Renal Failure Information

Renal failure:

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:
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 worsens to the point where kidney function is less than 10% of normal.

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 U.S., more than 400,000 people are on long-term dialysis and more than 20,000 have a functioning transplanted kidney. The most common cause of ESRD in the U.S. is diabetes. ESRD almost always follows chronic kidney failure, which may exist for 10-20 years or more before progressing to become ESRD.

Symptoms:

- Unintentional weight loss
- Nausea or vomiting
- General ill feeling
- Fatigue
- Headache
- Frequent hiccups
- Generalized itching
- Greatly decreased urine output - No urine output
- May have blood in the vomit or stools

- Easy bruising or bleeding - 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

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Treatment Options

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. Other treatments of chronic kidney failure may continue but are unlikely to work without dialysis or transplantation. Current therapy includes aggressive treatment of high blood pressure with an ACE inhibitor or an angiotensin receptor blocker.

Associated diseases that cause or result from chronic renal failure must be controlled. Hypertension (high blood pressure), congestive heart failure, urinary tract infections, kidney stones, obstructions of the urinary tract, glomerulonephritis, and other disorders should be treated.

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 a low- protein diet, with high carbohydrate levels to make up for the lost calories. Salt, potassium, phosphorus, and other electrolytes may be restricted.

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