Kidney failure - End-Stage Renal Disease: Symptoms, Causes & Treatment

Causes of kidney failure - ESRD

While there are various causes of ESRD only the risk factors which progress the chronic kidney damage can be specified as the reasons for kidney failure. The major causes of kidney failure resulting from progression factors accelerating chronic kidney damage as follows:

• Proteinuria
• Hypertension
• Diabetes
• Smoking
• Hyperlipidaemia
• Obesity

Proteinuria (increased levels of protein in urine) - In diabetic kidney disease, an albumin excretion rate higher than 30 mg per 24 hours (microalbuminuria) can strongly predict nephropathy (proteinuria) and subsequent loss of kidney function.

Hypertension (high blood pressure) – Hypotension patients are 32% less likely to develop kidney failure than hypertensives. Controlling high blood pressure can reduce the progression of kidney failure. 

Diabetes (persistent increase in blood sugar levels) – Diabetes leads to kidney failure. Large prospective studies from the early 1990s demonstrated the benefits of blood glucose control in both the development and progression of microvascular complications. Intensive control needs to achieve at least a ≤6.0% haemoglobin A1c. 

Smoking – Smoking from nicotine sources can initiate and help in CKD progression, especially in diabetics, approximately twofold. It is also seen with microalbuminuria and the development of stage 5 CKD (ESRD).

Hyperlipidaemia (high lipid levels in the blood) – Hyperlipidaemia predicts incident CKD. The prevalence of hyperlipidaemia appears to increase as kidney function declines, and hyperlipidaemia is a characteristic of nephrotic syndrome. In 85-90% of patients with decreased kidney function and proteinuria greater than 3 g/day, elevated plasma total and low-density lipoprotein cholesterol occur. 

Obesity - Studies demonstrated a close relationship between increased body mass index (BMI) and ESRD development, especially in men and less in women.

Causes of acute kidney failure

The three main causes of acute kidney functions include: 

• Factors which alter the blood flow to kidneys 
• Factors which could block the flow of urine and 
• Factors damaging the kidneys

Factors altering the renal blood flow could include: 

• Liver failure
• Serious burns or dehydration
• An infection
• Heart failure
• Blood pressure medications
• Blood or fluid loss

Factors blocking the flow of urine include: 

• Kidney calculi 
• Blood clots in the urinary tract
• Enlarged prostate.
• Nerve damage in bladder
• Bladder, cervical, colon, or prostate cancer

Factors damaging the kidneys include:

• Cholesterol deposits
• Blood clots
• Drug induced renal disease. 
• Glomerulonephritis. 
  

Causes of kidney failure in child

The causes of kidney failure in young adults could be caused by either AKI or CKD. These conditions can be caused by: 

• Hereditary Diseases
• Infection
• Nephrotic Syndrome
• Systemic Diseases
• Trauma
• Urine Blockage or Reflux
• Birth defects
  

Causes of death in ESRD patients 

An Israeli study in 1992 demonstrated that infectious and cardiac diseases were the primary causes of death in ESRD patients undergoing dialysis. 

Complications of kidney failure - ESRD

ESRD can be linked to various types of clinical manifestations complications of kidney failure, which can result in high morbidity and mortality and poor quality of life with the progressive decline of kidney function, which interact with each other. Some of the ESRD complications are of cardiovascular and neurologic origin, which can be quantified as follows: 

• Left ventricular hypertrophy - thickening left ventricle wall. 
• Cardiac chamber dilation - Enlarged heart chambers with difficulty in contraction.
• Ischemia - a restriction or reduction in a part of the body due to reduced blood circulation. 
• Myocardial fibrosis - scarring of cardiac muscle with increased collagen deposition. 
• Heart failure - Inability of the heart in pumping enough blood for the body's needs. 
• Arrhythmias - Irregular heartbeat.
• About 25-30% of ESRD patients with angina had no evidence of significant coronary artery disease, but an undetermined number have silent coronary disease. 
• Changes in the brain’s white matter - cause disturbed anatomical organisation, confusion, functional connectivity, etc.
• Cerebral atrophy (decrease in cerebral size) - loss of neurons causing dementia, seizures, etc.
• Osmotic demyelination syndrome - leads to brain cell dysfunction. 

The complications of end stage renal disease can be attributed, at least partly, to the accumulation of uremic toxins. However, a cause-and-effect relationship between these compounds and the complications of kidney failure (uraemia) has not been clearly established.

Acute Kidney Failure Complications

The acute kidney failure complications include few or all the following:

• Oedema (fluid buildup)
• Chest pain (especially in the pericardial region) 
• Acidosis (acidic blood)
• Muscle weakness (due to imbalanced electrolytes) 
• Death
  

Kidney failure prevention

• The prevention of kidney failure starts with avoiding contracting AKI or CKD. Nevertheless, the prevention of kidney failure can be initiated if the treatment strategies which are effective in slowing the progression toward kidney failure are started at earlier stages of CKD. 
• Avoiding or managing diabetes, hypertension, and other such health issues that cause kidney damage is the primary step in preventing kidney failure. Maintaining a healthy weight with healthy food and exercise helps both kidney failure patients as well as the risk population.
  

Kidney failure diet

The diet for kidney failure patients includes foods such as fresh fruits, whole grains, frozen or fresh vegetables, and low-fat or fat-free dairy products. Cutting back salts (< 2,300 mg sodium/day) and sugars can help. The diet for ESRD patients include:

• Choosing vegetables such as spinach, peppers, and broccoli.
• Baking meat items can be better than frying.
• Foods without added fats or gravy can be opted.
• Gradually shifting from whole milk to 2% milk.
• Whole grains foods (brown rice, whole wheat, oats, whole-grain corn, etc.) can be used instead of white rice. 
• Reading food labels can help, resulting in avoiding foods low in saturated fats, trans fats, etc. 
• A food diary can help to track food and food habits.
• The DASH diet plan can lower blood pressure. 

Other kidney failure prevention tips include: 

• Taking at least 30 minutes of rigorous physical activity daily, aiming for a healthy weight.
• Getting enough sleep (at least 7-8 hours each night)
• Abstaining from smoking and other tobacco product consumption. 
• Limiting alcohol intake, thus avoiding weight gain. 
• Exploring stress-reducing activities and sticking one (such as yoga) suiting your needs helps in relaxation and coping with emotional and physical health problems.
  

ESRD - kidney failure diagnosis

End stage renal disease diagnostic tests mainly include blood investigations which could reveal: 

• Decreased levels of 
• Serum bicarbonate
• Haemoglobin/haematocrit
• Iron stores
• Vitamin D levels. 
• Albumin 
• Increased levels of
• Serum creatinine
• Blood urea nitrogen
• Serum potassium
• Serum phosphorus 
  

Kidney failure treatment

As ESRD becomes inevitable, the nephrologists prescribe appropriate dialysis modality based on patient preference and options for vascular access for haemodialysis or peritoneal dialysis. The ESRD treatment options include: 

• Medicines – to manage and treat various other comorbid conditions.
• Diet restrictions – supplementing therapies. 
• Fluid management – to treat acidosis. 
• Renal (Kidney) transplant – to finally conclude kidney treatment

Kidney failure treatment without dialysis 

Patients with ESRD require medicines to manage comorbid conditions and secondary complications. Kidney failure treatment can be completed only with renal replacement therapies such as continuous hemofiltration and haemodialysis, intermittent haemodialysis, peritoneal dialysis. These can extend the life until kidney transplantation is completed.

Acute kidney failure vs Chronic kidney disease - Differences between Acute kidney failure & Chronic kidney disease

Acute kidney injury (AKI) and Chronic kidney disease (CKD) are two different conditions that affect the kidneys. AKI is a sudden loss of kidney function, while CKD is a gradual decline in kidney function.

FAQs (frequently asked questions on Kidney failure - End-Stage Renal Disease)

Department of Nephrology | Kidney Transplantation