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Doctor-Diagnosing-End-Stage-Renal-Disease

The damage that contributes to end-stage renal disease usually takes place over several months or years.

As kidney function is progressively lost, a point is reached where kidneys are no longer able to perform essential functions. This is referred to as advanced chronic kidney disease, or end-stage renal disease.

  • Healthy kidneys filter waste and harmful impurities out of blood and send those materials out of the body in the form of urine.
  • When damaged or diseased kidneys can no longer complete these tasks, treatment options typically include either dialysis or a kidney transplant.

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Signs of End-Stage Renal Disease

Kidney disease is classified as end-stage renal disease when kidney functioning is less than 15 percent of what's considered normal. Initially, there may not be any noticeable symptoms as kidney functioning continues to decline. This is because these two bean-shaped organs are highly adaptable. The body naturally compensates for reduced filtering abilities. When this is no longer possible, symptoms may include:

  • Nausea and vomiting
  • General fatigue and weakness
  • Loss of appetite
  • Changes in urination habits
  • Reduced mental clarity
  • High blood pressure that's becoming difficult to manage
  • Sleep-related issues
  • Recurring itching
  • Foot and ankle swelling
High-Blood-Pressure-Resulting-from-End-Stage-Renal-Disease
Dialysis-Treatment-for-End-Stage-Renal-Disease

Causes and Contributing Factors

Underlying conditions like type 1 and type 2 diabetes and chronic high blood pressure can make kidneys work harder and place added stress on these organs. Kidneys may also be affected by inflammation of the kidney filtering units (glomerulonephritis) and long-term urinary tract obstructions that may result from an enlarged prostate or kidney stones. Recurring infections can also be a contributing factor.

How Is Later-Stage Kidney Disease Diagnosed?

Since symptoms tend to become increasingly noticeable over time, diagnosis of end-stage renal disease often requires a thorough physical examination and a discussion of symptoms. A positive diagnosis is made with urine, blood, and image tests. In addition to an MRI and CT scan, an ultrasound may be done to look for abnormalities. A biopsy is also sometimes performed to collect a tissue sample.

Treatment Options

Many patients start with regular dialysis treatments when their kidneys are no longer able to properly function. Dialysis can be done in one of two ways. Involving the filtering of blood with a special machine that cleans the blood and returns it to the body, hemodialysis is the most common form of dialysis. With peritoneal dialysis, a special fluid is placed into the abdomen to absorb waste. The fluid is then drained.

If a kidney transplant is done, a donor kidney is taken from either a deceased individual or a living donor. In some cases, family members may be good matches. Other times, individuals end up on a waiting list. The new kidney will be attached to its corresponding ureter and blood vessels so it can function properly. Following a kidney transplant, patients will need to take immune suppression drugs to prevent rejection.

What a urologist can do to help with the decisions that will need to be made when end-stage renal disease occurs is to clearly explain options. Some patients prefer to continue with dialysis until a donor kidney is available. Others wish to solely rely on non-surgical care to stay as comfortable as possible during their remaining time. There is also research being done with regenerative medicine that may eventually make it possible for severely damaged organs and tissues to heal. As far as prevention goes, the risk of kidney problems can be reduced by making an effort to maintain good overall health and manage underlying conditions like diabetes that may affect kidney functioning.

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faculty_dhar
Mrinal Dhar, M.D.
General Urology
Associate Clinical Professor of Urology
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Michael K. Louie, M.D.
General Urology
Associate Clinical Professor & Director of Urology, Inland Empire
Dr Moskowitz-Ross
Ross Moskowitz, M.D.
General Urology
Assistant Clinical Professor of Urology
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M. Leon Seard, II, M.D.
General Urology
HS Associate Clinical Professor, Director of Ambulatory Urologic Services

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