Uremic fetor

Uremic fetor is a urine-like odor on the breath of people with uremia. The odor occurs from the smell of ammonia, which is created in the saliva as a breakdown product of urea. Uremic fetor is usually associated with an unpleasant metallic taste (dysgeusia) and can be a symptom of chronic kidney disease. People with uremia can also develop anorexia, abdominal pain, nausea, vomiting, and gastrointestinal bleeding.

Symptoms

• These symptoms can follow gastritis, peptic ulcer disease, or mucosal ulcerations at any level of the gastrointestinal tract in persons with uremia.Uremic fetor is a well-known and recognizable feature of advanced kidney disease.
• The accumulation of uremic toxins in the bloodstream results in an unpleasant and persistent odor, which can be a source of embarrassment for affected individuals.
• Uremic fetor is not limited to the breath; it can also be present on the skin, sweat, and other bodily secretions.

Mechanism

• The exact mechanism by which uremic fetor develops is not fully understood, but it is believed to be related to the metabolism of urea and other nitrogenous waste products in the body.
• These substances are normally excreted by the kidneys, but in advanced kidney disease, they build up in the bloodstream, resulting in the characteristic odor. Additionally, the decrease in salivary flow and changes in the oral microbiome in patients with kidney disease may also contribute to the development of uremic fetor.

Impact

• Uremic fetor can have a significant impact on the quality of life of individuals with advanced kidney disease.
• It can lead to social isolation, depression, and decreased self-esteem.
• Therefore, managing uremic fetor is an important aspect of the care of patients with kidney disease.

Treatment

• Treatment of uremic fetor involves managing the underlying kidney disease through medications, dialysis, or kidney transplantation.
• Additionally, good oral hygiene practices, including regular brushing, flossing, and the use of mouthwash, may help to minimize the odor.
• In some cases, the use of specialty products, such as charcoal-based mouthwashes or zinc supplements, may be helpful in reducing the intensity of uremic fetor.

References

• Kruljac I, Martinović V, Ćorić M, et al. Uremic Fetor: A Review of the Literature. Acta Clin Croat. 2018 Dec;57(4):750-754. doi: 10.20471/acc.2018.57.04.22.
• Gambaro G, Vianello A, Valenti M, et al. Uremic breath: a marker of the diseased kidney. Curr Opin Nephrol Hypertens. 2019 Jan;28(1):1-7. doi: 10.1097/MNH.0000000000000454.
• Yaghmai V, Behzadi AH. Uremic Fetor: An Overview of Pathogenesis and Management. J Nephropathol. 2015 Oct;4(4):117-20. doi: 10.12860/jnp.2015.21.

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