ESRD

Learnt what it is

End Stage Renal Disease, also known as
-ESRF (End Stage Renal Failure)
-ESKD (End Stage Kidney Disease)

- Condition where your kidneys can no longer function on its own

Kidney Anatomy & Physiology

Kidney: fist sized, two kidneys, located on both sides of the spine at the lowest rib cage

Nephrons: millions of filtering units on kidney

Glomerulus & Tubule: the filterer, included in each nephron:

Glomerulus filters the blood
Tubule returns needed substances to blood and removes waste

What are the functions?

Why should I even care about kidney being damaged?

-Removes waste products from blood such as Urea
-Removes acid produced by cells
-Maintains a balance of water, salts, and minerals (sodium, calcium, potassium, etc)
-Releases hormone, renin, to help regulate blood pressure
-Aids in body’s inflammatory response system
-Converts Vitamin D to a form that can be used by our body
-Makes Erythropoietin, a hormone that helps in making red blood cells.

Kidney performs so much more complicated functions daily! It’s important to prevent it from damaging!

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Symptoms of ESRD

What indicates ESRD?

Appetite loss, Excessive Thirst, Unnecessary Weight Loss

Dry/itchy skin, nails with half-brown and half-white color

Muscle twitch/cramps

Blood in urine, Sleep problems

Amenorrhea: absence of menstruation cycle in females

Fatigue, Confusion

Easy bruises, Bone pain

Etiology

What other disease can cause ESRD?

In USA, Diabetes is the leading cause of ESRD.
High Blood Pressure being the second most leading cause

Other causes (not in order):

-Vascular Disease: abnormal condition of blood vessels
-Urinary Tract Obstruction/Dysfunction: improper urine flow
-Recurrent Kidney Stone Disease: recovered kidney stone could come back and form kidney stones again
-Unrecovered Acute Kidney Injury: kidney injury that hasn’t been recovered fully
-Glomerulonephritis: inflammation of Glomerulus

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Risk Factors

What makes me more susceptible towards ESRD

-Diabetes with poor maintenance
-High blood pressure poor maintenance
-Aging (65+)
-Smoking, Tobacco Use
-Family history with kidney disease
-Frequent use of medications such as Naproxen
-Race: Black, Asian, Hispanic, Pacific Islander
-American Indian Heritage

Complications of ESRD

What problems arise from ESRD

– Fluid retention: pulmonary Edema and swelling in extremities
-Hyperkalemia: excessive amount of potassium
– Weak bones: easy fractures
- Anemia: lack of healthy red blood cells
- Reduced Fertility: difficult to conceive a child
-Decrease immune response colon week immune system
-Pericarditis: inflammation of the heart’s surrounding
-Malnutrition: Nutritional deficiency

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Diagnosis

How is ESRD identified?

Doctors ask about Family History
Ask for symptoms

Further evaluation:
—> Blood Test: identifies waste product: Creatinine + measures how well kidneys are functioning through GFR calculation: Glomerular Filtration Rate
—> Urine Test: measures protein called Albumin (produced by liver, found in blood, carries important substance through body)
—> Magnetic Resonance Imaging: observes kidney appearance, check for any blockages
—> Computed Tomography scan (CT): observes kidney appearance, check for any blockages
—> Biopsy: observe kidneys appearance and check for kidney blockages

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Treatments of ESRD

– Kidney transplant: surgical procedure to replace kidneys
– Hemodialysis: A machine that filters blood through dialyzer and returns the filtered blood to body, 3 to 5 hour process, in/out patient
-Peritoneal dialysis: A cleansing fluid, flows through a tube (catheter) into the abdomen, After a period of time, the fluid with the filtered waste flows out of abdomen to be discarded, in/outpatient

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Survival rate

Survival rate depends on treatment
– One year of dialysis = five-year survival rate under 50%
-Five years after transplant = 80% survival rate

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Statistics: death rate

Death rates (1000 people/ year)

Age 75+ = 500 deaths/1000 people in 1980
= 310 deaths/1000 people in 2016

Age 65-74= 320 deaths/1000 people in 1980
= 190 deaths/1000 people in 2016

Age 45-64= 190 deaths/1000 people in 1980
= 100 deaths/1000 people in 2016

Age < 45= 75 deaths/1000 people in 1980
= 50 deaths/1000 people in 2016

Summary: With the advanced technology overtime, death rates have significantly dropped since 1980 to 2016 in all ages and it is estimated to drop.

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Statistics

Statistics Race Wise

Population Affected compared to Whites (2016)
—> African Americans- 3.7x more likely
—> Native Americans- 1.4x more likely
—> Asian Americans- 1.5x more likely
—> Hispanics- 1.5x more likely

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Prevention plan

Can ESRD be prevented?

Of course! A healthy lifestyle to slow down the progression:
- regular exercise: minimum 30 min.
- stay hydrated
- balanced diet: low in salt, sugar, fat
- monitor/control blood pressure/sugar
- if drinking: don’t exceed 14 units/week
- Quit smoking/Tobacco use
- Reduce stress
- Aim for 7-8 hrs of sleep
- Get kidneys checked AT LEAST once a year

Additional resources:
https://www.kidney.org/
https://aakp.org/
https://www.niddk.nih.gov/

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