End stage renal disease Specialists  H. Albin Gritsch, MD J. Thomas Rosenthal, MD Jennifer Sandra Singer, MD Ongoing Clinical Trials Kidney Transplantation - The Effects of Switching Kidney Transplant Patients with Diabetes from Prograf® to Neoral Kidney transplantation - A Study Comparing an Experimental Drug versus Standard Treatment to Prevent Rejection and Reduce the Use of Steroids in Kidney Transplant Patients Kidney Transplantation - Reducing the Rate of Heart and Blood Vessel Disease in Stable Kidney Transplant Subjects Kidney Transplantation - Compare Two Medication Combinations to Prevent Kidney Transplant Rejection Related Research Projects No Current Research Projects...

End stage renal disease and UCLA

End-stage renal disease (ESRD) or kidney failure is usually identified by an elevated blood level of creatinine.  Creatinine is a normal breakdown product of muscle which is cleared by the kidneys.  Patients may also present with symptoms including  nausea or vomiting, weight loss, general malaise, fatigue, headache, hiccups, itching, decreased urination, easy bruising or bleeding, lethargy, difficulty breathing and seizures.  Some patients may notice that their urine makes excessive foam because of protein in the urine.  Because most people are born with two kidneys, ESRD is usually the result of a systemic disease.  The most common causes in adults are:

• High blood pressure (hypertension)
• Diabetes (high blood sugar)
• Vascular disease (atherosclerosis)
• Rheumatic diseases (such as lupus)
• Genetic disorders, such as polycystic kidney disease
• Exposure to toxic drugs, including certain antibiotics, chemotherapy, contrast dyes and pain relievers

Children may also have renal failure as a result of abnormal development of their kidneys or bladder.  These abnormalities can lead to repeated urine infections.  It is therefore very important to evaluate the anatomy and function of the kidneys and bladder in children with urinary tract infection.

Most people do not have significant symptoms of ESRD until their kidney function is less than 10 percent of normal capacity.  These patients need treatment, or progression of the disease can lead to death.

In the United States, the diagnosis of ESRD is increasing in frequency.  A great source for more information is the United States Renal Data System ( www.usrds.org ).

Prevention

If you have diabetes, control your blood sugar to reduce your chances of developing end-stage renal disease. Close monitoring and treatment of high blood pressure also can help prevent kidney disease. Many doctors prescribe medications called angiotensin converting enzyme (ACE) inhibitors at the first signs of elevated blood pressure or protein in the urine (a sign of kidney injury). A low protein diet (10 percent to 12 percent or less of total calories) also may slow or halt the progression of existing kidney disease, as will quitting smoking and lowering cholesterol levels. If you have chronic pain, check with your doctor to determine the best medicines for your condition.

Treatment

When kidney disease is diagnosed most patients are referred to a nephrologist, a medical specialist in kidney disease.  Based on the type of disease and risk factors for surgery the most effective treatment will be recommended.  Some rare types of kidney disease can be reversed, but the two treatments for chronic kidney disease are dialysis and kidney transplant.

There are two types of dialysis:

• Hemodialysis usually is performed at a dialysis center three times a week, in three to four hour sessions. During treatments, blood is removed from a vein, run through filters to remove waste products, and then returned to the body.
• Peritoneal dialysis may be performed at home, but takes longer and must be done more frequently. During peritoneal dialysis, fluid is pumped into the abdomen and waste products accumulate in the fluid, which is later removed.

There are two types of kidney transplant:

• Cadaveric renal transplant where a kidney is obtained from a person that has died is currently the most common.  This type of transplant is regulated by the United Network for Organ Sharing ( www.unos.org ).  Participating transplant centers work with organ procurement organizations to direct the organs that have been donated, to the patient that is most appropriate.  This system takes into account the genetic match and how long a patient has been waiting for a transplant.  Most candidates wait over four years in our region.
• Living donor renal transplant can occur when a healthy person with two normal kidneys volunteers to have one removed for transplant into the recipients.  In general, this type of transplant has better results and fewer complications.  The best results occur when the transplant is done before patients need dialysis.

Kidney transplants have allowed people with many forms of severe kidney disease to avoid or discontinue dialysis treatment. The results of transplants around the country are available from the Organ Procurement and Transplant Network (www.ustransplants.org ).  Unless the donor is an identical twin, the body would reject the new kidney if medicines that suppress the immune system were not administered regularly. Transplant candidates must be carefully evaluated to determine if the risks of surgery and medicine side effects are appropriate, since an organ recipient can expect to be on anti-rejection medications for life.

When To Call A Professional

If you have diabetes, hypertension or other diseases that put you at risk for end-stage renal disease, you should have regular check-ups along with urine and blood tests to measure your kidney function. Call your doctor if you notice any decrease in urination or other symptoms of end-stage renal disease, especially if you have known kidney disease or its risk factors.