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Kidney failure, end-stage

AGE  Risk factors depend on the causeGENDER  Risk factors depend on the cause
LIFESTYLE  Risk factors depend on the causeGENETICS  Risk factors depend on the cause

End-sage kidney failure is the irreversible loss of the function of both kidneys, which is often life-threatening.

In end-stage kidney failure, the kidneys have permanently lost over 90 per cent of their normal function. They are therefore unable to filter waste products and excess water out of the blood for excretion as urine. End-stage kidney failure usually progresses from chronic kidney failure. If prompt action is not taken to replace the function of the failed kidneys with dialysis or a kidney transplant, the condition is inevitably fatal.

What are the symptoms?

The main symptoms of end-stage kidney failure usually include:

  • Greatly reduced volume of urine.
  • Swelling of the face, the limbs, and the abdomen.
  • Severe lethargy.
  • Weight loss.
  • Headache and vomiting.
  • Furred tongue.
  • Very itchy skin.

Many people who have end-stage kidney failure also have breath that smells like ammonia, an odour similar to that of household bleach.

How is it diagnosed?

If your doctor suspects end-stage kidney failure, he or she will first arrange for urine tests and blood tests to detect abnormal levels of waste products in these body fluids. If the cause of kidney failure has not already been identified, you may also have to undergo imaging procedures such as ultrasound scanning, CT scanning, or radionuclide scanning to detect abnormalities in your kidneys.

What is the treatment?

Kidney dialysis, the usual treatment for end-stage kidney failure, takes over the function of filtering harmful waste products from the blood and controlling the water balance of the body. However, long-term dialysis may lead to complications such as gradual weakening of the bones (see Osteoporosis). Anaemia, in which the oxygen carrying capacity of the blood is reduced, may develop due to a lack of the hormone erythropoietin, which is made in the kidneys and stimulates red blood cell production. However, anaemia is easily treated by injections of erythropoietin.

A kidney transplant offers the best hope of returning to a normal lifestyle. The main drawback of a transplant is that you will need to take immunosuppressants for the rest of your life to prevent your immune system from rejecting the donor organ. Occasionally, a second transplant is needed if the first kidney stops functioning. If you do not have a kidney transplant, you will need dialysis for the rest of your life.

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