End Stage Renal Failure (ESRF) is the most advanced stage of chronic kidney disease (CKD). It occurs when the kidneys lose nearly all ability to filter waste and excess fluid from the blood. When kidney function declines to less than 15% of normal, the kidneys can no longer sustain life, necessitating interventions like dialysis or a kidney transplant.
Major Chronic Diseases
Diabetes is a primary cause of ESRF, particularly diabetic nephropathy, which damages the small blood vessels in the kidneys. High blood sugar levels over time harm the delicate filtering units, known as glomeruli. Both Type 1 and Type 2 diabetes contribute to this damage.
High blood pressure, or hypertension, is another leading cause of ESRF. Uncontrolled high blood pressure can constrict arteries supplying the kidneys, reducing blood flow. This sustained force damages filtering units and can lead to scarring of kidney tissue, impairing their ability to filter blood.
Other chronic conditions also contribute to kidney damage. Glomerulonephritis involves inflammation of the kidney’s filtering units, leading to scarring and impaired function. Polycystic Kidney Disease (PKD) is a genetic disorder causing fluid-filled cysts to grow in the kidneys. These cysts enlarge, distorting kidney structure and reducing functional tissue.
Additional Factors and Conditions
Obstructive kidney diseases can lead to ESRF by blocking urine flow, which causes pressure to build up and damage the kidneys. Conditions such as kidney stones, an enlarged prostate, or certain cancers can create these blockages. The backflow of urine into the kidneys can result in hydronephrosis, a swelling that harms kidney tissue.
Certain medications, particularly when used long-term or at high doses, can harm kidney function. Nonsteroidal anti-inflammatory drugs (NSAIDs), for example, can reduce blood flow to the kidneys. Other medications, like some antibiotics or proton pump inhibitors, have also been linked to kidney damage.
Autoimmune diseases, where the body’s immune system mistakenly attacks its own tissues, can target the kidneys. Conditions like lupus or IgA nephropathy can cause inflammation of the kidney’s filtering structures. Recurrent kidney infections, known as pyelonephritis, can also lead to scarring.
The Progression of Kidney Damage
Once kidney damage begins, it often progresses due to the kidney’s limited capacity for self-repair. Ongoing injury destroys nephrons, the tiny filtering units. As nephrons are lost, remaining healthy ones become overworked. This increased workload can accelerate their decline.
Damaged kidney tissue is often replaced by scar tissue, a process known as fibrosis. This scar tissue cannot perform the essential filtering functions of healthy kidney tissue. The accumulation of scar tissue further reduces the kidney’s overall capacity.
Chronic kidney disease typically progresses through several stages, with ESRF representing the fifth and final stage. This progression means long-term damage eventually overwhelms kidney function. Regular monitoring of kidney health is important to identify and manage underlying conditions before they lead to irreversible damage.