Description

End-stage renal disease, also called end-stage kidney disease or kidney failure, occurs when chronic kidney disease — the gradual loss of kidney function — reaches an advanced state. In the final stage of kidney disease, your kidneys are not working as they should to meet your body's needs.

The kidneys filter waste and excess fluid from the blood, which are then excreted in the urine. When the kidneys lose their filtering abilities, dangerous levels of fluid, electrolytes and wastes can build up in your body.

With end-stage renal disease, you need dialysis or a kidney transplant to stay alive. But you can also opt for conservative treatment to manage your symptoms — the pursuit of the improvement of the quality of life for the rest of your time.

Symptoms

Early in chronic kidney disease, you may have no signs or symptoms. As chronic kidney disease progresses to end-stage kidney disease, signs and symptoms may include:

  • Nausea
  • Vomiting
  • Loss of appetite
  • Fatigue and weakness
  • Changes in the amount of urine
  • Chest pain, if fluid builds up around the lining of the heart
  • Shortness of breath, if fluid builds up in the lungs
  • Swelling of feet and ankles
  • High blood pressure (hypertension) that is difficult to control
  • Headaches
  • Difficulty sleeping
  • Decreased mental acuity
  • Muscle spasms and cramps
  • Persistent itching
  • Metallic taste

The signs and symptoms of kidney disease are often nonspecific, which means that it can also be caused by other diseases. Because the kidneys can compensate for lost function, signs and symptoms may not appear until irreversible damage has occurred.

When to seek care

Make an appointment with your health care provider if you have signs or symptoms of kidney disease.

If you have a medical condition that increases your risk of kidney disease, your doctor is likely to monitor kidney function with urine and blood tests, and your blood pressure during office visits. Ask your healthcare provider if these tests are necessary for you.

Causes

Kidney disease occurs when a disease or condition impairs kidney function, causing kidney damage to worsen over several months or years. For some people, the kidney damage can continue to progress, even after the underlying condition is resolved.

The diseases and conditions that can lead to kidney disease include:

  • Type 1 or type 2 diabetes
  • High blood pressure
  • Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis) — an inflammation of the filtering units of the kidneys (glomeruli)
  • The nephritis interstitial (in-tur-STISH-ul-nuh-FRY-tis), an inflammation of the tubules of the kidney and surrounding structures
  • Polycystic kidney disease or other hereditary renal diseases
  • Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some types of cancer
  • Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux, a condition that causes urine to back up into your kidneys
  • Recurrent kidney infection, also called pyelonephritis (pie-uh-low-nuh-FRY-tis)

Risk factors

Certain factors increase the risk of chronic kidney disease will progress more rapidly to end-stage renal disease, including:

  • Diabetes with poor control of blood sugar
  • The kidney disease that affects the glomeruli, the structures in the kidneys that filter waste from the blood
  • Polycystic kidney disease
  • High blood pressure
  • The consumption of tobacco
  • Black, Hispanic, Asian, Pacific islander, or Native American heritage
  • Family history of kidney failure
  • Age
  • The frequent use of medications that could be harmful to the kidney

Complications

The kidney damage, once produced, can not be reversed. Possible complications that can affect almost any part of your body and can include:

  • Fluid retention, which could lead to swelling in the arms and legs, high blood pressure, or fluid in the lungs (pulmonary edema)
  • A sudden increase in the levels of potassium in your blood (hyperkalemia), which could affect the heart's ability to function and may be life-threatening
  • Heart disease
  • The weakness of the bones and an increased risk of bone fractures
  • Anemia
  • Decreased sexual desire, erectile dysfunction or reduced fertility
  • The damage to his central nervous system, which can cause difficulty concentrating, personality changes or seizures
  • Decreased immune response, which makes them more vulnerable to infection
  • Pericarditis, an inflammation of the saclike membrane that surrounds the heart (pericardium)
  • Pregnancy complications that carry risks for the mother and the developing fetus
  • Malnutrition
  • Irreversible damage to the kidneys (renal failure), finally, that requires dialysis or a kidney transplant to survive

Prevention

If you have kidney disease, you may be able to slow its progress, making a healthy lifestyle:

  • Achieve and maintain a healthy weight
  • Be active on most days
  • Limit of protein and a balanced diet of nutritious foods, low sodium food
  • The Control of your blood pressure
  • Take your medicines as prescribed
  • Have your cholesterol levels each year
  • Control your blood sugar level
  • Do not smoke or use tobacco products
  • Get regular checkups

Diagnosis

For the diagnosis of end-stage renal disease, the doctor may ask about your family and your medical history. You can also have physical and neurological examinations, along with other tests, such as:

  • Blood tests to measure the amount of waste products, such as urea and creatinine in the blood
  • Urine tests, to check the level of the protein albumin in the urine
  • Imaging tests, such as ultrasound, mri or a ct scan to evaluate the kidneys and look for unusual areas
  • Removing a sample of kidney tissue (biopsy), to examine under a microscope to find out what type of kidney disease that you have and what is the harm

Certain tests may be repeated over time to help your provider to follow the progress of your kidney disease.

Stages of kidney disease

There are five stages of kidney disease. To determine at which stage they have, the doctor performs a blood test to check the glomerular filtration rate (GFR). The GFR was measured by the amount of blood your kidneys filter each minute, it is recorded as milliliters per minute (mL/min). As the GFR decreases, so does your kidney function.

When the kidneys are no longer functioning at a level that is necessary to keep it alive, you have end-stage renal disease. End-stage renal disease usually occurs when kidney function is less than 15% of the typical renal function.

As part of the kidney disease staging, your healthcare provider may also check if you have protein in the urine.

Treatment

End-stage renal disease treatments include:

  • Kidney transplant
  • Dialysis
  • Supportive care

Kidney transplant

A kidney transplant is a surgical procedure to place a healthy kidney from a live or deceased donor into a person whose kidneys are not working properly. A kidney transplant is often the treatment of choice for end-stage renal disease, compared with a lifetime of dialysis.

The kidney transplant process takes time. It involves finding a living donor or deceased, whose kidney best suits your needs. Then you have the surgery to place the new kidney in your lower abdomen and attach the blood vessels and ureter — the tube that connects the kidney to the bladder, which will allow the new kidney to function.

You may need to spend several days to a week in the hospital. After leaving the hospital, you can expect frequent checkups to monitor the progress of your recovery continues. You can take a series of medications to help keep their immune system from rejecting the new kidney, and to reduce the risk of post-surgery complications, such as infection.

After a successful kidney transplant, your new kidney filters the blood, and you no longer need dialysis.

Dialysis

Dialysis does some of the work of the kidneys when the kidneys can't do it by themselves. This includes the removal of excess fluids and waste products from the blood, restoring the levels of electrolytes, and help control your blood pressure.

Dialysis options, which include peritoneal dialysis and hemodialysis.

For the dialysis to be successful, you may need to make lifestyle changes, such as following certain dietary recommendations.

Palliative care

If you do not wish to have a kidney transplant or dialysis, you can choose palliative or supportive care to help you manage your symptoms and feel better. You can also combine the palliative care with a kidney transplant or dialysis.

Without dialysis or a transplant, renal failure progresses, eventually leading to death. Death can occur quickly or take months or years. Supportive care may include the management of symptoms, measures to keep you comfortable and end-of-life planning.

Lifestyle and home remedies

As part of your treatment for kidney disease, your doctor may recommend that you follow a special diet to help support the kidneys and limit the work they do. Ask for a referral to a dietitian with expertise in kidney disease to learn ways to make your diet easier on the kidneys.

Depending on your situation, renal function and overall health, your dietitian may recommend that you:

  • Avoid products with added salt. Reduce the amount of sodium you consume each day by avoiding products with added salt, including many convenience foods, such as frozen dinners, canned soups, and fast foods. Other foods with added salt, which include salty snacks, canned vegetables, and processed meats and cheeses.
  • Choose lower potassium of the alimentos.Su dietitian may recommend that you choose lower potassium foods in each meal. Foods rich in potassium include bananas, oranges, potatoes, spinach and tomatoes. Examples of low-potassium foods include apples, carrots, cabbage, carrots, green beans, grapes, and strawberries. Be aware that many salt substitutes that contain potassium, so in general you should avoid if you have kidney failure.
  • Limit your protein. Your dietitian will calculate the grams of protein you need each day, and make recommendations based on that amount. Foods rich in protein include lean meats, eggs, milk, cheese, and beans. Low-protein foods are vegetables, fruits, breads and cereals.

Choose lower potassium foods. Your dietitian may recommend that you choose lower potassium foods in each meal. Foods rich in potassium include bananas, oranges, potatoes, spinach and tomatoes.

Examples of low-potassium foods include apples, carrots, cabbage, carrots, green beans, grapes, and strawberries. Be aware that many salt substitutes that contain potassium, so in general you should avoid if you have kidney failure.

Coping and support

The learning is in kidney failure can come as a shock, even if you have known about your kidney disease for a while. It can be difficult to manage the treatment plan if you are on dialysis.

To help cope, consider trying to:

  • Connect with other people who have kidney disease. It may help to talk to other people with end-stage renal disease Ask your doctor about support groups in your area. Or contact organizations such as the American Association of Kidney Patients, the National Kidney Foundation or the American Kidney Fund for groups in your area.
  • Stick to your routine when possible. Try to keep working and do the activities you enjoy, if their condition allows it.
  • Be active on most days of the week. With authorization from your healthcare professional, try to do at least 30 minutes of physical activity most days of the week. This can help with fatigue and stress.
  • Talk with someone you trust. It might help to talk about your feelings with a friend or a member of the family, a religious leader, or someone else you trust. Your doctor may be able to recommend a social worker or a counselor.

Preparing for your appointment

For end-stage renal disease, is likely to continue to see the same health care provider and the care team that you have been seeing for the treatment of chronic kidney disease. If you are not being cared for by a doctor who specializes in problems of the kidneys (kidney doctor), you may be referred to one as the disease progresses.

What you can do

To prepare for your appointment, ask if there is something that you need to make ahead of time, as you make changes to your diet. Then, take note of the following:

  • Your symptoms, including any that seem unrelated to your kidneys or urinary function, and when you started
  • Of all your medicines and doses, vitamins, or other supplements that you take
  • Its key of the medical history, including other medical conditions, and family history of kidney disease
  • Questions to ask your provider

Have a friend or family member, if possible, to help you remember the information they give you.

For end-stage renal disease, some basic questions to ask your provider include:

  • What is the level of damage to the kidneys?
  • It is my worsening of renal function?
  • I need more tests?
  • What is the cause of my condition?
  • Can kidney damage be reversed?
  • What are my treatment options?
  • What are the possible side effects of each treatment?
  • I have these other health conditions. How can I best manage them together?
  • What should I eat a special diet?
  • Can you give me the name of a dietitian who can help me plan my meals?
  • Are there brochures or other printed material I can have? What sites do you recommend?
  • How frequently do I need to have my kidney function tested?

Don't hesitate to ask any questions you may have.

What to expect from your health care provider

Your doctor may ask you questions, such as:

  • Have you noticed changes in your habits, urinary or unusual fatigue?
  • Have you been diagnosed or treated for high blood pressure?
Symptoms and treatment of End-stage renal disease