Question

The term 'end-stage renal disease (ESRD)' is considered appropriate when GFR falls to

• A. 50% of normal
• B. 25% of normal
• C. 10-25% of normal
• D. 5-10% of normal

Hint:

Think about the GFR range at which dialysis becomes necessary for survival.

Answer 1

The Correct Option is D

Step 1: Understanding the Question:
The question asks how far the glomerular filtration rate (GFR) must fall before a patient is labelled as having end-stage renal disease.

Step 2: Key Concept or Approach:
Chronic kidney disease is staged by GFR, and the label ESRD is reserved for the most severe stage, where kidney function has fallen so low that the kidneys can no longer sustain the body without dialysis or transplantation.

Step 3: Working Through the Options:
A GFR of 50% of normal corresponds to only mild renal impairment, often without symptoms. A GFR of 25% of normal marks moderate to severe chronic renal failure, where azotaemia begins but the kidneys can still be managed conservatively for a time. A GFR of 10-25% is the range of severe chronic renal failure, again short of the terminal stage. Only when GFR drops to about 5-10% of normal does the kidney's filtering capacity become so limited that uraemic symptoms and complications turn life-threatening without renal replacement therapy, which is exactly what defines ESRD.

Step 4: Conclusion:
The correct answer is 5-10% of normal, since this is the GFR range at which the kidneys can no longer sustain the body without dialysis or transplant.