Children's Hospital Colorado

End-Stage Renal Disease (ESRD)

What is end-stage renal disease?

End-stage renal disease (ESRD) is kidney disease that is beyond the point of healing or treatment. The term "renal" means related to the kidney. ESRD means that the kidney is no longer able to perform its main functions, which are to filter the blood to remove any waste and to balance fluids within the body.

Patients who have ESRD usually require kidney dialysis, which is a method of cleaning the blood and balancing the body’s fluids with the help of machines. If patients with ESRD do not receive dialysis to replace these vital functions of the kidney, they will need a kidney transplant to survive. Children often reach ESRD after suffering from less severe, but worsening, kidney disease for a few years. Kidney disease is different from acute kidney injury (AKI) because unlike kidney disease, AKI can improve and possibly resolve through dialysis.

What causes ESRD?

There are many types of kidney disease that can progress to ESRD. In adults, a common cause of ESRD is kidney damage caused by diabetes or high blood pressure. In children, common causes of ESRD are often related to congenital abnormalities of the kidneys and the urinary tract (CAKUT). The term congenital means the conditions are present at birth. Posterior urethral valves, for example, is a congenital condition that blocks the urethra, causing damage to the urinary tract and the kidneys. Other types of CAKUT include renal hypoplasia or dysplasia, which sometimes feature cysts in the malformed kidney or kidneys. Renal hypoplasia is a type of kidney malformation that develops while the baby is being formed in the mother's womb.

Not every form of CAKUT leads to ESRD but can lead to milder degrees of long-term kidney disease, which is called chronic kidney disease (CKD). There are also inherited metabolic conditions that affect the kidney, which can also lead to ESRD:

The following conditions can, but don't always lead to glomerulonephritis, which can then lead to ESRD:

  • Immunoglobulin A (IgA) nephropathy or Berger's disease: a kidney disease that causes the IgA antibody to build up in the kidneys
  • Focal segmental glomerulosclerosis (FSGS): a disease that causes scarring in the kidney filter, which is called the glomerulus
  • Lupus with kidney involvement or Lupus nephritis: an autoimmune disease that causes inflammation of the kidney filter or glomerulus

Who gets ESRD?

People of all ages, genders and ethnicities can get ESRD. It is more common in adults who have diabetes or are affected by other conditions that impact the kidney. Children who get ESRD are usually first diagnosed with a rare congenital or inherited disease, which then leads to ESRD.