Introduction

End-stage renal disease (ESRD) is the term given to patients whose eGFR is below 15 mls/min or who are requiring dialysis to avoid the life-threatening complications that arise (including electrolyte disturbances, uraemia, acidosis and fluid retention).

The majority of us are not within our comfort zones when managing patients with ESRD. This module provides the baseline knowledge required to take a thorough renal-specific history and to be able to anticipate some of the common problems experienced by ESRD patients. There is no mention of the Loop of Henle or the countercurrent mechanism! It will help you to avoid not looking or sounding stupid when speaking to the renal registrar or consultant. Always be prepared to involve the renal team at an early stage in a patient’s presentation – they know their patients extremely well and will want to shape their care.

The following case studies serve to illustrate some of the key issues you may be faced with when dealing with renal patients. Inevitably, it is by no means an exhaustive discussion.