Renal replacement therapy It is a term used to encompass life supporting treatments for renal failure CAN BE ACHIEVED BY

1. Renal replacement therapy It is a term used to encompass life supporting treatments for renal failure CAN BE ACHIEVED BY TWO MEANS • Dialysis a. Hemodialysis b. Peritoneal dialysis 2. Renal Transplantation Dr S Chakradhar

2. Dialysis • Dialysis does not correct metabolic & endocrine abnormalities  • Replaces excretory function – excretion of nitrogenous waste products , maintain electrolyte balance & extracellular fluid volume Indications • Plasma urea > 30 mmol /L (84.03 mg/dL) • Plasma creatinice >600µmol/L (6.79 mg/dL) • Hyperkalaemia >7 mmol/L • Fluid overload (not controled by fluid restriction & diuretics) • Uraemic pericarditis Dr S Chakradhar

3. Peritoneal dialysis • Dialysis in which fluid (dialysate / 500ml ) is infused into the peritoneal cavity through an implanted catheter • Diffusion takes place along the concentration gradient of the substances in the blood and dialysate. • And then drained from the body after absorbing metabolic toxins. Dr S Chakradhar

4. Complications of peritoneal dialysis • Infection – Peritoneal , around the cuff • Leakage of dialysate fluid along the insertion track • Poor flow of dialysate • Hernia formation e.gincisional Dr S Chakradhar

5. Hemodialysis The process of diffusing blood across a semipermeable membrane to remove toxic materials and to maintain fluid, electrolyte, and acid-base balance Vascular access • In emergency femoral or internal jugular vein • In elective A-V Fistula forearm vein (arterialization) Frequency & duration • 4-5 hours 3 times a week Dr S Chakradhar

6. Principle • Blood is pumped through the dialyzer, exposing it to a semipermeable membrane. • A solution of crystalloids is pumped along the other side of the membrane against the direction of the blood flow • The cleansed blood is then returned via the circuit back to the body. Dr S Chakradhar

7. Dr S Chakradhar

8. HEMOFILTRATION • Similar to hemodialysis as it also requires a semi permeable membrane • But no dialysate is used. • Requires a positive hydrostatic pressure driving water and solutes to filtrate compartment • Both small and large solute particles are dragged through, due to hydrostatic pressure. • High quality replacement fluid(isotonic) is used as ultrafilterate substitute Dr S Chakradhar

9. Renal transplantation Renal transplant is the organ transplant of a kidney in a patient having end stage renal disease. • Donors • Live donor • Cadaveric donor Tests • ABO, Cross matching and HLA matching Dr S Chakradhar

10. HOW RENAL TRANSPLANT IS DONE • Kidney is not removed as it increases surgical morbidities • Donated kidney is placed in the ILIAC FOSSA with a separate blood supply • Donors renal artery is connected to EXTERNAL ILIAC ARTERY of recipient • Renal vein is connected to EXTERNAL ILIAC VEIN of the recipient. • Blood is allowed to flow through kidney to minimize the ischemia time. • Final step is to connect the donors ureter to the recipient bladder

11. Immunosuppressive therapy • Prednisolone , Cyclosporin , Azathioprine , Mycophenolate mofetil (MMF), Tacrolimus life long Complications • Rejection • Infections • Malignancy • Acne, hairsuitism , hair loss, obesity, hypercholestrolemia , diabetes mellitus (type2) • In case of rejection (second transplant / dialysis) Dr S Chakradhar