Uremic Coma (Renal Syncope)

Etiology

Renal syncope results from severe kidney dysfunction, leading to renal qi depletion, impaired fluid metabolism, and accumulation of uremic toxins that ascend to cloud mental consciousness. It manifests as a syncopal disorder of the kidneys and brain, characterized by delirium or coma superimposed on pre-existing nephropathy.

Symptoms

1. History: Chronic kidney disease, acute blood/fluid loss, or high fever with oliguria/anuria.
2. Progression:
   • Early: Lethargy, fatigue, dizziness, headache, apathy, visual disturbances.
   • Advanced: Drowsiness → confusion → agitation/delirium → coma.
   • Hallmarks: Uremic fetor (urine-like breath odor), Kussmaul respiration (deep/rapid breathing), pinpoint pupils.
3. Labs: Elevated BUN/creatinine, low CO₂ combining power, proteinuria, fixed low urine specific gravity.
4. EEG: Slowed basal rhythm with diffuse slow waves.

Prevention & Treatment

Three-tiered approach:

1. Primary Prevention (Lifestyle):
   • Philosophy: “With robust zhengqi (vital energy), pathogens cannot invade.” Strengthen immunity through:
     • Health-conscious mindset (“Health is wealth”).
     • Balanced routines: Regular sleep, kidney-friendly diet (low-protein, low-sodium), stress management, and physical activity (extends lifespan by 10 years).
2. Secondary Prevention (Disease Control):
   • Target CKD causes:
     • Glomerulonephritis (55.7% of CRF cases in China) and pyelonephritis (21.2%).
     • Hypertension/diabetes (50% in Western nations; rising sharply in China).
   • Avoid nephrotoxic drugs (e.g., NSAIDs, aminoglycosides) and environmental toxins.
3. Tertiary Prevention (Early Intervention):
   • Detect renal impairment early; employ TCM to delay ESRD progression.

Differential Diagnosis

1. Stroke:
   • Key signs: Severe hypertension, thunderclap headache, bloody CSF. BUN/Cr may rise secondarily.
2. Diabetic Ketoacidosis (DKA):
   • Clues: Fruity breath, hyperglycemia/glucosuria, ketonuria. Normal BUN.
3. Hepatic Encephalopathy:
   • Features: Liver failure history, fetor hepaticus, ascites, abnormal LFTs.

Complications

• Peripheral neuropathy: Numbness, burning sensations (linked to methylguanidine toxicity).
• Multifactorial pathogenesis: Urea, guanidines, and other toxins collectively drive uremia.