End-Stage Renal Disease

What Is It?

End-stage renal disease is a condition in which the kidneys are no longer able to function normally. Usually this means that they are functioning at less than 10 percent of their normal capacity. When this occurs, dialysis or kidney transplant is needed.

In the United States, more than a third of people with end-stage renal disease have diabetes, and diabetic nephropathy (renal disease due to diabetes) is the leading cause of end-stage renal disease. Up to 40 percent of all people with type 1 (insulin-dependent or juvenile) diabetes eventually develop end-stage renal disease. Kidney disease also can develop in people with type 2 (non-insulin-dependent or adult-onset) diabetes. With either type, poor control of blood sugar increases the risk of end-stage renal disease.

Among other causes of end-stage renal disease, the most common are:

• High blood pressure (hypertension)
• Vascular disease (atherosclerosis)
• Rheumatic diseases (such as lupus)
• Genetic disorders, such as polycystic kidney disease
• Exposure to toxic drugs, including certain antibiotics, chemotherapy, contrast dyes and pain relievers

Symptoms

Symptoms of end-stage renal disease include weight loss, nausea or vomiting, general malaise, fatigue, headache, hiccups, itching, decreased urination, easy bruising or bleeding, lethargy, difficulty breathing and seizures. Symptoms may be mild until kidney function has dropped to less than 15 percent of normal.

Usually kidney disease has been recognized for many years before end-stage renal disease occurs. A blood test will show high levels of creatinine and blood urea nitrogen, chemicals ordinarily removed by the kidneys. Dialysis generally is considered when a specific set of problems has developed, such as:

• Pericarditis (inflammation of the lining of the heart)
• Fluid overload or congestive heart failure (in which fluid backs up behind the heart into the lungs) that cannot be adequately improved with diuretics (medications that encourage elimination of fluid)
• Severely elevated blood pressure that is not improved by antihypertensive medications
• Confusion, decreased alertness or seizures
• Bleeding related to kidney failure that cannot be improved through other means
• Severe, unrelenting nausea and vomiting
• Severe abnormalities in blood tests indicating that dialysis will soon be necessary, even if the problems mentioned above have not yet developed

Diagnosis

Kidney disease is diagnosed by analyzing urine and measuring elevated levels of creatinine and urea nitrogen in the blood. Additional tests may be necessary to determine the exact reason that the kidneys have stopped working.