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Care During Chemotherapy and Beyond

Azotemia



What Is Azotemia?

Azotemia is a type of Nephrotoxicity.

Azotemia is an excess of nitrogen compounds in the blood. Uremia, or uremic syndrome, occurs when the excess of nitrogen compounds becomes toxic to your system. Azotemia, if untreated, can lead to acute (sudden) renal failure. Renal failure is when each kidney shuts down.

What Are The Different Types of Azotemia?

Prerenal Azotemia (also called Prerenal Failure):

Prerenal azotemia is the most common cause of acute renal failure. It is an excess of nitrogen compounds in your blood stream due to a lack of blood flow to each kidney. This may occur when your heart is not pumping regularly due to heart rhythm abnormalities, or a prolonged period of low blood pressure readings due to a blood infection.  These symptoms of kidney problems can be corrected by making sure that blood flow to the kidney is returned.
 
Intrarenal Azotemia (also called Intrinsic Renal Failure):

This is when there has been damage to the kidneys themselves. Causes of Intrarenal Azotemia include:

  • Drugs such as Aminoglycoside antibiotics (like Gentamycin or Vancomycin)
  • Anti-fungal antibiotics (Amphotericin B)
  • Chemotherapy drugs, such as Cisplatin, Carboplatin, Carmustine, Mitomycin, high-dose Methotrexate, Mithramycin and Streptozocin.
  • Biologic therapies, such as Interleukin-2, or Interferon Alfa
  • Angiotensin-Convering Enzyme (ACE) Inhibitors - used in heart failure, or after a heart attack. ACE inhibitors are given to diabetics with mild kidney disease, yet you should not stay on them once your creatinine levels are elevated significantly, or a specialist has recommended that you stay on these medications. 
  • Intravenous (IV) radiocontrast dye - certain "dyes" may be injected into your bloodstream during a radiology procedure, to improve the "picture" that is seen on CT scan, MRI or x-ray. These dyes, if you are at risk for kidney problems such as failure due to multiple myeloma, diabetes, pre-existing heart conditions, or when given in combination with certain other medications, may cause further kidney problems.
  • Non-steroidal Anti-inflammatory Drugs (NSAID's like ibuprofen) - may cause kidney damage
  • Chronic (long-term) renal failure: can be caused by drugs or medications.
  • Diseases that may cause chronic renal failure include: Diabetes, Pyelonephritis (inflammation of a part of your kidneys), and chronic analgesic abuse

Post-renal Azotemia:

One of the causes of kidney problems is blockage in your kidneys, where the contents of the bladder are prevented from moving out from the kidneys. This can be due to an obstruction (or blockage) of a ureter (one of the tiny tubes leading out from the kidneys to the bladder), bladder or the urethra (the tube that goes from the bladder out into the body). Kidney stones can be a cause of Post-renal Azotemia.

Other causes of kidney failure may be due to:

  • A tumor causing a blockage of urine from the kidney
  • A urinary infection, or nephritis (inflammation of one or more of your kidneys)
  • Kidney stones
  • An enlarged prostate gland, in men
  • Depending on what caused your kidneys to be injured, the extent of the damage and your kidney problems symptoms, your kidneys may fail to work properly.

What Are Some Symptoms of Azotemia To Look For?

  • You may not be urinating very often. Your urine may be dark or red blood-tinged. You may have pain or an urgency to use the bathroom.
  • You may have fever or chills, if you have an infection
  • You may be overly tired, or very weak (fatigued). It may be hard for you to do any kind of your normal activities. Your muscles may become extremely weak.
  • You may notice that your feet or ankles are swelling. You may feel "puffy".
  • You may have nausea or vomiting. Some people experience a loss of appetite.
  • You may become confused, or have a seizure. These are all symptoms of kidney problems.

Things You Can Do To Treat Azotemia Symptoms:

Prevention of Dehydration:

  • Drink two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
  • Management of side effects that may lead to dehydration such as nausea, vomiting, or diahhrea.  (see specific symptoms for management tips that may help to prevent symptoms of kidney problems).

Testing of Kidney Function:

  • Your doctor or healthcare provider may order certain blood tests, including a blood urea nitrogen (BUN) and Creatinine test, to monitor your kidney function if signs of kidney problems are present. He or she may also ask you to save your urine for a 24-hour period, in order to monitor how much creatinine is in your urine during a 24-hour period.
  • Your doctor or healthcare provider may order some tests to evaluate your kidneys and bladder. He or she may order:
    • An ultrasound of your kidneys
    • An x-ray of your kidneys, ureter and bladder (KUB)
  • He or she may place a tube in your bladder (called a catheter), if you are not urinating, to see if there is a obstruction with urine behind the blockage, or if you are not making any urine at all
  • Follow all of your health care provider's instructions.

If You Have Been Diagnosed With Azotemia, Including Damage or Failure:

  • Make sure to inform all of your health care providers of your condition. Make sure that with each medication that you are given to take, your doctor or health care provider is aware of your kidney disease. Avoid any drugs that may cause you to have further symptoms of kidney problems.
  • You may be advised to follow a "renal diet".  This includes foods that are low in sodium, potassium, magnesium and protein. Reading the labels on food is helpful to know what kinds of calories, fat and protein you are taking in. Discuss this with your healthcare provider.
  • Some general recommendations include:
    • Limit Carbohydrates - Carbohydrates, either simple (such as fruit and sugar) or complex, (such as pasta and cereals), have the greatest impact on blood sugar levels, which is important if you have kidney problems due to your diabetes. In addition, excess carbohydrates that we take into our bodies are also converted into fat. In general, your diet should include around 50% carbohydrates. Avoid sugar, and instead, use artificial sweeteners, such as nutrasweet, aspartame, or saccharin, to help you lose weight, or maintain your current weight.
    • Protein - Foods that are high in protein include all kinds of meats. Your diet should consist of 15-20% protein. Long-term damage to your kidneys may be corrected by restricting protein, if you are diabetic, or experiencing symptoms of kidney problems.
    • Increase fresh vegetables and fiber intake - Up to 55 grams of fiber per day is recommended. Fiber and fresh vegetables help to maintain regular bowel habits, and may prevent certain cancers. However, you should avoid foods that are high in potassium and magnesium, if you are having kidney problems. Foods that are high in potassium include most fresh fruits and vegetables. Some specific examples include:
      • Oranges and orange juice
      • Leafy green vegetables, such as spinach and greens (collard and kale)
      • Potatoes
    • There are many types of "good and bad" fats. The easiest thing to remember is to limit your intake of saturated fats and oils.
    • Avoid excess magnesium in your diet, often found in laxatives (such as milk of magnesia), or antacids unless specified by your healthcare provider.

Drugs That May Be Prescribed By Your Doctor For Azotemia:

Depending on your overall health status, your doctor may recommend that certain drugs be used to treat or prevent your symptoms of kidney problems. Some of the common drugs may include:

Amifostine - Your doctor or health care provider may prescribe this medication to decrease toxicity with repeated doses of Cisplatin chemotherapy. It may also be given to you if you have a dry mouth following radiation therapy for cancer of your head and neck. This medication is usually given 30 minutes before chemotherapy and at least 15 minutes prior to your radiation therapy treatments.

Antibiotics - If your doctor or health care provider suspects that you have an infection that has caused your Azotemia, he or she may order antibiotics, either in a pill form or intravenous (IV). If you are prescribed antibiotics, take the full prescription. Do not stop taking pills once you feel better. Common antibiotics for a urinary tract infection include Bactrim or Ciprofloxacin (Cipro).

Insulin - Insulin is a hormone that is naturally found in our bodies, that regulates blood glucose levels. Insulin may be given in the vein (IV), while you are in the hospital, or more commonly, under the skin (subcutaneous). You will be given insulin if you have renal failure or Azotemia caused by your diabetes, and your blood sugar levels are too high.

  • If your blood sugar levels are not under good control, you may be ordered to take insulin alone, or in addition to an oral anti-diabetic agent. Insulin injections may be temporary, while you are first diagnosed, or they may need to be continued for a longer period of time. Your health care provider will determine this.

Loop Diuretics - are also known as "water pills", as they work by "challenging" your kidneys, by allowing them to excrete any extra fluid that has accumulated in your body. A common example of this medication may include Furosemide (Lasix). You may receive this medication alone or in combination with other medications.

Oral Anti-diabetic Agents - There are many different kinds of medications that work by allowing your body to process insulin more effectively. You will receive one of these medications if you are diabetic, and you have Azotemia due to your diabetes. These include Glipizide, Actos or Amaryl. Your health care provider will suggest one which is right for you.

  • Side effects of these medications may vary, but most include low blood sugar levels, weight loss, and improvement in your blood cholesterol levels. Some may cause slight nausea or loss of appetite, or diarrhea and bowel disturbances. It is important to follow your health care provider's recommendations for taking these pills.

Sodium Polystyrene Sulfonate (Kayexalate) - This medication works to lower blood potassium levels by binding with the potassium in your stomach or gut. You may receive this medication if you have developed kidney failure, and you are not able to get rid of excess potassium in your bloodstream. You may take this medication by mouth, or by enema. If you are given this medication and become constipated, you must take a special laxative (called Sorbitol) to relieve your constipation.

When To Call Your Doctor or Health Care Provider About Signs of Azotemia:

  • If you begin urinating less frequently, or if your urine is dark, cloudy, or painful.
  • Any unusual bleeding or bruising; black or tarry stools, or blood in your stools or urine
  • Diarrhea (4-6 episodes in a 24-hour period), especially if it is becoming worse
  • Nausea (interferes with ability to eat and unrelieved with prescribed medications).
  • Vomiting (vomiting more than 4-5 times in a 24-hour period).
  • Dizziness or lightheadedness, "feeling faint", especially if severe.
  • Any new rashes on your skin, itchy skin.
  • Any unusual swelling in your feet and legs, or weight gain of greater than 3 to 5 pounds in 1 week.
  • Fever of 100.5° F (38° C), chills, sore throat (possible signs of infection if you are receiving chemotherapy).
  • Changes in your mental state, including confusion; or a recent episode of seizure(s).
  • Feeling your heart beat rapidly, or experience palpitations.
  • Extreme muscle weakness or twitching (may signify electrolyte imbalances that should be corrected).
  • If your symptoms of kidney problems worsen or do not improve in 3 days of therapy.

Read More About:
Kidney Problems | Nephrotoxicity | Azotemia | ProteinuriaUrinary Tract Infection (UTI)

Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website about symptoms of kidney problems and other medical conditions is meant to be helpful and educational, but is not a substitute for medical advice.