End-stage kidney disease
Definition
End-stage kidney disease is the complete, or almost complete failure of the kidneys to function. The kidneys can no longer remove wastes, concentrate urine, and regulate electrolytes.
Alternative Names
Renal failure - end stage; Kidney failure - end stage; ESRD
Causes
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 when chronic kidney failure has progressed to the point where kidney function is less than 10% of normal.
The most common cause of ESRD in the U.S. is diabetes. ESRD almost always follows chronic kidney failure. A person may have kidney failure for 10 - 20 years or more before progressing to ESRD.
Symptoms
- Decreased alertness
- Decreased sensation in the hands, feet, or other areas
- Decreased urine output
- Easy bruising or bleeding
- Fatigue
- Frequent hiccups
- General ill feeling
- Headache
- Increased skin color (pigmentation)
- Itching
- May have blood in the vomit or stools
- Muscle twitching or cramps
- Nail abnormalities
- Nausea or vomiting
- No urine output
- Seizures
- Skin may appear yellow or brown
- Unintentional weight loss
Exams and Tests
There may be a long history of chronic kidney failure, which has progressed. The urine volume may decrease or urine production may stop totally. Signs of complications commonly are present.
Tests may include:
- Creatinine and BUN levels
- Creatinine clearance
Treatment
Dialysis or kidney transplantation are the only treatments for ESRD. Your physical condition and other factors determine which treatment is used.
When you start dialysis depends on different factors, including your lab test results, severity of symptoms, and readiness. You should begin to prepare for dialysis before it is absolutely necessary. The preparation includes learning about dialysis and the types of dialysis therapies, and placement of a dialysis access.
You may receive other treatments for chronic kidney failure, but they are unlikely to work without dialysis or a transplant. Treatment usually includes aggressive treatment of high blood pressure with an ACE inhibitor or angiotensin receptor blocker.
You will also receive treatment for diseases that cause, or are caused by chronic renal failure, including:
- Blockages (obstructions) of the urinary tract
- Congestive heart failure
- Glomerulonephritis
- High blood pressure (hypertension)
- Kidney stones
- Urinary tract infections
Blood transfusions and medications such as iron and erythropoietin may be needed to control anemia.
Dietary restrictions may slow the buildup of wastes in the bloodstream and control symptoms such as nausea and vomiting. Restrictions include:
- Eating a low- protein, high- carbohydrate diet
- Limiting fluids
- Limiting salt, potassium, phosphorus, and other electrolytes
Support Groups
For additional resources, see kidney disease support group.
Outlook (Prognosis)
Without dialysis or a kidney transplant, death will occur from the buildup of fluids and waste products in the body. Both of these treatments can have serious risks and consequences. The outcome is different for each person.
Possible Complications
- Anemia
- Brain dysfunction, nervous system damage, dementia
- Changes in electrolyte levels
- Changes in sugar (glucose) metabolism
- Congestive heart failure
- Decreased functioning of white blood cells and immune system
- Decreased libido, impotence
- Excessive bleeding (hemorrhage)
- Hepatitis B, hepatitis C, liver failure
- High blood pressure
- Infection
- Loss of blood in the gastrointestinal tract; duodenal or peptic ulcers
- Miscarriage, menstrual irregularities, infertility
- Pericarditis, cardiac tamponade
- Peripheral neuropathy
- Platelet dysfunction
- Permanent skin color (pigmentation) changes
- Seizures
- Skin dryness, itching/scratching, leading to skin infection
- Weakening of the bones, fractures, joint disorders
When to Contact a Medical Professional
Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of end-stage kidney disease. Call your health care provider if you have acute or chronic kidney failure and it continues or gets worse.
Prevention
Treatment of chronic kidney failure may delay or prevent progression to ESRD. Some cases may not be preventable.
References
Tolkoff-Rubin N. Treatment of irreversible renal failure. In: Goldman L, Ausiello D, eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 133.
Mitch WE. Chronic kidney disease. In: Goldman L, Ausiello D, eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 131.
Reviewed By: Parul Patel, MD, Private practice specializing in Nephrology, Kidney and Pancreas Transplantation, affiliated with California Pacific Medical Center Department of Transplantation, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
