What Diseases Cause Kidney Failure?

What diseases causes people to need dialysis or transplantation

Common causes of kidney failure that requires dialysis over the last decades.

Most people are surprised to learn that kidney failure usually does not start with a disease of the kidneys, but is actually more often secondary to other systemic diseases like diabetes or high blood pressure. Although native kidney diseases that cause kidney failure do exist, their contribution to the overall number of patients developing kidney failure is smaller.


In a nutshell, here are the top four causes of kidney failure, also referred to as end-stage renal disease (ESRD):

  • Diabetes mellitus
  • Hypertension
  • Glomerulonephritis
  • Cystic kidney disease

Diabetic kidney disease, also known as diabetic nephropathy is the leading cause of kidney failure, and for patients advancing to stage 5 chronic kidney disease (CKD) that requires dialysis. Till the late 1980s, diabetes and hypertension used to contribute equally to the incidence of kidney failure (end-stage renal disease). However, since then this incidence started to increase far more quickly for diabetic kidney disease. As per the 2013 United States Renal Data System (USRDS) Report, diabetes now is single-handedly responsible for over 50,000 people developing advanced kidney disease (that requires dialysis or kidney transplantation) every year!  The similar number for hypertension is about 30,000. As a percentage of the total patients with a kidney transplant or on dialysis yearly, diabetes accounts for 44%, while hypertension is responsible for about 28%.The picture with this article illustrates how the diseases that cause kidney failure have changed over the last few decades.

The mechanism by which diabetes and high blood pressure cause kidney failure are beyond the scope of this article, but I have touched on them briefly in some of my other posts. The inciting event is a phenomenon called "adaptive hyperfiltration", which is what I have explained in my other post.

Glomerulonephritis means inflammation of the glomerulus and the nephrons.

A simplistic explanation of these structures would be that they constitute the kidney’s filtration and drainage systems. Inflammation here could occur from multiple causes, but broadly the reasons could be drugs, autoimmune diseases like lupus, cancers, and infections. The kidney function in some types of glomerulonephritis could decline very quickly, sometimes over a span of days to weeks. Unlike other disease entities mentioned in this article, blood in the urine is a common sign.  

Finally, cystic kidneys, also sometimes referred to as Polycystic Kidney Disease (PKD) is an inherited disease of the kidneys that could cause kidney failure. It runs in families, being passed genetically from parent to children. Often, a family history of kidney failure would make this evident. However, sometimes the disease does not present till the late 70s because the age of presentation is determined by the type of genetic mutation. So it could be conceivable that the affected parent could have died at an age before the diagnosis could have been made.

In these cases, patients would deny the existence of a concerning family history. The disease is usually picked up on an imaging study, like an ultrasound, and could be an "incidental" discovery. Patients have multiple cysts in the kidney that enlarge with time and literally choke the blood supply out of the remaining viable tissue.  I will talk about glomerulonephritis and PKD in further detail in my subsequent posts.

U.S. Renal Data System, USRDS 2013 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2013

The data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. government.

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