End Stage Renal Disease (ESRD)

End Stage Renal Disease
(ESRD)
Chronic kidney disease and ESRD
• By definition, the presence of both of these factors (glomerular
filtration rate [GFR] less than 60 mL/min and albumin greater than 30
mg per gram of creatinine) along with abnormalities of kidney
structure or function for greater than three months signifies chronic
kidney disease.
• End-stage renal disease, moreover, is defined as a GFR less than 15
mL/min.
• The kidneys of people with ESRD function below 10 percent of their
normal ability, which may mean they’re barely functioning or not
functioning at all.
• Chronic kidney disease typically doesn’t reach the end stage until 10
to 20 years after diagnosis.
• End-stage renal disease, also called end-stage kidney disease,
occurs when chronic kidney disease — the gradual loss of
kidney function — reaches an advanced state.
• When kidneys lose their filtering capabilities, dangerous levels
of fluid, electrolytes and wastes can build up in the body.
• dialysis or a kidney transplant to stay alive
Symptoms
• signs and symptoms might include:

• Nausea
• Vomiting
• Loss of appetite
• Fatigue and weakness
• Sleep problems
• Changes in urine volume
• Decreased mental sharpness
• Muscle twitches and cramps
• Swelling of feet and ankles
• Persistent itching
• Chest pain, if fluid builds up around the lining of the heart
• Shortness of breath, if fluid builds up in the lungs
• High blood pressure (hypertension) that's difficult to control
• volume overload refractory to diuretics,
• hypertension poorly responsive to medication,
• anemia,
• metabolic derangements including hyperkalemia, hyponatremia,
metabolic acidosis, hypo/hypercalcemia, and hyperphosphatemia.
Causes
• Type 1 or type 2 diabetes

• High blood pressure
• Glomerulonephritis
• Interstitial nephritis (, an inflammation of the kidney's tubules
and surrounding structures
• Polycystic kidney disease
• Prolonged obstruction of the urinary tract, from conditions such
as enlarged prostate, kidney stones and some cancers
• Vesicoureteral reflux, a condition that causes urine to back up
into the kidneys
• Recurrent kidney infection, also called pyelonephritis
• Autoimmune diseases, such as lupus and IgA nephropathy
Risk factors
• Kidney disease after a kidney transplant

• High blood pressure
• Tobacco use
• Male sex
• Older age
Complications
• Kidney damage, once it occurs, can't be reversed. Potential
complications can affect almost any part of the body and can
include:
• Fluid retention, which could lead to swelling in arms and legs,
high blood pressure, or fluid in lungs (pulmonary edema)
• A sudden rise in potassium levels in blood (hyperkalemia),
which could impair the heart's ability to function and may be life-
threatening
• Heart and blood vessel (cardiovascular) disease
• Weak bones and an increased risk of bone fractures
• Anemia
• Damage to the central nervous system, which can cause
difficulty concentrating, personality changes or seizures
• Decreased immune response,
• Pericarditis, an inflammation of the saclike membrane that
envelops the heart (pericardium)
• Pregnancy complications that carry risks for the mother and the
developing fetus
• Irreversible damage to kidneys (end-stage kidney disease),
eventually requiring either dialysis or a kidney transplant for
survival
• Metabolic acidosis
• Hyperphosphatemia
• Hypoalbuminemia
Less commonly
• liver failure
• hyperparathyroidism
• malnutrition
• stomach and intestinal bleeding
Diagnosis
• Urinalysis:
• Urinalysis can detect signs of glomerulonephritis,
tubulointerstitial disease, vasculitis, hereditary nephritis, and
lupus nephritis;
• Findings include
• proteinuria
• hematuria,
• cellular casts,
Markers of Kidney Damage
• Proteinuria refers to increased excretion of any urinary protein,

including albumin and other serum proteins (tubular proteins).
• A normal urinary protein/creatinine ratio is less than 200 mg
per g; p
• To quantitate albuminuria, a spot urine protein/creatinine ratio can be
done
• A normal urinary albumin/creatinine ratio is less than 30 mg
per g.
• A value higher than 30 mg of albumin per gram of creatinine is
considered abnormal, while values greater than 300mg/g are
considered severely impaired renal function.
• Additionally, a 24-hour urine protein can also be performed.
• A value greater than 3.5 g is concerning for nephrotic range
proteinuria.
• High Blood urea nitrogen test:
• very low Estimated glomerular filtration rate (GFR)

•
• High Serum creatinine
Other tests
• Changes of substances in the blood that are normally controlled by
the kidneys.
• This may include abnormal levels of calcium, phosphorus,
parathyroid hormone, blood electrolytes, and potassium.
• An ultrasound can provide data estimating size, obstructions, stones,
cystic renal disease, mass lesions, echogenicity, and cortical thinning.
• End-stage renal disease is a progressive disorder, and timely renal
replacement therapy is necessary to prevent death
• Even with timely dialysis, the death rates vary from 20% to 50% over
24 months. The most common cause of death is hyperkalemia,
followed by adverse cardiac events

End Stage Renal Disease (ESRD)

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End Stage Renal Disease

• signs and symptoms might include:

• Type 1 or type 2 diabetes

• Kidney disease after a kidney transplant

• Proteinuria refers to increased excretion of any urinary protein,

• very low Estimated glomerular filtration rate (GFR)

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