Introduction to End Stage Renal Disease

Kidney Failure Statistics

• The Third National Health and Nutrition Examination Survey (NHANES III) estimated the prevalence of chronic kidney disease in U.S. adults to be 10.8% or approximately 19.2 million people.

• In 2000, end-stage renal disease affected more than 375,000 Americans and is expected to increase to 651,000 by 2010.

• Of the 375,000 persons with end-stage renal disease, 275,000 are on dialysis and more than 100,000 have a functioning kidney transplant.

• The typical end stage renal disease patient is male (55%), Caucasian (60%), and is between the ages of 45-64 (41%).

• Within the United States, 67,000 deaths occur annually as a result of kidney failure.

• In the United States alone, $19 billion was spent on end-stage renal disease in 2000, and costs are projected to exceed $28 billion by 2010.

Causes of Acute Renal Failure

The causes of acute renal failure include:

• Myocardial Infarction - a heart attack may lead to temporary kidney function.

• Rhabdomyolysis - muscle breakdown due to severe dehydration, infection, certain medications or other causes.

• Decrease blood flow to the kidneys due to blood loss or shock An obstruction or blockage along the urinary tract (such as kidney stones).

• Vesicoureteral reflux (VUR) - a condition in children in which urine abnormally flows backward from the bladder into the ureters. It may even reach the kidneys where infection and scarring can occur over time. VUR occurs in 1% of children and tends to run in families. Most children outgrow mild forms of VUR, but some children with VUR can develop permanent kidney damage and kidney failure later in life.

• Hemolytic uremic syndrome - usually caused by a bacterial (E. coli) infection due to obstruction of the small structures and vessels of the kidney.

• Ingestion of certain medications that may cause toxicity to the kidneys.

• Glomerulonephritis - Glomerulonephritis (inflammation of the kidney glomeruli) may be a temporary and reversible condition or it may be progressive resulting in destruction of the kidney glomeruli. Damage to the glomeruli with subsequent impaired filtering causes blood and protein to be lost in the urine. Often times, the precise cause is unknown. Because symptoms develop gradually, the disorder may be discovered when there is an abnormal urinalysis during a routine physical or evaluation of other medical issues, such as hypertension. Medications that have been associated with glomerulonephritis include: allopurinol, phenytoin, and varioius antibiotics. A common form of this condition occurs in young children following a case of strep throat.

Causes of End Stage Renal Disease

The causes of end-stage renal disease (ESRD), also known as chronic renal failure, include:

• Diabetes - Diabetic nephropathy is the most common cause of ESRD and is estimated to be the cause in about 35% of cases.

• Hypertension - High blood pressure is the second leading cause of ESRD and is estimated to be the cause in about 23% of cases.

• Glomerulonephritis - Glomerulonephritis (inflammation of the kidney glomeruli) may be a temporary and reversible condition, or it may be progressive resulting in destruction of the kidney glomeruli. Damage to the glomeruli with subsequent impaired filtering causes blood and protein to be lost in the urine. Often times, the precise cause is unknown. Because symptoms develop gradually, the disorder may be discovered when there is an abnormal urinalysis during a routine physical or evaluation of other medical issues, such as hypertension. Glomerulonephritis is estimated to be the cause of ESRD in about 16% of cases.

• Polycystic kidney disease - refers to a group of inherited disorders characterized by the growth of numerous fluid-filled cysts in the kidneys. Autosomal dominant polycystic kidney disease (ADPKD) typically affects adults while autosomal recessive polycystic kidney disease (ARPKD) mainly affects infants. Polycystic kidney disease has been estimated to be the cause of ESRD in about 4.3% of cases.

• Systemic lupus erythematosis (SLE) - a chronic inflammatory/autoimmune disease that can injure the skin, joints, kidneys and nervous system.

• A prolonged urinary tract obstruction or blockage.

• Alport syndrome - an inherited disorder that causes deafness, progressive kidney damage, and eye defects.

• Nephrotic syndrome - This is a type of kidney disease which leads to loss of protein in the urine and swelling of the face (often the eyes) or body. It is most common in children younger than 6 years old and is more prevalent in boys than in girls.

• Cystinosis - an inherited disorder of the renal tubules of the kidney that results in the accumulation of the amino acid cystine. The excessive build-up of cystine results in the formation of crystals that can damage the kidneys, eyes, and other organ systems.

• Interstitial nephritis - a hypersensitivity reaction causing inflammation of the small internal structures of the kidney. Medications that have been known to cause interstitial nephritis include: penicillins, cephalosporins, allopurinol, and azathioprine.

• Unknown causes account for approximately 20% of chronic renal disease