Differential Diagnosis for Uremia

The following differential diagnosis is organized into categories to help guide the thought process:

• Single most likely diagnosis

  • Chronic Kidney Disease (CKD) or Acute Kidney Injury (AKI) leading to uremia: This is the most direct cause of uremia, as both conditions result in the kidneys' inability to filter waste products from the blood, leading to their accumulation and the clinical presentation of uremia.

• Other Likely diagnoses

  • Dehydration: Severe dehydration can lead to a prerenal cause of acute kidney injury, which if not promptly addressed, can result in uremic symptoms.
  • Postrenal obstruction: Obstruction in the urinary tract (e.g., kidney stones, tumors) can prevent the normal flow of urine, leading to a buildup of waste products in the blood.
  • Sepsis: Sepsis can cause acute kidney injury through various mechanisms, including hypoperfusion and direct renal injury from inflammatory mediators.

• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

  • Rhabdomyolysis: This condition, characterized by the breakdown of muscle tissue, can lead to acute kidney injury and uremia due to the release of myoglobin into the bloodstream.
  • Hemolytic-uremic syndrome (HUS) or thrombotic thrombocytopenic purpura (TTP): These are rare conditions that can cause acute kidney injury and have significant morbidity and mortality if not promptly recognized and treated.
  • Ethylene glycol or methanol poisoning: These toxic ingestions can cause severe metabolic acidosis and acute kidney injury, leading to uremic symptoms.

• Rare diagnoses

  • Multiple myeloma: This plasma cell dyscrasia can lead to kidney injury through various mechanisms, including hypercalcemia, light chain deposition disease, and hyper viscosity syndrome.
  • Amyloidosis: The deposition of amyloid proteins in the kidneys can lead to chronic kidney disease and uremia.
  • Vasculitis (e.g., ANCA-associated vasculitis): Inflammation of the blood vessels can affect the kidneys and lead to acute or chronic kidney disease.