2025 ICD-10-CM code R39.2
Extrarenal uremia, also known as prerenal uremia, indicates a buildup of waste products in the blood due to factors outside the kidneys.
Medical necessity for diagnosis and treatment of extrarenal uremia is established by the presence of elevated BUN and creatinine levels in conjunction with a demonstrable cause for reduced renal perfusion, such as dehydration, heart failure, or hypovolemic shock.Treatment is medically necessary to prevent progression to acute kidney injury and associated complications.
The clinical responsibility for managing extrarenal uremia involves identifying and addressing the underlying cause of reduced renal perfusion. This includes evaluating cardiovascular status, fluid balance, and other potential contributing factors. Treatment focuses on restoring adequate blood flow to the kidneys to improve their filtering capacity.
- Chapter 18: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
- R30-R39 (Symptoms and signs involving the genitourinary system)
In simple words: Extrarenal uremia means that your blood has too much waste because something is preventing your kidneys from getting enough blood to filter properly.This isn't a kidney problem itself, but a problem that affects how well the kidneys work.
Extrarenal uremia, which includes prerenal uremia, signifies an elevation of urea and other nitrogenous waste products in the blood serum due to causes not directly related to the kidneys' intrinsic function.This condition typically arises from reduced renal blood flow, impaired renal perfusion, or decreased glomerular filtration rate secondary to factors such as dehydration, heart failure, or circulatory shock.The kidneys themselves are structurally and functionally intact, but their ability to filter waste is compromised by inadequate blood supply.
Example 1: A patient presents with symptoms of dehydration (thirst, decreased urine output) after prolonged strenuous exercise in hot weather.Laboratory tests reveal elevated BUN and creatinine levels indicative of extrarenal uremia due to pre-renal azotemia.Treatment focuses on fluid resuscitation and electrolyte correction., A patient with severe congestive heart failure exhibits reduced renal blood flow leading to an increase in BUN and creatinine levels. This reflects extrarenal uremia secondary to decreased cardiac output and compromised renal perfusion. Treatment involves managing heart failure and improving cardiac function to restore blood flow to the kidneys., A patient in septic shock displays decreased renal blood flow secondary to systemic vasodilation and decreased blood pressure.Elevated BUN and creatinine levels indicate extrarenal uremia.Treatment includes aggressive fluid resuscitation, vasopressor support, and management of the underlying infection.
Detailed history and physical examination, including assessment of hydration status, cardiovascular status, and other relevant systems.Laboratory results including BUN, creatinine, electrolyte levels, complete blood count (CBC), and urinalysis. Documentation of the underlying condition that is causing the decreased renal perfusion.Evidence of treatment provided to address the underlying condition and improve renal perfusion.
** Extrarenal uremia is a reversible condition if the underlying cause is identified and corrected promptly.Prolonged or severe extrarenal uremia can lead to acute kidney injury.
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- Specialties:Nephrology, Internal Medicine, Cardiology, Emergency Medicine, Critical Care
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