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Anatomy and physiology of Kidney

The kidneys are organswith several functions. They are seen in many types ofanimals, including

vertebratesand some invertebrates. They are an essential part of the urinary system and also

serve homeostaticfunctions such as the regulation ofelectrolytes, maintenance ofacid-base balance,

and regulation ofblood pressure. They serve the body as a natural filter of theblood, and remove

wastes which are diverted to the urinary bladder. In producing urine, the kidneys excrete wastes suchas urea and ammonium; the kidneys also are responsible for the re absorption ofwater,glucose,

and amino acids. The kidneys also producehormones including calcitriol, renin, and erythropoietin.

Located at the rear of the abdominal cavity in the retroperitoneum, the kidneys receive blood from the

paired renal arteries, and drain into the paired renal veins. Each kidney excretes urine into a ureter,

itself a paired structure that empties into the urinary bladder.

1. Renal pyramid 2. Interlobular artery 3. Renal artery 4. Renal vein 5. Renal hilum 6. Renal pelvis 7. Ureter 8. Minor calyx 9. Renal

capsule 10. Inferior renal capsule 11. Superior renal capsule 12. Interlobular vein 13. Nephron 14. Minor calyx 15. Major calyx 16. Renal

papilla 17. Renal column

1.Renal pyramids (or malpighian pyramids) are cone-shaped tissues of the kidney. The renal

medulla is made up of 7 to 18 of these conical subdivisions (usually 7 in humans). The broad base of

each pyramid faces the renal cortex, and its apex, orpapilla, points internally. The pyramids appear

striped because they are formed by straight parallel segments ofnephrons.

2.Interlobular arteries(orcortical radiate arteries, orcortical radial arteries), are given off at right

angles from the side of the arcuate arteries looking toward the cortical substance, and pass directly

outward between the medullary rays to reach the fibrous tunic, where they end in the capillary network

of this part.

3.Renal arteries normally arise off the side of the abdominal aorta, immediately below the superior

mesenteric artery, and supply the kidneys with blood. Each is directed across the crus of the diaphragm,

so as to form nearly a right angle with the aorta.

The renal arteries carry a large portion of total blood flow to the kidneys. Up to a third of total cardiac

output can pass through the renal arteries to be filtered by the kidneys.
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4.Renal veins are veins that drain the kidney. They connect the kidney to the inferior vena cava.

It is usually singular to each kidney, except in the condition "multiple renal veins".

It also divides into 2 divisions upon entering the kidney:

the anterior branch which receives blood from the anterior portion of the kidney and,

the posterior branch which receives blood from the posterior portion.

5.Renal hilum(Latin hilum renale) orrenal pedicle of the kidney is the recessed central fissure. The

medial border of the kidney is concave in the center and convex toward either extremity; it is directed

forward and a little downward. Its central part presents a deep longitudinal fissure, bounded by

prominent overhanging anterior and posterior lips. This fissure is named the hilum, and transmits the

vessels, nerves, and ureter. From anterior to posterior, the renal vein exits, the renal artery enters, and

the renal pelvis exits the kidney.

6.Renal pelvis is the funnel-like dilated proximal part of the ureterin the kidney.

In humans, the renal pelvis is the point of convergence of two or three major calyces. Each renal

papilla is surrounded by a branch of the renal pelvis called a calyx.

The major function of the renal pelvis is to act as a funnel for urine flowing to the ureter.

7.Ureters are muscular tubes that propel urine from the kidneys to the urinary bladder. In the adult, the

ureters are usually 2530 cm (1012 in) long and ~3-4 mm in diameter.

8.minor calyx, in the kidney, surrounds the apex of the malpighian pyramids.Urine formed in

the kidney passes through a papilla at the apex into the minor calyx then into the major calyx.

9,10,11.Renal capsule is a tough fibrous layer surrounding the kidney and covered in a thick layer

ofperinephricadipose tissue. It provides some protection from trauma and damage.

12.Venae stellatae join to form the interlobular veins, which pass inward between the rays, receive

branches from the plexuses around the convoluted tubules, and, having arrived at the bases of the renal

pyramids, join with the venae rectae.

13.Nephron (from Greek - nephros, meaning "kidney") is the basic structural and functional

unit of the kidney. Its chief function is to regulate the concentration ofwaterand soluble substances

like sodium salts by filtering theblood, reabsorbing what is needed and excreting the rest as urine. A

nephron eliminates wastes from the body, regulatesblood volume and blood pressure, controls levels

ofelectrolytes and metabolites, and regulates blood pH. Its functions are vital to life and are regulated

by the endocrine system by hormones such as antidiuretic hormone, aldosterone, andparathyroid

hormone.[1] In humans, a normal kidney contains 800,000 to 1.5 million nephrons.

14.Major calyx, in the kidney, surrounds the apex of the malpighian pyramids. Urine formed in

the kidney passes through apapilla at the apex into a minor calyxthen into major calyx before passing

through the renal pelvis into the ureter.

Peristalsis of the smooth muscle originating in pace-maker cells originating in the walls of the calyces

propels urine through the pelvis and ureters to thebladder.

15.Renal papilla is the location where the medullary pyramids empty urine into the minor calyx.

Histologically it is marked by medullary collecting ducts converging to form a duct of Bellini to

channel the fluid. Transitional epithelium begins to be seen.
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16.Renal column (orBertin column, orcolumn of Bertin) is a medullary extension of the renal

cortex in between the renal pyramids. It allows the cortex to be better anchored.

ESSENTISL FLUID AND ELECTROLYTES

Fluid and Electrolyte Balance

The kidneys are essential for regulating the volume and composition of bodily fluids. This pageoutlines key regulatory systems involving the kidneys for controlling volume, sodium and potassium

concentrations, and the pH of bodily fluids.

A most critical concept for you to understand is how water and sodium regulation are integrated to

defend the body against all possible disturbances in the volume and osmolarity of bodily fluids. Simpleexamples of such disturbances include dehydration, blood loss, salt ingestion, and plain water

ingestion.

Water balance

Water balance is achieved in the body by ensuring that the amount of water consumed in food and

drink (and generated by metabolism) equals the amount of water excreted. The consumption side isregulated by behavioral mechanisms, including thirst and salt cravings. While almost a liter of water

per day is lost through the skin, lungs, and feces, the kidneys are the major site ofregulated excretion

of water.

One way the the kidneys can directly control the volume of bodily fluids is by the amount of waterexcreted in the urine. Either the kidneys can conserve water by producing urine that is concentrated

relative to plasma, or they can rid the body of excess water by producing urine that is dilute relative to

plasma.

Direct control of water excretion in the kidneys is exercised by vasopressin, or anti-diuretic hormone(ADH), a peptide hormone secreted by the hypothalamus. ADH causes the insertion of water channels

into the membranes of cells lining the collecting ducts, allowing water reabsorption to occur. Without

ADH, little water is reabsorbed in the collecting ducts and dilute urine is excreted.

ADH secretion is influenced by several factors (note that anything that stimulates ADH secretion alsostimulates thirst):

1. By special receptors in the hypothalamus that are sensitive to increasing plasma osmolarity (when

the plasma gets too concentrated). These stimulate ADH secretion.

2. By stretch receptors in the atria of the heart, which are activated by a larger than normal volume of

blood returning to the heart from the veins. These inhibit ADH secretion, because the body wants to

rid itself of the excess fluid volume.3. By stretch receptors in the aorta and carotid arteries, which are stimulated when blood pressure falls.

These stimulate ADH secretion, because the body wants to maintain enough volume to generate the

blood pressure necessary to deliver blood to the tissues.

Sodium balance

In addition to regulating total volume, the osmolarity (the amount of solute per unit volume) of bodily

fluids is also tightly regulated. Extreme variation in osmolarity causes cells to shrink or swell,

damaging or destroying cellular structure and disrupting normal cellular function.
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Regulation of osmolarity is achieved by balancing the intake and excretion of sodium with that of

water. (Sodium is by far the major solute in extracellular fluids, so it effectively determines the

osmolarity of extracellular fluids.)

An important concept is that regulation of osmolarity must be integrated with regulation of volume,because changes in water volume alone have diluting or concentrating effects on the bodily fluids. For

example, when you become dehydrated you lose proportionately more water than solute (sodium), so

the osmolarity of your bodily fluids increases. In this situation the body must conserve water but notsodium, thus stemming the rise in osmolarity. If you lose a large amount of blood from trauma orsurgery, however, your loses of sodium and water are proportionate to the composition of bodily fluids.

In this situation the body should conserve both water and sodium.

As noted above, ADH plays a role in lowering osmolarity (reducing sodium concentration) by

increasing water reabsorption in the kidneys, thus helping to dilute bodily fluids. To prevent osmolarityfrom decreasing below normal, the kidneys also have a regulated mechanism for reabsorbing sodium in

the distal nephron. This mechanism is controlled by aldosterone, a steroid hormone produced by the

adrenal cortex. Aldosterone secretion is controlled two ways:

1.The adrenal cortex directly senses plasma osmolarity. When the osmolarity increases above normal,

aldosterone secretion is inhibited. The lack of aldosterone causes less sodium to be reabsorbed in thedistal tubule. Remember that in this setting ADH secretion will increase to conserve water, thus

complementing the effect of low aldosterone levels to decrease the osmolarity of bodily fluids. The neteffect on urine excretion is a decrease in the amount of urine excreted, with an increase in the

osmolarity of the urine.

2. The kidneys sense low blood pressure (which results in lower filtration rates and lower flow through

the tubule). This triggers a complex response to raise blood pressure and conserve volume. Specializedcells (juxtaglomerular cells) in the afferent and efferent arterioles produce renin, a peptide hormone

that initiates a hormonal cascade that ultimately produces angiotensin II. Angiotensin II stimulates the

adrenal cortex to produce aldosterone.

*Note that in this setting, where the body is attempting to conserve volume, ADH secretion is alsostimulated and water reabsorption increases. Because aldosterone is also acting to increase sodium

reabsorption, the net effect is retention of fluid that is roughly the same osmolarity as bodily fluids. The

net effect on urine excretion is a decrease in the amount of urine excreted, with lower osmolarity thanin the previous example.

Dialysis

In medicine,dialysis (from Greek"dialusis", meaning dissolution, "dia", meaning through, and "lysis",meaning loosening) is primarily used to provide an artificial replacement for lost kidney functionn

people with renal failure. Dialysis may be used for those with an acute disturbance in kidney function(acute kidney injury, previously acute renal failure) or for those with progressive but chronicallyworsening kidney functiona state known as chronic kidney disease stage 5 (previously chronic renal

failure or end-stage kidney disease). The latter form may develop over months or years, but in contrast

to acute kidney injury is not usually reversible, and dialysis is regarded as a "holding measure" untila renal transplant can be performed, or sometimes as the only supportive measure in those for whom a

transplant would be inappropriate.[

The kidneys have important roles in maintaining health. When healthy, the kidneys maintain the body's

internal equilibrium of water and minerals (sodium, potassium, chloride, calcium, phosphorus,
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magnesium, sulfate). Those acidic metabolism end products that the body cannot get rid of via

respiration are also excreted through the kidneys. The kidneys also function as a part of the endocrine

system producing erythropoietin and calcitriol. Erythropoetin is involved in the production of red blood

cells and calcitriol plays a role in bone formation. Dialysis is an imperfect treatment to replace kidney

function because it does not correct the endocrine functions of the kidney. Dialysis treatments replace

some of these functions through diffusion (waste removal) and ultrafiltration (fluid removal)

TYPES OF DIALYSIS

There are two primary and two secondary types of dialysis:hemodialysis,peritonealdialysis,hemofiltration, hemodiafiltration, and intestinal dialysis.

Hemodialysis

In hemodialysis, the patient's blood is pumped through the blood compartment of a dialyzer, exposing

it to a partially permeable membrane. The dialyzer is composed of thousands of tiny synthetic hollow

fibers. The fiber wall acts as the semipermeable membrane. Blood flows through the fibers, dialysis

solution flows around the outside the fibers, and water and wastes move between these two

solutions.The cleansed blood is then returned via the circuit back to the body. Ultrafiltration occurs by

increasing the hydrostatic pressure across the dialyzer membrane. This usually is done by applying a

negative pressure to the dialysate compartment of the dialyzer. This pressure gradient causes water and

dissolved solutes to move from blood to dialysate, and allows the removal of several litres of excess

fluid during a typical 3 to 5 hour treatment. In the US, hemodialysis treatments are typically given in a

dialysis center three times per week (due in the US to Medicare reimbursement rules); however, as of

2007 over 2,500 people in the US are dialyzing at home more frequently for various treatment

lengths. Studies have demonstrated the clinical benefits of dialyzing 5 to 7 times a week, for 6 to 8

hours. This type of hemodialysis is usually called "nocturnal daily hemodialysis", which a study has

shown a significant improvement in both small and large molecular weight clearance and decrease the

requirement of taking phosphate binders.These frequent long treatments are often done at home while

sleeping, but home dialysis is a flexible modality and schedules can be changed day to day, week toweek. In general, studies have shown that both increased treatment length and frequency are clinically

beneficial.
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Peritoneal dialysisIn peritoneal dialysis, a sterile solution containing glucose is run through a tube into theperitoneal

cavity, the abdominalbody cavity around theintestine, where the peritoneal membrane acts as a

semipermeable membrane.The peritoneal membrane or peritoneum is a layer of tissue containing blood

vessels that lines and surrounds the peritoneal, or abdominal, cavity and the internal abdominal organs

(stomach, spleen, liver, and intestines). The dialysate is left there for a period of time to absorb waste

products, and then it is drained out through the tube and discarded. This cycle or "exchange" isnormally repeated 4-5 times during the day, (sometimes more often overnight with an automated

system). Each time the dialysate fills and empties from the abdomen is called one exchange. A dwell

time means that the time of dialysate stay in patient's abdominal cavity - wastes, chemicals and extra

fluid move from patient's blood to the dialysate across the peritoneum. A drain process is the process

after the dwell time, the dialysate full with waste products and extra fluid is drained out of patient's

blood.Ultrafiltration occurs via osmosis; the dialysis solution used contains a high concentration of

glucose, and the resulting osmotic pressure causes fluid to move from the blood into the dialysate. As a

result, more fluid is drained than was instilled. Peritoneal dialysis is less efficient than hemodialysis,

but because it is carried out for a longer period of time the net effect in terms of removal of waste

products and of salt and water are similar to hemodialysis. Peritoneal dialysis is carried out at home by

the patient. Although support is helpful, it is not essential. It does free patients from the routine ofhaving to go to a dialysis clinic on a fixed schedule multiple times per week, and it can be done while

travelling with a minimum of specialized equipment.

Hemodiafiltration

Hemodialfiltration is a combination of hemodialysis and hemofiltration. In theory, this technique offers

the advantages of both hemodialysis and hemofiltration.

Intestinal dialysis

In intestinal dialysis, the diet is supplemented with soluble fibres such as acacia fibre, which is digested

by bacteria in the colon. This bacterial growth increases the amount of nitrogen that is eliminated in

fecal waste.An alternative approach utilizes the ingestion of 1 to 1.5 liters of non-absorbable solutions

of polyethylene glycol or mannitol every fourth hour.
http://en.wikipedia.org/wiki/Peritoneumhttp://en.wikipedia.org/wiki/Peritoneumhttp://en.wikipedia.org/wiki/Peritoneumhttp://en.wikipedia.org/wiki/Abdomenhttp://en.wikipedia.org/wiki/Abdomenhttp://en.wikipedia.org/wiki/Intestinehttp://en.wikipedia.org/wiki/Intestinehttp://en.wikipedia.org/wiki/Intestinehttp://en.wikipedia.org/wiki/Osmosishttp://en.wikipedia.org/wiki/Gum_arabichttp://en.wikipedia.org/wiki/File:Peritoneal_dialysis.gifhttp://en.wikipedia.org/wiki/Peritoneumhttp://en.wikipedia.org/wiki/Peritoneumhttp://en.wikipedia.org/wiki/Abdomenhttp://en.wikipedia.org/wiki/Intestinehttp://en.wikipedia.org/wiki/Osmosishttp://en.wikipedia.org/wiki/Gum_arabic


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HEMODIALYSIS MACHINES

The Fresenius 2008 Kidney Dialysis

Machine series were designed for

flexibility. They all Equipped with

advanced therapy options;

ultrafiltration, fixed proportioning,

heat disinfecting, variable dialysate

flow, and including automatic blood

pressure monitoring as well as

computer documentation capabilities.

The Fresenius 2008 Kidney Dialysis

Machine, Easy to operate touchmembrane control panel with

improved visual displays and

advancetherapy options in the E model is retrofittable to the C and the D machines and the panel of the

H system is retrofittable to the C, D, and the E model machines.

The Prismaflex (TM) Machine is the newest generation of technology

forCRRT (Kidney Dialysis) offered by Gambro.

With the Prismaflex (TM) System, Gambro enhance prescription flexibility byoffering a platform with increased therapy options and features.

This is the information about the main differencesbetween the current

technology and the Prismaflex (TM) :

The Prismaflex (TM) has the combination of vivid colors and clear graphics

on a large 12 inch touch screen.

The safety system of Prismaflex (TM) is proactive, offering many helpful

features, such as automatic bar code identification of the set and customized

default safe values.
http://www.dotmed.com/http://www.gambro.com/http://www.fbodaily.com/http://www.lhsc.on.ca/http://2.bp.blogspot.com/_u337ThvlyDw/SnnkXW9RyXI/AAAAAAAAB8g/b_RemiyavpY/s1600-h/Fresenius-2008E+Kidney+Dialysis+machine.jpghttp://www.dotmed.com/http://www.gambro.com/http://www.fbodaily.com/http://www.lhsc.on.ca/


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Principle involve hemodialysis

Dialysis works on the principles of the diffusion of solutes and ultrafiltration of fluid across a semi-

permeable membrane. Diffusion describes a property of substances in water. Substances in water tend

to move from an area of high concentration to an area of low concentration. Blood flows by one side of

a semi-permeable membrane, and a dialysate, or special dialysis fluid, flows by the opposite side. A

semipermeable membrane is a thin layer of material that contains various sized holes, or pores. Smaller

solutes and fluid pass through the membrane, but the membrane blocks the passage of larger substances

(for example, red blood cells, large proteins).

The two main types of dialysis, hemodialysis and Peritoneal dialysis, remove wastes and excess water

from the blood in different ways. Hemodialysis removes wastes and water by circulating blood outside

the body through an external filter, called a dialyzer, that contains a semipermeable membrane. The

blood flows in one direction and the dialysate flows in the opposite. The counter-current flow of

the blood and dialysate maximizes the concentration gradient of solutes between the blood and

dialysate, which helps to remove more urea and creatinine from the blood. The concentrations of

solutes (for examplepotassium,phosphorus, and urea) are undesirably high in the blood, but low or

absent in the dialysis solution and constant replacement of the dialysate ensures that the concentration

of undesired solutes is kept low on this side of the membrane. The dialysis solution has levels ofminerals likepotassium and calcium that are similar to their natural concentration in healthy blood. For

another solute, bicarbonate, dialysis solution level is set at a slightly higher level than in normal blood,

to encourage diffusion ofbicarbonate into the blood, to act as a pH buffer to neutralize the metabolic

acidosis that is often present in these patients. The levels of the components of dialysate are typically

prescribed by a nephrologist according to the needs of the individual patient.

Inperitoneal dialysis, wastes and water are removed from the blood inside the body using

theperitoneal membraneof theperitoneum as a natural semipermeable membrane. Wastes and excess

water move from the blood, across the peritoneal membrane, and into a special dialysis solution, called

dialysate, in the abdominal cavity which has a composition similar to the fluid portion of blood.

Side effects and complications of Hemodialysis

Hemodialysis often involves fluid removal (through ultrafiltration), because most patients with renal

failure pass little or no urine. Side effects caused by removing too much fluid and/or removing fluid too

rapidly include low blood pressure,fatigue, chest pains, leg-cramps, nausea and headaches. These

symptoms can occur during the treatment and can persist post treatment; they are sometimes

collectively referred to as the dialysis hangover or dialysis washout. The severity of these symptoms is

usually proportionate to the amount and speed of fluid removal. However, the impact of a given

amount or rate of fluid removal can vary greatly from person to person and day to day. These sideeffects can be avoided and/or their severity lessened by limiting fluid intake between treatments or

increasing the dose of dialysis e.g. dialyzing more often or longer per treatment than the standard three

times a week, 34 hours per treatment schedule.

Since hemodialysis requires access to the circulatory system, patients undergoing hemodialysis may

expose their circulatory system to microbes, which can lead to sepsis, an infection affecting the heart

valves (endocarditis) or an infection affecting the bones (osteomyelitis). The risk of infection varies
http://en.wikipedia.org/wiki/Diffusionhttp://en.wikipedia.org/wiki/Ultrafiltrationhttp://en.wikipedia.org/wiki/Semi-permeable_membranehttp://en.wikipedia.org/wiki/Semi-permeable_membranehttp://en.wikipedia.org/wiki/Semi-permeable_membranehttp://en.wikipedia.org/wiki/Hemodialysishttp://en.wikipedia.org/wiki/PDhttp://en.wikipedia.org/w/index.php?title=Dialyzer&action=edit&redlink=1http://en.wikipedia.org/wiki/Semipermeable_membranehttp://en.wikipedia.org/wiki/Dialysatehttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Potassiumhttp://en.wikipedia.org/wiki/Phosphorushttp://en.wikipedia.org/wiki/Potassiumhttp://en.wikipedia.org/wiki/Calciumhttp://en.wikipedia.org/wiki/Bicarbonatehttp://en.wikipedia.org/wiki/Bicarbonatehttp://en.wikipedia.org/wiki/Metabolic_acidosishttp://en.wikipedia.org/wiki/Metabolic_acidosishttp://en.wikipedia.org/wiki/Peritoneal_dialysishttp://en.wikipedia.org/w/index.php?title=Peritoneal_membrane&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Peritoneal_membrane&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Peritoneal_membrane&action=edit&redlink=1http://en.wikipedia.org/wiki/Peritoneumhttp://en.wikipedia.org/wiki/Abdominal_cavityhttp://en.wikipedia.org/wiki/Ultrafiltration_(renal)http://en.wikipedia.org/wiki/Renal_failurehttp://en.wikipedia.org/wiki/Renal_failurehttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Fatigue_(physical)http://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Headacheshttp://en.wikipedia.org/wiki/Microbeshttp://en.wikipedia.org/wiki/Sepsishttp://en.wikipedia.org/wiki/Endocarditishttp://en.wikipedia.org/wiki/Osteomyelitishttp://en.wikipedia.org/wiki/Diffusionhttp://en.wikipedia.org/wiki/Ultrafiltrationhttp://en.wikipedia.org/wiki/Semi-permeable_membranehttp://en.wikipedia.org/wiki/Semi-permeable_membranehttp://en.wikipedia.org/wiki/Hemodialysishttp://en.wikipedia.org/wiki/PDhttp://en.wikipedia.org/w/index.php?title=Dialyzer&action=edit&redlink=1http://en.wikipedia.org/wiki/Semipermeable_membranehttp://en.wikipedia.org/wiki/Dialysatehttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Potassiumhttp://en.wikipedia.org/wiki/Phosphorushttp://en.wikipedia.org/wiki/Potassiumhttp://en.wikipedia.org/wiki/Calciumhttp://en.wikipedia.org/wiki/Bicarbonatehttp://en.wikipedia.org/wiki/Bicarbonatehttp://en.wikipedia.org/wiki/Metabolic_acidosishttp://en.wikipedia.org/wiki/Metabolic_acidosishttp://en.wikipedia.org/wiki/Peritoneal_dialysishttp://en.wikipedia.org/w/index.php?title=Peritoneal_membrane&action=edit&redlink=1http://en.wikipedia.org/wiki/Peritoneumhttp://en.wikipedia.org/wiki/Abdominal_cavityhttp://en.wikipedia.org/wiki/Ultrafiltration_(renal)http://en.wikipedia.org/wiki/Renal_failurehttp://en.wikipedia.org/wiki/Renal_failurehttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Fatigue_(physical)http://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Headacheshttp://en.wikipedia.org/wiki/Microbeshttp://en.wikipedia.org/wiki/Sepsishttp://en.wikipedia.org/wiki/Endocarditishttp://en.wikipedia.org/wiki/Osteomyelitis


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depending on the type of access used. Bleeding may also occur, again the risk varies depending on the

type of access used. Infections can be minimized by strictly adhering to infection control best practices.

Heparin is the most commonly used anticoagulant in hemodialysis, as it is generally well tolerated and

can be quickly reversed withprotamine sulfate. Heparin allergy can infrequently be a problem and can

cause a low platelet count. In such patients, alternative anticoagulants can be used. In patients at high

risk of bleeding, dialysis can be done without anticoagulation.

First Use Syndrome is a rare but severe anaphylactic reaction to the artificial kidney. Its symptoms

include sneezing, wheezing, shortness of breath, back pain, chest pain, or sudden death. It can be

caused by residual sterilant in the artificial kidney or the material of the membrane itself. In recent

years, the incidence of First Use Syndrome has decreased, due to an increased use ofgamma

irradiation, steam sterilization, or electron-beam radiation instead of chemical sterilants, and the

development of new semipermeable membranes of higherbiocompatibility. New methods of

processing previously acceptable components of dialysis must always been considered. For example, in

2008, a series of first-use type or reactions, including deaths occurred due to heparin contaminated

during the manufacturing process with oversulfatedchondroitin sulfate.

Longterm complications of hemodialysis include amyloidosis, neuropathy and various forms ofheart

disease. Increasing the frequency and length of treatments have been shown to improve fluid overload

and enlargement of the heart that is commonly seen in such patients.

Listed below are specific complications associated with different types of hemodialysis access.

Nursing care for hemodialysis patient

Adapt from nephrology nursing practice recommendations developed by Canadian Association of

Nephrology and Technology (CANNT) based on best available evidence and clinical practice

guidelines, a nephrology nurse should perform.

Hemodialysis Vascular Access:Assess the fistula/graft and arm before, after each dialysis or everyshift: the access flow, complications Assess the complication of central venous catheter: the tip

placement, exit site, complications document and notify appropriate health care provider regarding any

concerns. educates the patient with appropriate cleaning of fistula/graft and exit site; with recognizing

and reporting signs and symptoms of infection and complication.

Hemodialysis adequacy: Assesses patient constantly for signs and symptoms of inadequate dialysis.

Assesses possible causes of inadequate dialysis. Educations patients the importance of receiving

adequate dialysis.

Hemodialysis treatment and complications: Performs head to toe physical assessment before, during

and after hemodialysis regarding complications and accesss security. Confirm and deliver dialysis

prescription after review most update lab results. Address any concerns of the patient and educate

patient when recognizing the learning gap.

Medication management and infection control practice: Collaborate with the patient to develop a

medication regimen. Follow infection control guidelines as per unit protocol.
http://en.wikipedia.org/wiki/Infection_controlhttp://en.wikipedia.org/wiki/Heparinhttp://en.wikipedia.org/wiki/Protamine_sulfatehttp://en.wikipedia.org/wiki/Anaphylaxishttp://en.wikipedia.org/wiki/Artificial_kidneyhttp://en.wikipedia.org/w/index.php?title=Gamma_irradiation&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Gamma_irradiation&action=edit&redlink=1http://en.wikipedia.org/wiki/Biocompatibilityhttp://en.wikipedia.org/wiki/Chondroitin_sulfatehttp://en.wikipedia.org/wiki/Amyloidosishttp://en.wikipedia.org/wiki/Neuropathyhttp://en.wikipedia.org/wiki/Heart_diseasehttp://en.wikipedia.org/wiki/Heart_diseasehttp://en.wikipedia.org/wiki/Infection_controlhttp://en.wikipedia.org/wiki/Heparinhttp://en.wikipedia.org/wiki/Protamine_sulfatehttp://en.wikipedia.org/wiki/Anaphylaxishttp://en.wikipedia.org/wiki/Artificial_kidneyhttp://en.wikipedia.org/w/index.php?title=Gamma_irradiation&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Gamma_irradiation&action=edit&redlink=1http://en.wikipedia.org/wiki/Biocompatibilityhttp://en.wikipedia.org/wiki/Chondroitin_sulfatehttp://en.wikipedia.org/wiki/Amyloidosishttp://en.wikipedia.org/wiki/Neuropathyhttp://en.wikipedia.org/wiki/Heart_diseasehttp://en.wikipedia.org/wiki/Heart_disease


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Eat Right to Feel Right on Hemodialysis

How does food affect my hemodialysis?

Food gives you energy and helps your body repair itself. Food is broken down in your stomach andintestines. Your blood picks up nutrients from the digested food and carries them to all your body cells.

These cells take nutrients from your blood and put waste products back into the bloodstream. Whenyour kidneys were healthy, they worked around the clock to remove wastes from your blood. Thewastes left your body when you urinated. Other wastes are removed in bowel movements.

Now that your kidneys have stopped working, hemodialysis removes wastes from your blood. But

between dialysis sessions, wastes can build up in your blood and make you sick. You can reduce the

amount of wastes by watching what you eat and drink. A good meal plan can improve your dialysis andyour health.

Your clinic has a dietitian to help you plan meals. A dietitian specializes in food and nutrition. A

dietitian with special training in care for kidney health is called a renal dietitian.

What do I need to know about fluids?

You already know you need to watch how much you drink. Any food that is liquid at room temperature

also contains water. These foods include soup, Jell-O, and ice cream. Many fruits and vegetables

contain lots of water, too. They include melons, grapes, apples, oranges, tomatoes, lettuce, and celery.

All these foods add to your fluid intake.

Fluid can build up between dialysis sessions, causing swelling and weight gain. The extra fluid affects

your blood pressure and can make your heart work harder. You could have serious heart trouble fromoverloading your system with fluid.

Control Your thirst

The best way to reduce fluid intake is to reduce thirst caused by the salt you eat. Avoid salty foods likechips and pretzels. Choose low-sodium products.

You can keep your fluids down by drinking from smaller cups or glasses. Freeze juice in an ice cube

tray and eat it like a popsicle. (Remember to count the popsicle in your fluid allowance!) The dietitian

will be able to give you other tips for managing your thirst.


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12/15

High-Potassium Foods:

apricotsavocados

bananas

beetsBrussels sprouts

cantaloupeclams

datesfigs

kiwi fruitlima beans

melons

milknectarines

orange juiceoranges

peanutspears (fresh)

potatoesprune juice

prunes

raisinssardines

spinachtomatoes

winter squashyogurt

What do I need to know about phosphorus?

Phosphorus is a mineral found in many foods. If you have too much phosphorus in your blood, it pulls

calcium from your bones. Losing calcium will make your bones weak and likely to break. Also, too

much phosphorus may make your skin itch. Foods like milk and cheese, dried beans, peas, colas, nuts,

and peanut butter are high in phosphorus. Usually, people on dialysis are limited to 1/2 cup of milk perday. The renal dietitian will give you more specific information regarding phosphorus.

You probably will need to take a phosphate binder like Renagel, PhosLo, Tums, or calcium carbonate

to control the phosphorus in your blood between dialysis sessions. These medications act like spongesto soak up, or bind, phosphorus while it is in the stomach. Because it is bound, the phosphorus does not

get into the blood. Instead, it is passed out of the body in the stool.

What do I need to know about protein?

Before you were on dialysis, your doctor may have told you to follow a low-protein diet. Being on

dialysis changes this. Most people on dialysis are encouraged to eat as much high-quality protein as

they can. Protein helps you keep muscle and repair tissue. The better nourished you are, the healthier

you will be. You will also have greater resistance to infection and recover from surgery more quickly.

Your body breaks protein down into a waste product called urea. If urea builds up in your blood, its a

sign you have become very sick. Eating mostly high-quality proteins is important because they produce


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less waste than others. High-quality proteins come from meat, fish, poultry, and eggs (especially egg

whites).

What do I need to know about sodium?

Sodium is found in salt and other foods. Most canned foods and frozen dinners contain large amounts

of sodium. Too much sodium makes you thirsty. But if you drink more fluid, your heart has to workharder to pump the fluid through your body. Over time, this can cause high blood pressure and

congestive heart failure.

Try to eat fresh foods that are naturally low in sodium Look for products labeled low sodium.

Do not use salt substitutes because they contain potassium. Talk with a dietitian about spices you can

use to flavor your food. The dietitian can help you find spice blends without sodium or potassium.

What do I need to know about calories?

Calories provide energy for your body. If your doctor recommends it, you may need to cut down on thecalories you eat. A dietitian can help you plan ways to cut calories in the best possible way.

Some people on dialysis need to gain weight. You may need to find ways to add calories to your diet.

Vegetable oilslike olive oil, canola oil, and safflower oilare good sources of calories. Use them

generously on breads, rice, and noodles.


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Butter and margarines are rich in calories. But these fatty foods can also clog your arteries. Use them

less often. Soft margarine that comes in a tub is better than stick margarine. Vegetable oils are the

healthiest way to add fat to your diet if you need to gain weight.

Hard candy, sugar, honey, jam, and jelly provide calories and energy without clogging arteries oradding other things that your body does not need. If you have diabetes, be very careful about eating

sweets. A dietitians guidance is very important for people with diabetes.

Should I take vitamins and minerals?

Vitamins and minerals may be missing from your diet because you have to avoid so many foods. Yourdoctor may prescribe a vitamin and mineral supplement like Nephrocaps.

Warning: Do not take vitamin supplements that you can buy off the store shelf. They may containvitamins or minerals that are harmful to you.

Resources:

http://kidney.niddk.nih.gov/kudiseases/pubs/eatright/index.htm
http://kidney.niddk.nih.gov/kudiseases/pubs/eatright/index.htmhttp://kidney.niddk.nih.gov/kudiseases/pubs/eatright/index.htm


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ARELLANO UNIVERSITY

COLLEGE OF NURSING2600 Legarda Street,Sampaloc,Manila

REQUIREMENT

in

RELATED LEARNING

EXPERIENCE

HEMODIALYSIS UNIT

SUBMITTED BY:

CRUZ, Jennina Mae V.

IV-BSN-14

GROUP54A

SUBMITTED TO:

Ms. Melindaneva S. Biteng RN,MAN

Documents

jennina HEMO