Artificial Kidney and Renal Transplant

1. Abnormalities of renal functions

2. Abnormalities of renal functions
1. Proteinuria OR Albuminuria
2. Polyurea & Nocturia
3. Oliguria & Anuria
4. Uremia & Azotemia
5. Acidosis
6. Haematuria

3. Abnormalities of renal functions [contd]
• 1] Proteinuria OR Albuminuria –
 Nephrotic syndrome  Excretion of [] large amount of protein
thro urine  inability of liver for complete [] resynthesis of
lost protein  Hypoproteinaemia   blood oncotic pressure
  plasma volume   fluid accumulation in tissues 
edema.
 Orthostatic proteinuria – on long standing. Cause not known.
Not pathological
• 2] Polyurea & Nocturia –
– Polyurea – in kidney diseases   in concentrating capacity
  vol of dilute urine   flow rate  urine output =
3L/day; urine osm =  250 mOsm/L
– Nocturia – waking up at night frequently to void urine.
• 3] Oliguria & Anuria –
– Oliguria –  urine vloume
– Anuria – no urine formation

4. Abnormalities of renal functions [contd]
• 4] Uremia & Azotemia – found in renal failure
i. Uremia –  in plasma urea level.
ii. Azotaemia - retention of nitrogenous waste
products e.g. urea, creatinine etc.
• Symptoms are –
nausea, vomiting, confusion, convulsions, even
death.
• Treatment –
haemodialysis followed by renal transplant
• 5] Acidosis - at plasma pH of 7.35
• 6] Haematuria

5. Abnormalities of renal functions [contd]
• Acidosis - at plasma pH of 7.35.
Metabolic acidosis Respiratory acidosis
1] Diabetic acidosis 1] Hypoventilation
[depression of resp center]
2] Diarrhea [ loss of alkali] 2] Pulmonary oedema
3] Renal failure
4] Lactic acidosis
5] Aspirin in large doses

6. Abnormalities of renal functions [contd]
• 6] Haematuria -
• Presence of plenty of [ ]RBCs in urine
 Due to damage to glomerular capillaries e.g.
glomeruloneprhtitis
 In renal stones, renal TB, trauma to kidney etc
• In urinary tract infections  Haematuria +
pyuria [presence of pus cells] + bacteriuria

7. DIALYSIS
• INDICATIONS –
• Need for dialysis – serum creatinine level > 6mg %
1. Acute renal failure [ damage to kidney is reversible] – e.g.
i. Acute nephritis,
ii. Poisoning with lead OR mercury.
iii. Circulatory shock,
iv. Severe transfusion reactions,
v. Ureteric obstructions
2. Chronic renal failure [ damage to kidney is irreversible . So
renal transplantation is treatment of choice] –e.g.
a) Chronic nephritis,
b) Severe hypertension.
c) Carcinoma of kidney
3. Snake bite
4. Poisoning

8. TYPES OF DIALYSIS
1. Haemodialysis -
PRINCIPLE –
 diffusion of substances across a semipermeable
membrane with blood on one side & dialysate
[cleansing solution] on other side.
 Waste materials from blood diffuse out &
desirable components of dialysate diffuse into
blood.
2. Peritoneal dialysis

10. Compositionof ECF & Dialysate
Substance ECF [m mol/L] Dialysate
Sodium 152 140 -145
Potassium 4.5 1-3
Calcium 1.5 1.5
Magnesium 0.5 0.5
Chloride 109 100 – 105
Bicarbonate 32 -38 32 -38
Glucose 5 0 -10

12. Artificial kidney [apparatus for dialysis] OR Dialyzer
• It is hollow fibre or capillary dialyzer.
• Blood flows inside capillaries & dialysating fluid outside.
• Flow of dialysate is parallel current to blood flow.
• Composition of dialysate = Composition of plasma.[ may
vary depending on need]
• 9 -12 hrs of dialysis/week.
• Before dialysis –
surgical arterio venous fistula by anastomosis in forearm
done.[radial art to cephalic vein]
Blood heparinised before entering dialyzer & deheparinised
by PROTAMINE before returning to body.
• Complications –
• Septicaemia, Embolization, intracranial haemorrhage
[due to heparinisation], hypotension, depression etc

13. 2] PERITONEAL DIALYSIS
• Principle - Peritoneal membrane acts as dialysis
membrane.
• Procedure –
i. Indwelling catheter in peritoneal cavity.
ii. Introduction of 2L of dialysate.
iii. Every 4 -6 hrs empty & replace the dialysate.
• Advantages –
a) Avoidance of heparinization.+ vascular surgery.
b) Useful in cardiac insufficiency.
• Complications – PERITONITIS.

14. RENAL TRANSPLANTATION
• Effective treatment in Chr. Renal diseases
• Donor must be
i. Histo compatible [HLA antigen] +
ii. Same blood group.
• Administration of drugs after transplant –
a) To prevent rejection of transplant, immuno
suppressive drugs e.g. azathioprine,
cyclosporine, & glucocorticoids
b) To prevent anaemia, Erythropoitin .