What is the Definition of End-stage Renal Disease?

End-stage renal disease (ESRD) is that stage of kidney impairment which is

irreversible, cannot be controlled by conservative management alone, and
requires dialysis or kidney transplantation to maintain life.
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Description of End-stage Renal Disease

There are two types of kidney failure: acute and chronic.

Acute kidney failure is a temporary decline in kidney function that can most
often be corrected.

Chronic kidney failure, on the other hand, is a permanent condition, meaning

that once it occurs, the kidneys cannot be made to function again.

Chronic kidney failure may be the result of heredity, as with polycystic kidney
disease, or may be caused by prolonged medical conditions, such as high
blood pressure or diabetes. Persons with chronic renal failure are referred to
as having end-stage renal disease. The term indicates that the patient must
rely on some type of medical treatment to help replace the loss of kidney
function.

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Treatment for End-stage Renal Disease

The treatment alternatives for ESRD include hemodialysis, peritoneal dialysis,

and kidney transplantation. These are all viable treatment alternatives.

Alternative Names

Renal failure - end stage; Kidney failure - end stage; ESRD

Treatment:

Dialysis or kidney transplantation is the only treatment 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.
See also: Dialysis

Treatment usually includes an ACE inhibitor, angiotensin receptor blocker,

or other medications for high blood pressure.

You may need to make changes in your diet.

• Eat a low-protein diet

• Limit fluids
• Limit salt, potassium, phosphorous, and other electrolytes
• Get enough calories if you are losing weight

Symptoms:

Symptoms may include:

• General ill feeling and fatigue

• Generalized itching (pruritus) and dry skin
• Headaches
• Weight loss without trying
• Loss of appetite
• Nausea

Other symptoms may develop, including:

• Abnormally dark or light skin and changes in nails

• Bone pain
• Brain and nervous system symptoms
o Drowsiness and confusion
o Problems concentrating or thinking
o Numbness in the hands, feet, or other areas
o Muscle twitching or cramps
• Breath odor
• Easy bruising, nosebleeds, or blood in the stool
• Excessive thirst
• Frequent hiccups
• Low level of sexual interest and impotence
• Menstrual periods stop (amenorrhea)
• Sleep problems, such as insomnia, restless leg syndrome, or
obstructive sleep apnea
 • Swelling of the feet and hands (edema)
• Vomiting, especially in the morning

Signs and tests:

The urine volume may decrease or urine production may stop. The
patient will usually have signs of the many complications of chronic
kidney disease.

End-stage kidney disease changes the results of many tests. Patients

receiving dialysis will need these and other tests done often:

• Potassium
• Sodium
• Albumin
• Phosphorous
• Calcium
• Cholesterol
• Magnesium
• Complete blood count (CBC)
• Electrolytes

Potassium test - Overview

• Overview
• Risks
• Results
• All Information

Alternative Names

Hypokalemia test; K+

Definition of Potassium test:

This test measures the amount of potassium in the blood. Potassium (K+)
helps nerves and muscles communicate. It also helps move nutrients into
cells and waste products out of cells.

Potassium levels in the body are mainly controlled by the hormone

aldosterone.
See also: Aldosterone test

How the test is performed:

Blood is typically drawn from a vein, usually from the inside of the elbow
or the back of the hand. The site is cleaned with germ-killing medicine
(antiseptic). The health care provider wraps an elastic band around the
upper arm to apply pressure to the area and make the vein swell with
blood.

Next, the health care provider gently inserts a needle into the vein. The
blood collects into an airtight vial or tube attached to the needle. The
elastic band is removed from your arm.

Once the blood has been collected, the needle is removed, and the
puncture site is covered to stop any bleeding.

In infants or young children, a sharp tool called a lancet may be used to

puncture the skin and make it bleed. The blood collects into a small glass
tube called a pipette, or onto a slide or test strip. A bandage may be
placed over the area if there is any bleeding.

How to prepare for the test:

The health care provider may tell you to stop taking any drugs that may
affect the test.

Drugs that can increase potassium measurements include:

• Aminocaproic acid
• Antineoplastic drugs
• ACE inhibitors
• Certain diuretics
• Epinephrine
• Heparin
• Histamine
• Isoniazid
• Mannitol
• Succinylcholine

Drugs that can decrease potassium measurements include:

 • Acetazolamide
• Aminosalicylic acid
• Amphotericin B
• Carbenicillin
• Cisplatin
• Certain diuretics
• Insulin
• Laxatives
• Penicillin G
• Phenothiazines
• Salicylates
• Sodium polystyrene sulfonate

The following factors can interfere with the test:

• Infusion of potassium-containing fluids

• Infusion of glucose or insulin

How the test will feel:

When the needle is inserted to draw blood, some people feel moderate
pain, while others feel only a prick or stinging sensation. Afterward, there
may be some throbbing.

Why the test is performed:

This test is routinely done as part of an electrolyte level test.

Your doctor may order this test to diagnose or monitor kidney disease.
The most common cause of high potassium levels is kidney disease.

Because potassium is important to heart function, your doctor may order

this test if you have signs of high blood pressure or heart problems. Small
changes in potassium levels can have a big effect on the activity of nerves
and muscles, especially the heart. Low levels of potassium cause
increased heart muscle activity, which can lead to an irregular heartbeat.
High levels cause decreased heart muscle activity. Either situation can
lead to a heart attack in some cases.
It may also be done if your doctor suspects metabolic acidosis (for
example, caused by uncontrolled diabetes) or alkalosis (for example,
caused by excess vomiting).

Occasionally, the potassium test may be done in persons who are having
an attack of paralysis.

Sodium - blood - Overview

• Overview
• Risks
• Results
• All Information

Alternative Names

Serum sodium

Definition of Sodium - blood:

This test measures the concentration of sodium in the blood.

How the test is performed:

Blood is drawn from a vein, usually from the inside of the elbow or the
back of the hand. The site is cleaned with germ-killing medicine
(antiseptic). The health care provider wraps an elastic band around the
upper arm to apply pressure to the area and make the vein swell with
blood.

Next, the health care provider gently inserts a needle into the vein. The
blood collects into an airtight vial or tube attached to the needle. The
elastic band is removed from your arm.

Once the blood has been collected, the needle is removed, and the
puncture site is covered to stop any bleeding.

In infants or young children, a sharp tool called a lancet may be used to

puncture the skin and make it bleed. The blood collects into a small glass
tube called a pipette, or onto a slide or test strip. A bandage may be
placed over the area if there is any bleeding.
How to prepare for the test:

Your health care provider will instruct you, if necessary, to discontinue

drugs that may interfere with the test. Do not stop or change your
medications without your doctor's knowledge.

Drugs that can increase blood sodium levels include:

• Anabolic steroids
• Birth control pills
• Certain antibiotics
• Clonidine
• Corticosteroids
• Laxatives
• Lithium
• Nonsteroidal anti-inflammatory drugs (NSAIDs)

Drugs that can reduce blood sodium levels include:

• Carbamazepine
• Diuretics
• Morphine
• Sulfonylureas
• Triamterene
• Vasopressin

How the test will feel:

When the needle is inserted to draw blood, some people feel moderate
pain, while others feel only a prick or stinging sensation. Afterward, there
may be some throbbing.

Why the test is performed:

Your doctor may order this test if you have signs of a sodium imbalance
or disorders associated with abnormal sodium levels.

Your blood sodium level represents a balance between the sodium and
water in the food and drinks you consume and the amount in urine. A
small percentage is lost through stool and sweat.
Many factors affect sodium levels, including:

• Recent trauma, surgery, or shock

• Consuming large or small amounts of salt or fluid
• Receiving intravenous (IV) fluids containing sodium
• Taking diuretics or certain other medications, including the
hormone aldosterone