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m 

Prepared by,
Avinder Kaur Mann
Group 13
Êm

 
› w removes was es from e blood.
› w removes excess fluid from e blood and
i keeps elec roly es well balanced.
› Êa sor of ings are excre ed by e kidney?
› Urea - 30 g/day
› Crea inine - 2 g/day
› Sal - 15 g/day
› Uric Acid - 0.7 g/day
› Êa er - 1500 mL/day
› Unknown
› Kidney failure
› accumula ion of was e
› acidosis, edema, yper ension, coma
 
  
  
› mydroxybenzoa es
› mippura es
› Neu ro ransmi ers (dopamine)
› Bile pigmen s
› Uric acid
› An ibio ics
› Morpine
› Saccarin
ë
  
› Glucose
› Amino acids
› Pospa e
› Sulfa e
› Lac a e
› Succina e
› Ci ra e
u  

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Õ  Õ 

    

    

 

  
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› Purpose - removal of was es from e body
› Kidney sould be e ideal model for emodialysis
› Êa er re en ion / removal
› Sal re en ion / removal
› Pro ein re en ion
mÊ

Êë
› ëialysis works on e principles of e diffusion and
osmosis of salu es and fluids across a semi permeable
membrane.
› Blood flows by one side of a semi-permeable
membrane and a dialysa e or fluid flows by e
opposi e side.
 

 
 
› ëiffusive ranspor
› Blood from e pa ien flowing wi in e dialysis
appara us in erfacing wi  dialysa e fluid via pores
loca ed wi in eac fiber of e dialysis membrane
› Convec ive ranspor
› wn is mecanism, solu es are effec ively dragged along
wi  fluid as i moves across e membrane depending
upon eir size rela ive o e size of e membrane
pores.


!

› movemen due o concen ra ion gradien


› wf concen ra ion is iger in e blood and e species
can pass roug e membrane, ranspor occurs un il
e concen ra ions are equal
› Slow
› wf dialysa e concen ra ion is iger, e flow goes oward
e blood
 

› Massive movemen of fluid across membrane


› Fluid carries dissolved or suspended species a can
pass roug e membrane
› Usually as a resul of fluid pressure (bo  posi ive and
suc ion pressure)
› Principal means of wa er and elec roly e removal
(ul rafil ra ion)
› Can also remove wa er by adding glucose o dialysa e
(osmo ic gradien )
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m 

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m   
 

› Con ain ousands of


ollow fibers similar in
s ruc ure o a uman
capillary
› Types of membranes
› Cellulose
› Subs i u ed cellulose
› Syn e ic


 
 
›AV fis ula
›AV graf
›Cen ral venous ca e ers
 
  

 


› Pericardi is or pleuri is
› Progressive uremic encepalopa y or neuropa y, wi  signs suc as
confusion, as erixis, myoclonus, wris or foo drop, or, in severe cases,
seizures
› A clinically significan bleeding dia esis a ribu able o uremia
› Fluid overload refrac ory o diure ics
› Persis en me abolic dis urbances a are refrac ory o medical
erapy; ese include yperkalemia, me abolic acidosis,
ypercalcemia, and yperpospa emia
› Persis en nausea and vomi ing
› m  
     
 
›  
    


  
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› Mos neprologis s agree a delaying ini ia ion of dialysis
un il one or more of ese complica ions is presen may pu
e pa ien a unnecessary jeopardy
› An impor an goal of dialysis is o enance e quali y of
life as well as o prolong survival
› w is erefore impor an o consider less acu e indica ions
for dialysis
› Es ima ion of GFR (<15 ml/min)
› Nu ri ional s a us
  
#

     
 
› mypo ension (20-50%) › ëialysis disequilibrium
› Muscle cramps (5-20%) › Arry mias
› Nausea (5-15%) › Cardiac amponade
› meadace (5%) › wn racranial bleeding
› w cing (5%) › memolysis
› Ces pain/back pain (2-5%) › Air embolism
› Fever and cills (<1%)
  
 
› Tere are wo clinical pa erns of dialysis-associa ed
ypo ension
› Episodic ypo ension, wic ypically occurs during e la er
s ages of dialysis; is is associa ed wi  vomi ing, muscle
cramps, and o er vagal symp oms (suc as yawning).
› Cronic persis en ypo ension, wic may occur in long-
erm pa ien s in wom predialysis sys olic blood pressures of
less an 100 mmmg are frequen ly observed.

  



› Arry mias
› Especially common in pa ien s on ëigoxin
› wn racranial bleeding
› Underlying cerebrovascular disease combined wi  e use of
eparin
› memolysis
› Por wine appearance o blood in re urn lines
› Sudden back/ces pain
› Associa ed wi  obs ruc ion of blood line and problems wi  e
dialysis solu ions
› Air embolism
› En ers cerebral venous sys em in sea ed pa ien s
› En ers rig ven ricle in recumben pa ien s