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Introduction

The kidneys play key roles in body function, not only by filtering the blood and getting rid of waste products, but also by balancing levels of electrolyte levels in the body, controlling blood pressure, and stimulating the production of red blood cells. The primary functions of the kidneys are to filter the blood and eliminate metabolic waste products and excess water and electrolytes. Another function is to help regulate the bodys blood pressure by excreting excess sodium. If too little sodium is excreted, blood pressure is likely to increase but when the blood pressure is low, the kidneys secrete renin into the bloodstream, thereby activating renin-angiotensin-aldosterone system, which in turn raises blood pressure. A person with kidney failure is less able to regulate blood pressure and tends to have increased blood pressure. The kidneys also produce a hormone called erythropoietin, which stimulates the production of red blood cells in the bone marrow. The kidneys can also help regulate levels of calcium and phosphorus which are essential to bone health. The kidneys convert the Vit. D from its inactive to active form. The focus of our case study is about ESRD or end-stage renal disease which is a progressive, irreversible deterioration in renal function in which the bodys ability to maintain metabolic and fluid and electrolyte balance fails. This is the final stage of chronic renal failure and occurs when there is less than 10% nephron function remaining. All of the normal regulatory, excretory, and hormonal functions of the kidney are severely impaired. ESRD is evidenced by elevated creatinine and blood urea nitrogen levels as well as electrolyte imbalances. There is dangerous accumulation of water, waste, and toxic substances, and most individuals in this stage of kidney disease need dialysis or transplantation to stay alive. A person may have gradual worsening of kidney function for 10 - 20 years or more before progressing to ESRD. ESRD may be caused by systemic diseases, such as diabetes mellitus (leading cause); hypertension; chronic glomerulonephritis; pyelonephritis; obstruction of the urinary tract; hereditary lesions, as in polycystic kidney disease; vascular disorders; infections; medications; or toxic agents.

ESRD is not just a single disease. It could actually lead to various complications including anemia, fluid and electrolyte imbalance, uremia, pleural effusion, hyperparathyroidism, malnutrition, skin dryness and itchyness, fractures, peripheral neuropathy, brain dysfunction and heart and vessel complications such as congestive heart failure, coronary artery disease, high blood pressure, pericarditis and stroke. These complications make the patients condition worse but these complications vary from case to case basis. Kidney diseases, especially End Stage Renal Disease (ESRD), are already the 7 th leading cause of death among the Filipinos. Among the kidney diseases, the end-stage renal disease (ERSD) has the highest rate of prevalence as reported in the Philippine Renal Disease Registry (PRDR) in 2007. There are 10,000 to 12,500 Filipinos nationwide who develop ESRD annually. The rate of death due to end-stage renal disease has been in the top ten list of the mortality of the Department of Health (DOH - 2007). Estimates reveal that the number of these patients might double in 2010. The population of ESRD patients requiring dialysis therapy in Asia is expanding at a faster rate than in the rest of the world. In Philippines, the dialysis population is growing at a rate of 10% or more annually. It is said that a Filipino is having the disease hourly or 120 Filipinos per million populations per year. This shows that about 10, 000 Filipinos need to replace their kidney function. Unfortunately though only 73% or about 7, 267 patients received treatment. An estimate of about a quarter of the whole population probably just died without receiving any treatment.ouble in 2010. The main cause of kidney disease seems to be the increasing diabetic conditions among the Filipinos. It is seen that about 55% of Filipinos develop kidney disease when they suffer from diabetes. The Philippine Society of Nephrology (PSN) issued the statement that diabetes is the single most common cause of kidney failure among diabetes mellitus nephropathy patients. . Intro lang yan jun.