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Kidney anatomy
Kidney anatomy

End-stage kidney disease

Definition:
End-stage kidney disease is a complete or near complete failure of the kidneys to function to excrete wastes, concentrate urine, and regulate electrolytes. Also called End-stage renal disease (ESRD).

Alternative Names:
Renal failure - end stage; Kidney failure - end stage; ESRD

Causes, incidence, and risk factors:
End-stage kidney disease occurs when the kidneys are no longer able to function at a level that is necessary for day to day life. It usually occurs as chronic renal failure progresses to the point where kidney function is less than 10% of baseline. 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.

In the United States, nearly 300,000 people are on long-term dialysis and more than 20,000 have a functioning transplanted kidney. The most common cause of ESRD in the US is diabetes. ESRD almost always follows chronic kidney failure, which may exist for 10 to 20 years or more before progression to ESRD.

Symptoms:


Signs and tests:
The patient usually has a long history of chronic kidney 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 kidney 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:
For additional resources, see kidney disease support group.

Expectations (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:


Calling your health care provider:
Go to the emergency room or call the local emergency number (such as 911) if symptoms indicating end-stage kidney disease have developed. Call your health care provider if known acute or chronic kidney failure persists or worsens.

Prevention:
Treatment of chronic kidney failure may delay or prevent progression to ESRD. Some cases may not be preventable.


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