End-Stage Renal Failure - Causes, Symptoms, and Treatment

Introduction:

The kidneys are the excretory systems of the human body, and they filter waste and excess water from the blood. Chronic kidney diseases hamper kidney function. End-stage renal failure, also known as end-stage kidney disease (ESRD), is the last chronic kidney disease stage. In people with end-stage kidney failure, the kidneys function below ten percent of their standard capability, meaning they are not working as they should. Kidney diseases are progressive. The duration of each stage depends on how the kidney disease is treated. Kidney disease takes around ten to twenty years to reach the end stage. ESRD is the fifth stage of chronic kidney disease progression.

What Causes End-Stage Renal Failure?

Most kidney diseases attack the tiny filtering units of the kidneys- nephrons. This leads to poor blood filtering, eventually leading to end-stage renal disease.

The most common causes of end-stage renal failure are -

• Diabetes - In diabetes or high blood sugar, the body cannot break down sugar properly, so blood sugar levels are always high. This increased blood sugar level damages the nephrons causing end-stage kidney failure.

• Hypertension - High blood pressure puts extra pressure on the kidneys' tiny blood vessels, damaging them. This damage prevents the kidney blood vessels from performing the filtration of blood.

• Kidney Stones.

• Enlarged Prostate.

• Cancer.

• Glomerulonephritis - It is the inflammation of the tiny filters of the kidney.

• Vesicoureteral Reflux - The urine flows back into the kidneys in this condition.

• Congenital Abnormalities - Abnormalities present since birth.

What Are the Symptoms of End-Stage Renal Failure?

End-stage renal failure presents a wide range of symptoms. They are:

• Decrease in the frequency of urination.

• Not able to urinate.

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• Fatigue.

• Malaise.

• Headaches.

• Unexplained weight loss.

• Loss of appetite.

• Nausea and vomiting.

• Dry and itchy skin.

• Change in the color of skin.

• Bone pain.

• Confusion.

• Difficulty in concentrating.

• Easily bruised.

• Epistaxis - Nose bleeding.

• Numbness of hands and feet.

• Foul-smelling breath.

• Excessive thirst.

• Hiccups.

• Absence of menstrual cycles.

• Obstructive sleep apnea.

• Restless leg syndrome.

• Low libido/ impotence.

• Edema - Swelling in the hands and feet.

How Is End-Stage Renal Failure Diagnosed?

• A thorough physical examination.

• Urinalysis - This urine test detects protein and blood in the urine. The presence of protein and blood in the urine suggests that the kidneys are not properly filtering waste.

• Serum Creatinine Test - Creatinine is the waste product of normal wear and tear of the muscles. This test helps the doctor determine how well the kidneys are functioning.

• Blood Urea Nitrogen Test - This test checks the amount of nitrogen in the blood.

• Estimated Glomerular Filtration Rate (GFR) - This test determines how well the kidneys filter waste. Glomeruli are tiny filters in the kidneys. This test tells how much blood passes through these filters per minute.

How Is End-Stage Renal Failure Treated?

The treatment modalities of end-stage renal failure are dialysis and kidney transplant.

• Dialysis - Dialysis is when waste products and extra fluid are removed from the blood when the kidneys stop working. The blood is diverted to an external machine to be filtered. Dialysis can help in removing excess salt, water, and waste from the body, keeping the levels of minerals and vitamins within normal limits, and controlling high blood pressure and red blood cell synthesis. Two types of dialysis can be carried out. They are:

1. 1. Hemodialysis - This process uses a machine to filter the blood. The machine filters the waste with the help of a solution. The filtered blood is then placed back into the body. This is carried out three to four times a week and takes around three hours for each cycle.
   2. Peritoneal Dialysis - This procedure involves using a cleansing fluid in the abdomen with the help of a tube or catheter. After some time, the fluid and waste products are removed from the catheter. This dialysis can be done at home or overnight during sleep.

• Kidney Transplant - A kidney transplant involves the removal of diseased kidneys and replacing them with a healthy donor kidney. A person can survive with one healthy kidney.

• Medications - Drugs used to control high blood pressure and diabetes so that end-stage renal failure can be prevented.

1. 1. Angiotensin converting enzyme inhibitors (ACE Inhibitors) and Angiotensin receptor blockers (ARBs)
   2. Finerenone- It is a prescribed drug used to reduce the risk of cardiovascular death, heart attack, and hospitalization for heart failure in people with chronic kidney disease associated with type 2 diabetes.
   3. Phosphate binders- These help to prevent the level of phosphorus from becoming high.
   4. Erythropoietin- To treat fewer blood cells or anemia.

• Vaccines - Hepatitis A and B vaccines, Pneumococcal polysaccharide (PPSV23) vaccines, and Flu vaccines can produce positive results if taken before and during dialysis.

• Lifestyle Modification - Water retention in the body due to end-stage kidney failure can lead to a gain in weight. So maintaining a healthy weight should be a priority.

1. 1. Calorie intake should be increased.
   2. A diet high in protein, sodium, and potassium should be avoided.
   3. Fluid intake should be restricted.
   4. Foods such as bananas, tomatoes, oranges, chocolate, nuts, spinach, and avocados should be consumed mindfully.
   5. Supplements like calcium, vitamins C, and D, and iron may help the kidneys function well.

What Is the Prognosis of End Stage Renal Failure?

End-stage renal failure can lead to mortality if prompt treatment with dialysis or a kidney transplant is not carried out. The prognosis depends upon the extent of the disease progression and differs for different patients.

What Are the Complications of End-Stage Renal Failure?

• Anemia - Lack of healthy blood cells.

• Bleeding from the stomach or intestines.

• Pain in the bones, joints, and muscles.

• Changes in the level of blood sugar.

• Damage to the nerves of arms and legs.

• Pleurisy - Fluid deposition around lungs.

• High blood pressure.

• Risk of heart attack and heart failure.

• High level of potassium.

• Increased risk of infection.

• Liver failure.

• Malnutrition.

• Miscarriage.

• Infertility.

• Restless Leg Syndrome - A condition with an uncontrollable urge to move the legs.

• Strokes and seizures.

• Edema - A condition where there is swelling of the body.

• Weak and fracture-prone bones.

Conclusion:

As the name suggests, end-stage renal failure is the last chronic kidney disease stage. After that, the level of kidney function drops drastically. It is a life-threatening condition that can be treated with the help of dialysis or kidney transplantation. If one has kidney disease, keeping a watch and getting regular check-ups can help them avoid progressing to end-stage renal failure.