Pediatric Nephrology Clinical Services : Conditions & Procedures

End Stage Renal Failure

End-stage kidney disease is the complete or almost complete failure of the kidneys to function. The kidneys can no longer remove wastes, concentrate urine and regulate electrolytes.
End-stage kidney disease occurs when the kidneys are no longer able to function at a level that is necessary for day-to-day life. It usually occurs when chronic kidney failure has progressed to the point where kidney function is less than 10% of normal.

The most common cause of ESRD in the U.S. is diabetes. ESRD almost always follows chronic kidney failure. A person may have kidney failure for 10 – 20 years or more before progressing to ESRD.

Symptoms include:

  • Decreased alertness
  • Drowsiness, somnolence, lethargy
  • Confusion, delirium
  • Coma
  • Decreased sensation in the hands, feet, or other areas
  • Decreased urine output
  • Easy bruising or bleeding
  • Fatigue
  • Frequent hiccups
  • General ill feeling
  • Headache
  • Increased skin color (pigmentation)
  • Itching
  • Blood in vomit or stools
  • Muscle twitching or cramps
  • Nail abnormalities
  • Nausea or vomiting
  • No urine output
  • Seizures
  • Skin may appear yellow or brown
  • Unintentional weight loss

Treatment Options

Dialysis or kidney transplantation are the only treatments for ESRD. Your physical condition and other factors determine which treatment is used. When you start dialysis depends on different factors, including your lab test results, severity of symptoms and readiness. You should begin to prepare for dialysis before it is absolutely necessary. The preparation includes learning about dialysis and the types of dialysis therapies, and placement of a dialysis access.

You may receive other treatments for chronic kidney failure, but they are unlikely to work without dialysis or a transplant. Treatment usually includes aggressive treatment of high blood pressure with an ACE inhibitor or angiotensin receptor blocker.

You will also receive treatment for diseases that cause, or are caused by chronic renal failure, including:

  • Blockages (obstructions) of the urinary tract
  • Congestive heart failure
  • Glomerulonephritis
  • High blood pressure (hypertension)
  • Kidney stones
  • Urinary tract infections

Blood transfusions and medications such as iron and erythropoietin may be needed to control anemia.

Dietary restrictions may slow the buildup of wastes in the bloodstream and control symptoms such as nausea and vomiting. Restrictions include:

  • Eating a low- protein, high- carbohydrate diet
  • Limiting fluids
  • Limiting salt, potassium, phosphorus and other electrolytes