It can be defined as an excess in the blood of amino acid and protein metabolism end products, such as urea and creatinine, which would normally be excreted in the urine.

[2] Both uremia and uremic syndrome have been used interchangeably to denote a very high plasma urea concentration that is the result of renal failure.

People with kidney function below 50% (i.e. a glomerular filtration rate [GFR] between 50 and 60 mL/min) and over 30 years of age may have uremia to a degree.

Treatment can be by dialysis or a kidney transplant, though some patients choose to pursue symptom control and conservative care instead.

[3] Classical signs of uremia are: progressive weakness and easy fatigue, loss of appetite due to nausea and vomiting, muscle atrophy, tremors, abnormal mental function, frequent shallow respiration, and metabolic acidosis.

Without intervention via dialysis or kidney transplant, uremia due to renal failure will progress and cause stupor, coma, and death.

[citation needed] Glomerular filtration rate (GFR) measures the amount of plasma in millilitres being filtered through the kidneys each minute.

[citation needed] Prerenal azotemia can be caused by decreased blood flow through the kidneys (e.g. low blood pressure, congestive heart failure, shock, bleeding, dehydration) or by increased production of urea in the liver via a high protein diet or increased protein catabolism (e.g. stress, fever, major illness, corticosteroid therapy, or gastrointestinal bleeding).

In the cases of acute uremia, causes may be identified and eliminated, leading to a higher chance for recovery of normal kidney function, if treated correctly.

Another laboratory test that should be considered is urinalysis with microscopic examination for the presence of protein, casts, blood and pH.

[3] Urea could be the precursor of more toxic molecules, but it is more likely that damage done to the body is from a combination of different compounds which may act as enzyme inhibitors or derange membrane transport.

Regulation of body fluids, salt retention, acid and nitrogenous metabolite excretion are all impaired and can fluctuate widely.

Later research suggested that major neurological disorders like coma and convulsions did not correlate with physical findings which included generalized edema of the brain.

The patients may present with ammonia-like taste and smell in mouth, stomatitis, gingivitis, decreased salivary flow, xerostomia and parotitis.

Uremic stomatitis appears as a pseudo membrane or frank ulcerations with redness and a pultaceous coat in the mouth.

It is a white plaque found on the skin or in the mouth which is caused by residual urea crystals left on the epithelial surface after perspiration and saliva evaporation, or as a result of reduced salivary flow.

[12] In patients with renal disease, pallor of the oral mucosa can sometimes be noticed due to anaemia caused by reduction of erythropoietin.

This situation, combined with the use of heparin and other anticoagulants in haemodialysis, causes these patients to become predisposed to ecchymosis, petechiae, and haemorrhages in the oral cavity.

For example, enamel hypoplasia in the form of white or brown discoloration of primary teeth is commonly seen in young children with early-onset renal disease.

[13] Poor oral hygiene, a carbohydrate-rich diet, disease-related debilitation, hypoplastic enamel, low salivary flow rate and long-term medication contribute to increased risk of cavity formation.

[12] When treating patients with renal insufficiency, a dentist should collect a complete medical history, with particular attention to ESRD-related illnesses, drugs with prescribed dosages, blood parameters, timing, and type of dialysis performed.

Dental treatment should be started on the day after hemodialysis due to several reasons: there is no accumulation of uremic toxins in the blood, and circulating heparin is absent.

Treatment should not commence on the same day as hemodialysis as patients usually feel unwell and their blood is heparinized, which might cause excessive bleeding.

If the AV site is located on a leg, the patient should avoid sitting for lengthy periods, as venous drainage may be obstructed.

[citation needed] Hemostatic aids should be instituted in cases of excessive bleeding, which is commonly seen in uremia and renal failure.

[12][15] Patients undergoing dialysis are exposed to numerous transfusions and renal failure-related immunosuppression; thus, they are at greater risks of infection by human immunodeficiency virus (HIV) and hepatitis types B and C. It is important to adopt infection control measures to avoid cross-contamination in the dental clinic and prevent risk of exposure to dental personnel.

Due to renal failure, the plasma half-lives of drugs normally excreted in urine will be prolonged, leading to increased toxicity.

[15] The challenge in pharmacotherapy for patients with renal disease is to maintain a medication's therapeutic level within a narrow range in order to avoid subtherapeutic dosing and toxicity.