Please be advised that the information given ahead is solely for educational purposes and is not to be considered as a diagnostic aid or as a treatment plan.
End Stage Kidney Disease or ESRD –
End Stage Renal Disease is often a result of chronic kidney disease or the aggression of an acute kidney failure. The underlying causes for these diseases to occur or develop are frequent fluctuations in blood pressure, diabetes, family history, heart problems, prolonged intake of medications known to damage the kidneys, severe and extended periods of dehydration or infection.
Let us take some time to understand what the kidney does and how the kidney works. The kidneys are the organs responsible for the filtration of impurities from our blood. They consist of ureters, the tubes that connect the kidneys to the bladder. Renal pelvis is a conical shaped layer of tissues that collect the urine from the inside of kidneys to the ureter.
The Renal pelvis leads out from the Renal medulla which in turn connects to the Renal cortex, which is responsible for the separation of impurities from the blood. The smallest unit of the kidney to filter is called a nephron (not to be confused with a neuron, aka nerve cell). Each nephron has a bundle of capillaries in it, called the glomerulus. The capillaries (very thin blood vessels) are so thin that it allows ultrafiltration, meaning they allow the water and other tiny molecules including the impurities to flow out of the blood and into the Bowman’s capsule while stopping the bigger cells like RBC (Red Blood Cells) and other blood proteins. Then the essential molecules of blood and other nutrients are left in the glomerulus capillaries. By the process of reabsorption, water molecules and other nutrition are sent back to the glomerulus. And the removed waste is sent to the bladder.
ESRF, as the name denotes, indicates that the organ has almost failed to function already. It takes 10 to 20 years of damage to the kidney to lead to ESRF. The symptoms of ESRF are fatigue (tiredness), itching (due to dry skin), edema in legs or chest (swelling due to water retention), headaches, nausea, weight loss (caused by lack of appetite), changes in skin colour, getting easily bruised, reduce urine output. Other symptoms include getting cramps, odour in breath, excessive thirst, etc.
GFR (Glomerulus Filtration Rate) is the factor that shows how well the kidneys are functioning. The normal value of GFR ranges between 90 mL/min and 125 mL/min. But, the GFR for patients with Renal Failure is less than 15 mL/ min. It is thus clear that the patient is unable to remove any toxins or salts from their body by their own. Thus leads to increase in toxicity in the body that could have a fatal result. Unfortunately, there is not much to be done through medication. The options left are either a kidney transplant from a viable donor or regular dialysis for the rest of their lives. Kidney transplants may take a long time as it depends on finding a willing donor with healthy kidneys that match with the patient. If and when the transplant becomes viable, the donor and patient are prepared for surgery. The healthy kidney of the donor is taken, one of the failed kidneys of the patient is also removed and replaced with the donated organ.
Till the transplant option becomes possible, the patient has to be put on dialysis. There are 2 kinds of dialysis – Peritoneal and Haemodialysis. Peritoneal dialysis can be done at home. In this procedure, a space in the abdominal lining ( i.e. peritoneal lining – a membrane surrounding the organs in the abdomen or the belly) is filled with dialysis solution through a permanently inserted catheter. The lining acts ad the filter and the toxins in the blood drain into the solution. This is left for a few hours and removed through the catheter. This solution is immediately replaced with a new one so that the dialysis can continue. In Haemodialysis, the blood is drawn out of the body and into a machine where the dialysis happens. This can be performed at home or in a hospital. But for dialysis to work well, certain dietary changes are to be made for the patient.
In cases where both transplant or dialysis is not possible, the patient usually succumbs to death. The patients are to be given palliative care during this time as their time may come in months or years.
