MedlinePlus Medical Encyclopedia: End-stage kidney disease

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End-stage kidney disease

Contents of this page:
Illustrations Alternative names Definition Causes, incidence, and risk factors Symptoms Signs and tests	Treatment Support Groups Expectations (prognosis) Complications Calling your health care provider Prevention

Illustrations

Kidney anatomy

Alternative names Return to top

Renal failure - end stage; Kidney failure - end stage; ESRD

Definition Return to top

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).

Causes, incidence, and risk factors Return to top

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 Return to top

Unintentional weight loss
Nausea or vomiting
General ill feeling
Fatigue
Headache
Frequent hiccups
Generalized itching
Greatly decreased urine output
No urine output
Easy bruising or bleeding
May have blood in the vomit or stools
Decreased alertness
- drowsiness, somnolence, lethargy
- confusion, delirium
- coma
Muscle twitching or cramps
Seizures
Increased skin pigmentation
Skin may appear yellow or brown
Nail abnormalities
Decreased sensation in the hands, feet, or other areas

Signs and tests Return to top

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.

Creatinine and BUN levels are chronically high.
Creatinine clearance is very low.

Treatment Return to top

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 Return to top

For additional resources, see kidney disease support group.

Expectations (prognosis) Return to top

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 Return to top

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

Calling your health care provider Return to top

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 Return to top

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

Update Date: 10/17/2003

Updated by: Irfan A. Agha, M.D., Department of Medicine, Renal Division, St. Louis University, St. Louis, MO. Review provided by VeriMed Healthcare Network.

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