Snapshot A 45-year-old woman presents to the emergency room with persistent bleeding after a tooth extraction. She has gone through many packs of gauze without any improvement. Her past medical history includes a nephrectomy on the right side ten years ago. While dialysis was recommended two years ago, she refused. On labs, her creatinine is 6 mg/dl with normal coagulation factor levels and normal PT/PTT. She is given desmopressin (DDAVP). Introduction Overview uremic platelet dysfunction is caused by renal dysfunction and azotemia, resulting in bleeding Epidemiology Risk factors renal insufficiency requiring dialysis chronic kidney disease etiology Pathogenesis mechanism intrinsic defect of platelet results in abnormal platelet to endothelium interaction login to view 8 more bullets Associated conditions renal insufficiency requiring dialysis Presentation Symptoms common symptoms easy bruising Physical exam inspection mucocutaneous bleeding login to view 3 more bullets Studies Serum labs normal or prolonged bleeding time normal coagulation factors normal PT and PTT normal or mildly decreased platelets Peripheral blood smear echinocytes, also called burr cells, are red blood cells with serrated edges Differential Glanzmann thrombasthenia key distinguishing factor mucocutaneous bleeding since childhood, without uremia Treatment Medical desmopressin (DDAVP) indications login to view 2 more bullets dialysis indication login to view 1 more bullet blood transfusions indication login to view 1 more bullet conjugated estrogen or cryoprecipitate indication login to view 1 more bullet Complications Life-threatening gastrointestinal bleeding Prognosis Overall prognosis is poor in patients with uremia However, uremic platelet dysfunction is not the most common cause of death