End-Stage Kidney (Renal) Disease
End-stage renal disease is the name for kidney failure so advanced it cannot be reversed ("renal" is another word for kidney). The kidneys in end-stage renal disease function so poorly that they can no longer keep one alive.
End-stage renal disease (ERSD) cannot be treated with conventional medical treatments such as drugs. Dialysis and kidney transplantation are the only treatments for this condition.
- Dialysis is the term for several different methods of artificially filtering the blood. People who require dialysis are kept alive but give up some degree of freedom due to their dialysis schedule, fragile health, or both.
- Kidney transplantation means replacement of the failed kidneys with a working kidney from another person, called a donor. Kidney transplantation is not a complete cure, although many people who receive a kidney transplant are able to live much as they did before their kidneys failed. People who receive a transplant must take medication and be monitored by a physician who specializes in kidney disease (nephrologist) for the rest of their lives.
The National Kidney Foundation estimates that more than 594,000 people in the United States have end-stage renal disease. About 415,000 are dialysis patients and more than 179,000 have had a kidney transplant. In 2010, over 91,000 people died of causes related to kidney failure.
- As of December 2012, nearly 95,000 people in the United States were waiting for a kidney transplant.
- Because of a shortage of donor kidneys, each year only a small percentage of people who need a transplant actually receive a kidney. The wait for a donor kidney can take years.
How the Kidneys Work
The kidneys have several important functions in the body.
- They filter wastes from the bloodstream and maintain the balance of electrolytes in the body.
- They remove chemical and drug by-products and toxins from the blood.
- They eliminate these substances and excess water as urine.
- They secrete hormones that regulate the absorption of calcium from food (and thus bone strength), the production of red blood cells (thus preventing anemia), and the amount of fluid in the circulatory system (and thus blood pressure).
When blood enters the kidneys, it is first filtered through structures called glomeruli. The second step is filtering through a series of tubules called nephrons.
- The tubules both remove unwanted substances and reabsorb useful substances back into the blood.
- Each of the kidneys contains several million nephrons, which cannot be restored if they are damaged.
Michael B McDonnell, MD, Staff Physician, Department of Emergency Medicine, University of Southern California
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