Exam Cram

• End stage renal disease refers to renal failure, 60% caused by diabetes and hypertension

• Presentation: chronic- asymptomatic, lethargy, gradual fall in eGFR, acute- overload, hyperkalaemia, hyperuraemia, acidosis

• Diagnosis: typically eGFR < 15

• Management: renal replacement therapy- renal transplant or dialysis- haemodialysis or peritoneal, at home or in centres

ESRD

Aetiology

Core (60%)

• Diabetes

• Hypertension

Common

• IgA Nephropathy,

• Lupus Nephritis

• Polycystic Kidney Disease

• Fabry Disease

Dialysis

Haemodialysis

• The majority of dialysis is performed via haemodialysis

• Route: arterial/ venous fistula or central line (Hickmann line or Portocath)

• Location: usually in centre; can be done at home

• Quicker than peritoneal dialysis

Peritoneal Dialysis

• Peritoneal dialysis can be done via access to the peritoneum

• Usually done at home

• Slower & risk of peritoneal infection

Renal Transplant

• Renal Transplants have been a success story 

• 60% of ESRD patients live with a transplant, and this percentage is slowly rising with growing numbers of transplants performed and improving survival rates

• Typical regime for renal transplants is: tacrolimus, MMF and prednisolone

• Compared to dialysis, renal tranplant patients have lower mortality rates and risks of cardiovascular disease but higher rates of malignancy and infection

Aetiology

National Kidney Foundation 2022: 

• Diabetes: 27%

• Hypertension: 25%

• Glomerulonephritis: 18%

• Polycystic Kidney Disease: 9%

References

1. https://www.kidney.org/kidney-topics/kidney-failure