الفهرس 
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Abstract
End-Stage Renal Disease (ESRD) is a progressive irreversible deterioration and decline of renal functions resulting in accumulation of nitrogenous waste products causing pathophysiological disturbances allover the body systems. The early stage of ESRD is usually asymptomatic, when the kidney functions decline very slowly until reach less than one-tenth of the normal Glumerular filtration rate (GFR). This alteration gradually leads to the final stage of chronic kidney disease these is known as end-stage renal disease. The decline of kidney functions usually occurs over months or years. It appears in the form of a decrease red blood cell production, uncontrolled blood pressure, alter the vitamin D synthesis as well as bone demineralization side by side with fluid and electrolytes imbalance causing serious deterioration allover the body.
ESRD is resulting from general predisposing factors including diabetes mellitus, uncontrolled blood pressure, autoimmune disorder, systemic lupus erythematosus, intake or abuse of certain medications (as certain painkillers and antibiotics) as well as certain toxic elements as Lead and Cadmium. Local risk factors of ESRD include chronic glumerionephritis, pyelonephritis, congenital renal conditions and polycystic kidney diseases. Ureteral strictures, ureteral stones, ureteral or bladder cancers and renal trauma are other local causes of ESRD.
Regardless the cause, the clinical manifestations of ESRD appear allover the body based on the degree and duration of renal impairment, other underlying conditions, patient’s age and the received therapeutic maneuver. These manifestations include different body systems as cardiovascular, hematological, dermatological, neurological and gastrointestinal systems. Cardiovascular manifestations include uncontrolled hypertension, pericardial effusion, and pitting edema. Hematological manifestations include anemia and bleeding tendency. Furthermore, dermatological manifestations in the form of severe pruritus, uremic frost, ecchymosis and dry flaky skin, as well as alteration of skin color as gray-bronze, dry brittle hair and nails usually occur. Neurological manifestations include peripheral neuropathy, restless legs syndromes, and sleep disturbances.
Gastrointestinal manifestations appear in the form of metallic taste, uremic fetor (ammonia odor or halitosis), anorexia, nausea, vomiting, as well as mouth ulceration and increase gastric acid secretion causing heartburn. Moreover, alteration of the bowel functions as diarrhea or constipation may occur. However, the gastrointestinal manifestations are a cornerstone of discomfort among those patients. Finally, these alterations as well as improper or inadequate diet regimen and non-compliance for follow up may lead to poor nutrition and weight loss, among those patients.