VA AM Report Pearls: My-remia? Ur-emia!

Hey team,

Great case today by Drs Motzkin and Rodriguez and Stetson, encephalopathy in an older man with a likely component of uremia.

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Above from NEJM review article 2007 on Uremia. Do you see BUN on that list? Me neither! The point is, BUN and creatinine (and cystatin-C) are all proxies for renal function, but we don’t measure all of the “uremic toxins” the normal kidney handles. As our renal colleagues pointed out this morning, uremia is a clinical diagnosis: encephalopathy, myoclonus, sustained clonus, in this case even hypothermia! Rare to see later findings (uremic frost, uremic fetor) but always look. Treatment is dialysis, though our patient improved with diuresis and time.

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