Abstract

Almost all uremic patients have a bleeding diathesis which becomes a problem during invasive procedures such as surgery, biopsy and catheter placement. Intracranial bleeding, pericardial tamponade and gastrointestinal bleeding are the other life threatening clinical presentations. Pathogenesis of uremic hemorrhagic diathesis is not totally clear. A complex platelet dysfunction with abnormal platelet vessel wall interaction is claimed to be the main cause. Uremic toxins are shown to be responsible. Adequate dialysis may correct prolonged bleeding time, but fails at times. The incidence of uremic bleeding has been reduced by kidney transplantation, better management of anemia with recombinant human erythropoietin, and the use of desmopressin (DDAVP), cryoprecipitate, conjugated estrogens. In this article underlying pathophysiology; prophylactic and therapeutic approaches are reviewed.