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Last reviewed by Dr. Raj MD on January 12th, 2022.

Azotemia Definition

The definition of azotemia is having an unusually high amount of nitrogen waste product in your bloodstream. Normally this is the job of your kidneys to filter your blood and expel the waste in the form of urine.

Azotemia Symptoms

Most of the time when you develop azotemia it is acute which means that the symptoms associated with this medical condition comes about suddenly. There have been reports of some cases becoming progressively worse over the course of several weeks, even months. The most common symptom is having dark, reddish urine but the color of your urine can shift drastically.

If you have azotemia you may experience:

  • Confusion or decreased alertness
  • High blood pressure and/or fluctuation in your blood pressure
  • Fatigue feeling even while just sitting and doing nothing
  • Rapid heart rate
  • Lightheaded
  • Decreased urine production and/or having trouble urinating that may or may not be painful
  • Skin turning pale
  • Joints that become inflamed and swollen
  • Nausea and/or vomiting
  • Decreased appetite
  • Dry mouth
  • Seizures
  • High fever

There are some people who might even experience extreme tenderness and pain in their lower back and abdomen. You may even notice swelling near your elbows and/or ankles because of the accumulation of nitrogenous compounds in your bloodstream.

Azotemia Causes

There can be several reasons why a person would have azotemia. Azotemia is divided into three categories and which one is the cause depends on where the problem is that is causing azotemia.

The three categories of azotemia are:

Prerenal azotemia

This refers to the complications that decreases your blood flow to your kidneys like atherosclerosis, which is the medical term for hardening of the arteries. Other causes of prerenal azotemia are low blood pressure and irregular pumping of your heart.

Intrarenal azotemia

This is basically kidney failure whereas the problem lies in your kidneys. It is normally caused by an increase in the levels of nitrogenous compounds in your blood because of damage to your kidneys. There are diseases like pyelonephritis and diabetes that can lead to the development of this category. There are also certain medications like Gentamycin, and Mitomycin that can cause it also.

Postrenal azotemia

This is when there is an obstruction of urine flow after the waste leaves your kidneys. This obstruction or blockage can happen in the urethra, ureters, or even in the passages through your bladder. The most common obstruction is kidney stones. An obstruction can also be caused by the enlargement of a man’s prostate gland or inflammation of your kidneys.

Basically a person can develop azotemia when your kidneys are not able to sufficiently remove creatinine, urea, and other compounds that contain nitrogen from your blood. All three categories can lead to a dangerous increase in your blood urea nitrogen (BUN) along with other compounds that are normally expelled in your urine.

Although most of the time developing azotemia is because of kidney dysfunction it can also develop after being diagnosed with a blood composition problem even though you have normal kidney function. The reason that this can happen is that the amount of blood flowing through your kidneys are less than what is normal so the volume of blood that is being filtered is not enough to maintain the normal levels of nitrogenous compounds. It happens because of the reduced supply of blood to your kidneys. This would fall under the category of prerenal azotemia.

Azotemia Treatment

It is important that you seek treatment because if not you may suffer eventual kidney failure and possibly irreversible damage to your kidneys. Many times it is necessary to seek emergency care to help identify what is causing your case of azotemia and then remedying the underlying cause in order to prevent any serious health complications. Because it can lead to serious health complication if not treated early it is imperative that if you believe you are experiencing any symptoms of azotemia you should see your physician immediately or go to an emergency room as quickly as possible.

If you are diagnosed with azotemia you will most likely be placed in the hospital and given intravenous fluids to help reduce the chances of you becoming dehydrated. If the cause falls into the intrarenal category using a dialysis machine temporarily to take over the blood filtration process may be necessary while the physician assesses your kidney problems. If the cause falls in either the prerenal or postrenal category it can be treated with medications to help open constricted blood vessels, reduce inflammation, and help to control your blood pressure. If the problem is because of a blockage or your kidneys shut down completely surgery may be necessary if the physician cannot resolve the issue with medication.

One of the most commonly prescribed medication that is used is Amifostine. This medication will help to reduce the adverse effects that are caused by medications like Mitomycin and can also help to reduce the possibility of developing azotemia. Your physician may also administer loop diuretic medications and insulin to help prevent nitrogenous compounds from accumulating in your bloodstream.

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