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  • Conditions InDepth: End-stage Renal Disease (ESRD)

    Renal failure (kidney failure) occurs when the kidneys can't perform their normal functions. It usually occurs in middle-aged and older people. The kidneys are two bean-shaped organs on either side of the spine in the lower back. Their main functions are to remove waste from the body and to balance the water and mineral content of the blood by filtering waste, minerals, and water. The waste and water combine to form urine.
    Anatomy of the Kidney
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    End-stage renal disease (ESRD) refers to a permanent condition in which the kidneys are no longer able to filter waste from the blood. As the wastes build up, the tiny filters in the kidneys (nephrons) continue to lose their filtering ability. Although damage to the nephrons may occur suddenly after an injury or poisoning, many kidney diseases take years or decades to cause noticeable damage. ESRD is generally diagnosed when kidney function drops to 10% of normal. The two most common causes of ESRD are:
    • Diabetes —the nephrons are damaged by chronically high blood sugar levels that occur in poorly controlled diabetes
    • High blood pressure —causes damage to the blood vessels in the kidneys
    End-stage renal disease can lead to anemia , high blood pressure, bone disorders, heart failure, and mental confusion.
    As of the end of 2006, 506,256 Americans were undergoing treatment for ESRD. According to the National Kidney Foundation and National Institutes of Health, 354,754 were undergoing dialysis (an external filtering of the blood). About 18,052 individuals received a kidney transplant in 2006. More than 77,675 were waiting for a kidney transplant in 2008. And about 87,654 died of ESRD in 2006.
    What are the risk factors for end-stage renal disease?What are the symptoms of end-stage renal disease?How is end-stage renal disease diagnosed?What are the treatments for end-stage renal disease?Are there screening tests for end-stage renal disease?How can I reduce my risk of end-stage renal disease?What questions should I ask my doctor?What is it like to live with end-stage renal disease?Where can I get more information about end-stage renal disease?

    References

    Andrews PA. Renal Transplantation Brit Med J. 2002;324:530-534.

    Brenner, BM et al. Brenner & Rector’s The Kidney . 9th ed. Philadelphia, PA: Saunders, 2011.

    Ferri, Fred, ed. Ferri’s Clinical Advisor 2010 . 1st ed. Philadelphia, PA: Mosby Elsevier, 2009.

    Goldman L, Ausiello D., eds. Cecil Textbook of Internal Medicine . 23rd ed. Philadelphia, PA: Saunders, 2008.

    End-stage renal disease. National Institute of Diabetes & Digestive & Kidney Diseases website. Available at: http://www2.niddk.nih.gov/Research/ScientificAreas/Kidney/KEB.htm . Updated September 15, 2010. Accessed October 16, 2012.

    Rakel, R. Textbook of Family Medicine 2007 . 7th ed. Philadelphia, PA: Saunders Elsevier, 2009.

    Rakel, RE, Bope, ET Conn's Current Therapy . 60th ed. Philadelphia, PA: Saunders Elsevier, 2009.

    Wein, AJ et al. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders, 2007.

    Yu HT. Progression of chronic renal failure. Arch Int Med. 2003;163:1417-1429.

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