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

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

And then drained from the body after absorbing metabolic toxins. 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

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

In emergency femoral or internal jugular vein 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

The cleansed blood is then returned via the circuit back to the body. 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

Dr S Chakradhar

Similar to hemodialysis as it also requires a semi permeable membrane 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

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

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

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