End-stage renal disease Causes and Risks:
End-stage renal disease
(ESRD) occurs when chronic renal failure progresses to the point at which the kidneys are permanently functioning at less than 10% of their capacity. At this point, the kidney function is so low that without dialysis or kidney transplantation, complications are multiple and severe, and death will occur from accumulation of fluids and waste products in the body.
About 4 out of every 10,000 people have end-stage renal disease. In the U.S. almost 100,000 people are on chronic dialysis and more than 20,000 people have a functioning transplanted kidney. Almost half of the people with ESRD are those with diabetes mellitus . ESRD almost always follows chronic kidney failure , which may exist for 10 to 20 years or more before progression to ESRD.
Prevention:
Treatment of chronic renal failure may delay or prevent progression to ESRD. Some cases may not be preventable.
Symptoms:
Signs and Tests:
The patient usually has a long history of chronic renal failure , which has progressed. The person may have required dialysis to control chronic renal failure. The urine volume may decrease or urine production may stop totally. Signs of complications commonly are present.
Treatment:
Dialysis or kidney transplantation are the only treatments for ESRD. The physical condition of the person and other factors determines which of these is used for treatment. Other treatments of chronic renal failure may continue but are ineffective without dialysis or transplantation.Associated diseases that cause or result from chronic renal failure must be controlled. Hypertension , congestive heart failure , urinary tract infections , kidney stones , obstructions of the urinary tract, glomerulonephritis , and other disorders should be treated as appropriate.Blood transfusions and medications such as iron and erythropoietin may be needed to control anemia .Fluids may be restricted to an amount nearly equal to the volume of urine produced. Dietary restrictions may slow the build-up of wastes in the bloodstream and control associated symptoms such as nausea and vomiting . Restrictions include low protein in diet , with high carbohydrate levels to make up calories. Salt, potassium, phosphorus, and other electrolytes may be restricted.
Support Groups:
The stress of illness can often be helped by joining a support group where members share common experiences and problems. See kidney disease - support group .
Prognosis:
ESRD is fatal unless treated with dialysis or transplantation. Both of these treatments can have serious risks and consequences. The outcome varies and is unique to each individual.
Complications:
- complications of dialysis and kidney transplantation
- pericarditis , cardiac tamponade
- congestive heart failure
- hypertension
- platelet dysfunction
- gastrointestinal loss of blood, duodenal or peptic ulcers
- hemorrhage
- anemia
- hepatitis B , hepatitis C , liver failure
- decreased functioning of white blood cells and immune system
- infection
- peripheral neuropathy
- seizures
- encephalopathy, nervous system damage, dementia
- weakening of the bones, fractures , joint disorders
- permanent skin pigmentation changes
- skin dryness, itching /scratching with resultant skin infection
- changes in glucose metabolism
- changes in electrolyte levels
- decreased libido, impotence
- miscarriage , menstrual irregularities , infertility
Call Your Healthcare Provider:
Go to the emergency room or call the local emergency number (such as 911) if symptoms indicating end-stage renal disease have developed.Call your health care provider if known acute or chronic renal failure persists or worsens.
The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and the stimulation of red blood cell production. The gross anatomical structure of the kidney is illustrated.
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