End-stage renal failure

Summary

• End-stage renal disease is the point at which the kidneys cannot sustain life any more.
• It is a permanent condition.
• It is treated with dialysis or a kidney transplant.

Definition

Also called end-stage renal disease, it is the point at which the kidneys cannot sustain life any more. It is a permanent condition and the patient is treated with dialysis or a kidney transplant. It usually follows longstanding chronic renal failure but can sometimes be the result of acute renal failure.

Symptoms

Symptoms are rare in the early stages of chronic renal failure with most occurring when the disease is advanced. Symptoms can include lethargy, weakness, unpleasant breath, pale itchy skin, shortness of breath, bone pain nausea, vomiting, headache and confusion.

Diagnosis

Diagnosis is made when patients with chronic kidney failure develop symptoms of ESRD and is confirmed by consistently high levels of certain blood chemicals like urea and creatinine. The kidneys are invariably small on special examination using sonar or special X-rays of the kidneys called tomograms. The glomerular filtration rate measures kidney function and it is 10 to 15 percent of what is expected in normal persons.

Treatment

Reversible factors such as dehydration and nephrotoxic drugs are first excluded. ESRD is treated with dialysis until a suitable donor can be found for a kidney transplant.

Written by Dr K. Coetzee, reviewed by Dr R. Moosa, head of the Renal Unit, Tygerberg Academic Hospital