End Stage Renal Disease

Overview, Causes, & Risk Factors

End-stage renal disease (ESRD) is a condition in which there is apermanent and almost complete loss of kidney function. The kidney functions atless than 10% of its normal capacity

What is going on in the body?

Diabetes and high blood pressure are two diseases that cause morethan 60% of all cases of end-stage renal disease in the US. Other conditionsthat can lead to end-stage renal disease include:

  • glomerulonephritis, which isswelling and scarring of the filtering part of the kidneys
  • polycystic kidneys, aninherited disorder in which cysts enlarge the kidney
  • interstitial disease, a swelling of the bladder wall
  • obstructive uropathy, or a blockage in the urinary system
  • systemic lupus erythematosus,in which there is long-term swelling of the joints, skin, and other organs
  • multiple myeloma, a cancer of the bone marrow
  • In end-stage renal disease, toxins slowly build up in the body. Normal kidneysremove these toxins from the body through urine. The toxins most commonly foundare called urea and creatinine. By measuring these waste products in the blood,healthcare providers can tell if the kidneys are functioning normally.

    What are the causes and risks of the disease?

    The risk of end-stage renal disease is increased for

  • older persons
  • men
  • blacks
  • those with a family history of the disease
  • Symptoms & Signs

    What are the signs and symptoms of the disease?

    The symptoms that are caused by the the toxic buildup of waste products incude:

  • a decrease in the amount of urine
  • overall swelling of the body
  • feeling out of breath
  • nausea
  • vomiting
  • poor appetite
  • metallic taste in the mouth
  • frequent hiccups
  • weight loss
  • fatigue
  • mental slowness or confusion
  • seizures or convulsions
  • leg cramps
  • itching
  • pale skin color
  • Diagnosis & Tests

    How is the disease diagnosed?

    The disease is diagnosed by a careful look at a person’s medical history andthrough blood tests. Many people with end-stage renal disease are also malnourished. Blood samples will betaken to check the levels of creatinine and urea. In many cases, there is a lowlevel of the kidney hormone erythropoetin. The blood tests may also show highlevels of potassium, phosphorus, parathyroid hormone, and magnesium as well aslow levels of calcium.

    An ultrasound of the kidneys may show small, scarred kidneys. A kidney biopsy, in which a small sample ofkidney tissue is taken, may show how much damage has been done to thekidneys.

    Prevention & Expectations

    What can be done to prevent the disease?

    End-stage renal disease can be prevented by controlling high blood pressure.Also, keeping blood sugar levels in tight control for people with diabetes canhelp prevent the problem.

    ACE inhibitor medications, such as lisinopril or enalapril, canbe used to control high blood pressure. These drugs are also used to lower theamount of protein in the urine. These drugs can slow the rate of kidneyfailure.

    What are the long-term effects of the disease?

    The long-term effects of end-stage renal disease include:

  • high blood pressure
  • overall swelling, because the body is unable to get rid of extra fluid
  • electrolyte or mineral abnormalities, especially potassium, calcium, andphosphorus
  • anemia, a low level of red blood cells that carry oxygen
  • new or worsening heart disease
  • malnutrition
  • increased risk of infections
  • menstrual problems
  • decreased sexual drive
  • Treatment & Monitoring

    What are the treatments for the disease?

    The treatments for end-stage renal disease include:

  • a diet that restricts protein,potassium, and phosphorus
  • limited fluid intake
  • control of blood pressure by antihypertensive drugs
  • control of fluids by diuretics, or “water pills”
  • shots of erythropoetin toimprove anemia
  • use of bicarbonate to improve the pH balance of the blood
  • Once end-stage renal disease is diagnosed, a person needs to have either dialysis or a kidney transplant. In dialysis, a machine acts as ahealthy kidney would, filtering out waste products from the blood or otherfluids. Hemodialysis is the process of filtering out toxins from the blood andreturning the blood to the body. Peritoneal dialysis removes wastes from theperitoneal cavity, which includes the belly and pelvic areas.

    What are the side effects of the treatments?

    Side effects vary with the treatment used. All surgery may resultin bleeding, infection, and even death. There can be many complications withdialysis, including infections, low blood pressure, and lung and heartproblems.

    What happens after treatment for the disease?

    A person who receives a kidney transplant needs lifelongtreatment with immunosuppressants. These are drugs that keep the body’s immunesystem from attacking the new kidney. Dialysis must be done on a regularschedule. Diet is important for those with kidney failure. A person may bereferred to a dietician for advice.

    How is the disease monitored?

    A kidney specialist will monitor dialysis treatment or any effects after akidney transplant. Long-term follow-up is very important. A person should seehis or her healthcare provider regularly even if there are no symptoms.

    Article type: xmedgeneral