. Kuhlmann U et al (2015) Nephrology: Pathophysiology - Clinic - Kidney replacement procedure. Thieme Publishing House S 445 - 446
7. Weckmann S et al. (2019) S 3- Guideline Care of patients with chronic non-dialysis-related kidney disease in general practice. AWMF register number: S 053 - 048
8. Woolliscroft J (2013) Diagnostic and therapeutic lexicon for the family doctor: The most important diseases from A - Z. Springer publishing house S 294 - 295