Alternative Names ESRD , end-stage kidney disease, end-stage renal failure
Definition End-stage renal disease (ESRD) is a condition in which there is a permanent and almost complete loss of kidney function. The kidney functions at less than 10% of its normal capacity
What is going on in the body? The most common cause of end stage renal disease (ESRD) in Australia is glomerulonephritis, which is swelling and scarring of filtering parts of the kidney. Diabetes is the second most common cause for end stage renal disease. Polycystic kidney disease is the most common genetic cause for ESRD. It is also the fourth most common cause for ESRD in Australia and 1 in 2 people with polycystic kidney disease will develop ESRD by the age of 60.
Other conditions that can lead to ESRD are:
interstitial disease, a swelling of the bladder wall
obstructive uropathy, or a blockage in the urinary system
In end-stage renal disease, toxins slowly build up in the body. Normal kidneys remove these toxins from the body through urine. The toxins most commonly found are called urea and creatinine. By measuring these waste products in the blood, doctors can tell if the kidneys are functioning normally.
What are the signs and symptoms of the disease? The symptoms that are caused by the the toxic buildup of waste products include:
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 colour
What are the causes and risks of the disease? The risk of end-stage renal disease is increased for
older persons
men
indigenous Australians
those with a family history of the disease
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 can help prevent the problem.
ACE inhibitor medications, such as lisinopril or enalapril, can be used to control high blood pressure. These drugs are also used to lower the amount of protein in the urine. These drugs can slow the rate of kidney failure. Special protein restricted diets can help some people.
How is the disease diagnosed? The disease is diagnosed by a careful look at a person's medical history and through blood tests. Many people with end-stage renal disease are also malnourished. Blood samples will be taken to check the levels of creatinine and urea. In many cases, there is a low level of the kidney hormone erythropoetin. The blood tests may also show high levels of potassium, phosphorous, parathyroid hormone, and magnesium as well as low levels of calcium.
An ultrasound of the kidneys may show small, scarred kidneys. A kidney biopsy, in which a small sample of kidney tissue is taken, may show how much damage has been done to the kidneys.
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, and phosphorous
anaemia, 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
What are the treatments for the disease? The treatments for end-stage renal disease include:
control of blood pressure by antihypertensive drugs
control of fluids by diuretics, or "water pills"
Injections of erythropoetin to improve anaemia
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 a healthy kidney would, filtering out waste products from the blood or other fluids. Haemodialysis is the process of filtering out toxins from the blood and returning the blood to the body. Peritoneal dialysis removes wastes from the peritoneal 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 result in bleeding, infection, and even death. There can be many complications with dialysis, including infections, low blood pressure, and lung and heart problems.
What happens after treatment for the disease? A person who receives a kidney transplant needs lifelong treatment with immunosuppressants. These are drugs that keep the body's immune system from attacking the new kidney. Dialysis must be done on a regular schedule. Diet is important for those with kidney failure. A person may be referred to a dietician for advice.
How is the disease monitored? A kidney specialist will monitor dialysis treatment or any effects after a kidney transplant. Long-term follow-up is very important. A person should see his or her doctor regularly even if there are no symptoms.
Author: Rajnish K. Dhingra, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
