The main causes of end-stage renal disease are, in approximate order of frequency: diabetes, glomerulonephritis (nephritis or Bright's disease), hypertension, and various congenital causes including polycystic kidney disease and kidney stones.
In the last 2 decades, diabetes has become the most common cause of end- stage renal disease in the developed world, requiring dialysis or transplantation. This results from a steady increase in the aging population as well as better treatment of diabetes: patients live longer and often long enough to develop severe complications such as kidney failure.
Glomerulonephritis is a term used to describe diffuse inflammation of the glomeruli usually brought on by immunological processes. It can occur in many forms and in association with many different diseases. Different types of glomerulonephritis progress at different rates. Some types respond to specific treatments such as steroids or immunosuppressive medications, while some do not.
The role of high blood pressure as a cause of end-stage renal disease is somewhat controversial. It is often difficult to determine whether high blood pressure has caused kidney failure or vice versa. However, it is reasonably clear that primary hypertension can lead to kidney failure, especially in African Americans.
Kidney stones and urological problems
In the developed world, kidney stones and other urological problems can also cause kidney failure. However, in developing countries, where urological treatment for stone episodes is often poor or unavailable, stone disease is a more prevalent cause of kidney failure, being responsible for up to 10% of patients with kidney failure.
Roger A.L. Sutton, DM