by John C. L. Wang, M.D.

(Presented at the CAMS 1999 Semiannual Scientific meeting)

Renal disease continues to be a significant health care issue in the U.S. End-stage renal disease (ESRD), not an uncommon final result, is a major health problem. There has been an increase in the prevalence and incidence of ESRD over the past two decades. Contributing factors include: 1) aging of the U.S. population and 2) improved survival of patients with chronic diseases such as diabetes mellitus and hypertension. In addition, minority groups have a higher incidence of ESRD than whites. These include African-Americans, Native-Americans and Hispanic-Americans. Fortunately, Asian Americans are comparable to whites.

Renal failure can be either acute or chronic. Acute renal failure (ARF) is a clinical syndrome characterized by a rapid deterioration in renal function over a short period of time, days or even hours. There are many specific causes of ARF, an can be categorized into three: 1)Prerenal failure, 2) Intrinsic renal failure, and 3) Postrenal failure (Obstruction). The potential reversibility of many specific entities in the differential diagnosis mandates that a rapid diagnosis be made and appropriate therapy begins. However, it does carry a high morbidity and mortality (40-60%). Chronic renal failure (CRF), on the other hand, evolves over a long period of years. Diabetes mellitus is the leading cause of ESRD in all major racial and ethnic groups except in African Americans. Hypertension is the most frequently reported cause of ESRD in African Americans. Whereas glomerulonephritis is the leading cause of ESRD in children while it places a distant third place in adults. Cystic renal disease, predominantly polycystic kidney disease, is the 4^th cause of ESRD and seems at about the same rate in all race groups.

The uremic syndrome, associated with the progressive decline in renal function, may be defined clinically as a state of systemic poisoning. It affects the cardiovascular, nervous, hematopoietic, gastrointestinal, endocrine, and immune systems. Renal replacement therapy is required to sustain life when renal functions becomes inadequate, usually GFR of less than 8 ml/min.

Therapeutic options available for the treatment of patients with ESRD have become numerous. These include hemodialysis, peritoneal dialysis either as continuous ambulatory peritoneal dialysis (CAPD) or as continuous cycling peritoneal dialysis (CCPD), and kidney transplantation (cadaveric or living donor). Overall, the Asian-American ESRD) patients enjoy the same, if not better outcome as other race groups. ðP

Dr. Wang is Associate Professor of Medicine, Cornell University Medical College.