1. © OCR 2016 Treating kidney failure

2. © OCR 2016 Objectives of lesson Describe the symptoms and causes of kidney failure Explain methods of diagnosing kidney failure Describe treatments for kidney failure and the pros and cons for each treatment Discuss how organ donations could be increased

3. © OCR 2016 Kidney failure When kidneys start to fail, toxins such as urea start to accumulate in the body and fluid will accumulate in tissues. What symptoms would you expect a patient to notice?

4. © OCR 2016 Kidney failure Oedema – swelling due to accumulation of fluid in tissues Urine may contain blood, protein and be cloudy Anaemia and tiredness– as kidneys stop producing erythropoetin Rashes, nausea – due to build up of toxins

5. © OCR 2016 Kidney failure http://www.lifeoptions.org/kidneyinfo/ckdinfo.php?page=4www.lifeoptions.org/kidneyinfo/ckdinfo.php?page=4

6. © OCR 2016 Causes of acute renal failure A serious illness or operation especially if severe infection occurs. Loss of large amount of blood or tissue fluid A blockage preventing drainage of urine from the kidney eg a kidney stone Also – can be caused by side effect of some medications and by a bacterial infection of the kidney

7. © OCR 2016 Causes of chronic renal failure Complication of diabetes mellitus Uncontrolled high blood pressure Inflammation of kidney tissue As a result of inherited diseases of the kidney such as polycystic kidney disease.

8. © OCR 2016 Diagnosing kidney disease Look for symptoms such as oedema and cloudy or bloody urine Ultrasound and CT scans to look for blockages Analyse urine samples for blood cells and protein. –Q: Why should these not be present in urine?

9. © OCR 2016 Diagnosing kidney disease Look for symptoms such as oedema and cloudy or bloody urine Ultrasound and CT scans to look for blockages Analyse urine samples for blood cells and protein. –Q: Why should these not be present in urine? –A: They are too big to pass from the blood, through the walls of the capillaries in the glomerulus and into the Bowman’s capsule

10. © OCR 2016 Analysing blood samples Blood can be analysed for a waste substance called creatinine which increases as kidney disease progresses – failing kidneys do not remove wastes from the blood.

11. © OCR 2016 Glomerular filtration rate (GFR) This is the volume of fluid that is filtered out of the blood per minute and can also be used to measure kidney function. A substance such as inulin* can be injected into the blood stream and its removal rate measured, or the removal rate of wastes such as creatinine can be measured. The lower the GFR, the less effective kidney function. *yes, inulin, NOT insulin! Inulin is a polysaccharide that passes easily into the urine during filtration in the healthy glomeruli and is not reabsorbed later, so the amount in urine is a very good indicator of how well that part of the kidney is working

12. © OCR 2016 Glomerular filtration rate (GFR) Q: Why must the salt intake of someone with kidney failure be carefully controlled? A: Sodium chloride would build up in the blood altering the water potential of blood plasma leading to retention of water (oedema), excessive thirst and eventually cardiac arrest.

13. © OCR 2016 Diagnosing kidney failure In pairs, imagine one of you is the doctor and one is the patient with kidneys that are beginning to fail. As the doctor, what questions could you ask and what simple tests could you carry out to determine whether the patient has kidney problems? As the patient, what symptoms should you describe?

14. © OCR 2016 Diagnosing kidney failure Test urine for protein Look for oedema Measure blood pressure Ask about feeling ill or tired Excessive thirst?

15. © OCR 2016 Treating Kidney Failure Three possible treatments:- –Haemodialysis –Peritoneal dialysis –Kidney transplant

16. © OCR 2016 Haemodialysis This removes waste products from the blood by passing it out of the body, through a filtering system (dialyser) and returning it, cleaned, to the body.dialyser The blood flows through tubes made of a selectively permeable membrane that allows the waste products (which are much smaller than blood cells) to pass out through it.membraneblood cells

17. © OCR 2016 Haemodialysis In dialysis, how are substances transported from the patient’s blood to the dialysis fluid? Diffusion and osmosis How could you avoid useful substances being removed from the blood? Same concentration of substance in dialysis fluid as in blood

18. © OCR 2016 Haemodialysis Why should the temperature and the water potential of the dialysis fluid be the same as that of the blood? To prevent cooling or warming in patient and to prevent dehydration or over-hydration of the patient Why is heparin added to the blood? To prevent clotting of blood in dialysis machine

19. © OCR 2016 Haemodialysis In the animation http://www.kidneypatientguide.org.uk/HDanim.php the blood is shown being pumped in at the top and out at the bottom of the dialyser diagram. The dialysate is pumped through the machine in the opposite direction (in at bottom in the diagram, out at the top). Why do you think it is designed like this? Can you see a link to one of the gas exchange topics earlier in the course? http://www.kidneypatientguide.org.uk/HDanim.php

20. © OCR 2016 Haemodialysis In the animation http://www.kidneypatientguide.org.uk/HDanim.php the blood is shown being pumped in at the top and out at the bottom of the dialyser diagram. The dialysate is pumped through the machine in the opposite direction (in at bottom in the diagram, out at the top). Why do you think it is designed like this? Can you see a link to one of the gas exchange topics earlier in the course? http://www.kidneypatientguide.org.uk/HDanim.php Hint: It’s an example of a ‘countercurrent’

21. © OCR 2016 Peritoneal dialysis Dialysis fluid is placed around the membrane lining the intestine (peritoneal membrane) and toxins and excess water diffuse out of the blood and into the dialysis fluid, which is regularly changed.

22. © OCR 2016 Peritoneal dialysis http://www.kidneypatientguide.org.uk/site/pdanim.phpwww.kidneypatientguide.org.uk/site/pdanim.php

23. © OCR 2016 Kidney transplant http://www.visibleproductions.com/index.php?page=asse t_detail&asset_id=vpl_0485_001http://www.visibleproductions.com/index.php?page=asse t_detail&asset_id=vpl_0485_001

24. © OCR 2016 Kidney transplantation Can you think of any advantages and disadvantages of transplantation compared with dialysis?

25. © OCR 2016 Discussion How would you try to increase the availability of kidneys for donation?

26. © OCR 2016 Objectives of lesson Describe the symptoms and causes of kidney failure Explain methods of diagnosing kidney failure Describe treatments for kidney failure and the pros and cons for each treatment Discuss how organ donations could be increased OCR Resources: the small print OCR’s resources are provided to support the teaching of OCR specifications, but in no way constitute an endorsed teaching method that is required by the Board, and the decision to use them lies with the individual teacher. Whilst every effort is made to ensure the accuracy of the content, OCR cannot be held responsible for any errors or omissions within these resources. © OCR 2016 - This resource may be freely copied and distributed, as long as the OCR logo and this message remain intact and OCR is acknowledged as the originator of this work. Please get in touch if you want to discuss the accessibility of resources we offer to support delivery of our qualifications: resources.feedback@ocr.org.ukresources.feedback@ocr.org.uk