1. Kidney Failure

2. Spec (e) the effects of kidney failure and its potential treatments
To include the problems that arise from kidney failure including the effect on glomerular filtration rate (GFR) and electrolyte balance AND the use of renal dialysis and transplants for the treatment of kidney failure.

3. Learning Objective Success Criteria
To know about kidney failure
Outline the problems that arise from kidney failure including the effect on glomerular filtration rate (GFR)
Discuss the use of renal dialysis and transplants for the treatment of kidney failure
Describe how excretory products can be used in medial diagnosis

4. Put the statements into order
B. ADH enters blood capillaries in the posterior pituitary gland and travels to the collecting duct
A. Negative water potential
C. Collecting duct wall becomes more permeable
D. More water reabsorbed into the blood/ less urine produced
F. Osmoreceptors shrink and stimulate neurosecretory cells in hypothalamus
E. Action potential sent down axon of Neurosecretory cells causing the release of ADH

5. Answers
B. ADH enters blood capillaries in the posterior pituitary gland and travels to the collecting duct
A. Negative water potential
F. Osmoreceptors shrink and stimulate neurosecretory cells in hypothalamus
C. Collecting duct wall becomes more permeable
E. Action potential sent down axon of Neurosecretory cells causing the release of ADH
D. More water reabsorbed into the blood/ less urine produced

6. Kidney Failure
Failing kidneys can’t regulate the water and electrolyte levels in the body, or remove waste products from the body

7. Assessing Kidney Function
Estimating GFR (glomerular filtration rate)
Analyse urine for e.g. proteins (proteins in the blood indicate ultrafiltration mechanism is damaged)
A measure of how much fluid passes into the nephrons each minute
Normal reading: cm3/min
Chronic kidney disease reading: <60cm3/min
Kidney failure reading: <15cm3/min

8. Causes of Kidney Failure
Diabetes Mellitus (type I and type II)
Heart Disease
Hypertension
Infection

9. Kidney failure You have two kidneys, but you can manage with just one.
But if both kidneys fail, urea (waste) rises and the body is poisoned.
So if your kidneys fail, there are 2 options:
Option 1: Dialysis
You are attached to a kidney machine via a tube from a vein.
Your blood flows into the machine, is cleansed, and returns to your body.
You are attached for about 5 hours, 3 times per week.
Option 2: A kidney transplant
You have an operation to remove your failed kidney and replace it with a working kidney from a donor.
One or both kidneys may need to be transplanted
Questions you may like to ask about kidney failure:
Q. How would you feel about being attached to a kidney machine?

10. Task
In pairs students given info on either peritoneal dialysis or heamodialysis. They must pick out 5 key points and write them down. One of the pair then remains to explain while the other goes to collect info on other form of dialysis. They then report back to their partner

11. Dialysis

12. Are you an organ donor? 16,487,373 people – 27% of the population are
90% of people in the UK say they support organ donation
Q: How long after a transplant would it be before the NHS starts saving money, compared to keeping the patient on dialysis?
A: About two and a half years.
Q: If a 20 year old has a kidney transplant and lives to 80, roughly how much money would the NHS save?
A: Cost of dialysis: 60 years x £23,000 = £1,380,000. Cost of transplant: (60 years x £6,500) + £42,000 = £432,000. Saving: £948,000 – roughly one million pounds.

13. Where do the donor kidneys come from?
A living person can donate one kidney.
To donate a kidney (or any organ) after death, you have to have died in hospital – they have to be removed quickly.
Most people die at home so there is a serious shortage of donor kidneys for transplant.
There are around 7,000 people waiting for a kidney transplant.
Around 2,000 kidney transplants are carried out annually and each year 2,000 more people go on the kidney transplant list
Important: this topic needs to be handled with sensitivity. Please be aware that some students may have lost a friend or relative in tragic circumstances.
If appropriate, this is a chance to talk about why it is so important for anyone who joins the Organ Donor Register to discuss their decision with their close family.
Many organ donation opportunities are lost because next of kin are unaware of the deceased’s wish to donate, which places doctors in a very difficult position.
Most donor kidneys come from patients who have died while on a ventilator following a severe brain injury.
Q: Why do organs need to be removed from a dead person quickly?
A: Organs are made of living tissue which will die if it is not supplied with oxygen and glucose for cell respiration.

14. Matching donor organs to recipients – Human Leukocyte Antigen (HLA) tissue type
A kidney donor needs to be a close HLA type match with the recipient.
HLA type can make the difference between a patient’s body accepting or
rejecting a donated organ.
HLA type is defined by six principal pieces of protein: HLA antigens.
Each newly discovered HLA antigen has been numbered.
Doctors aim for at least a four HLA match between a donor and patient.
Which of these donors is the best match for someone in need of a
kidney transplant, with HLA numbers ?
Recipient 1:
Recipient 2:
Recipient 3:
Details of the HLA tissue type system fall outside most exam specifications, it’s just the principle that is required for the class activity that follows.

15. Task Write 6 numbers between 1 & 13 in a line on your mini whiteboard
That is your HLA type, can you find a match?

16. Dialysis or transplant?
Kidney dialysis works quite well, but is a time-consuming burden.
Apart from taking drugs to stop their body rejecting the new kidney, someone with a successful transplant can lead a completely normal life.
A transplant costs about £42,000 for the operation plus £6,500 a year in drugs and check-ups.
BUT
Dialysis isn’t cheap – about £23,000 per year, for life.
Q: How long after a transplant would it be before the NHS starts saving money, compared to keeping the patient on dialysis?
A: About two and a half years.
Q: If a 20 year old has a kidney transplant and lives to 80, roughly how much money would the NHS save?
A: Cost of dialysis: 60 years x £23,000 = £1,380,000. Cost of transplant: (60 years x £6,500) + £42,000 = £432,000. Saving: £948,000 – roughly one million pounds.

17. Dialysis or transplant?
Q. How long after a transplant would it be before the NHS starts saving money, compared to keeping the patient on dialysis?
Q: If a 20 year old has a kidney transplant and lives to 80, roughly how much money would the NHS save?
Q: How long after a transplant would it be before the NHS starts saving money, compared to keeping the patient on dialysis?
A: About two and a half years.
Q: If a 20 year old has a kidney transplant and lives to 80, roughly how much money would the NHS save?
A: Cost of dialysis: 60 years x £23,000 = £1,380,000. Cost of transplant: (60 years x £6,500) + £42,000 = £432,000. Saving: £948,000 – roughly one million pounds.

18. Dialysis or transplant?
How long after a transplant would it be before the NHS starts saving money, compared to keeping the patient on dialysis?
A: About two and a half years.
Q: If a 20 year old has a kidney transplant and lives to 80, roughly how much money would the NHS save?
A: Cost of dialysis: 60 years x £23,000 = £1,380,000. Cost of transplant: (60 years x £6,500) + £42,000 = £432,000. Saving: £948,000 – roughly one million pounds.
Q: How long after a transplant would it be before the NHS starts saving money, compared to keeping the patient on dialysis?
A: About two and a half years.
Q: If a 20 year old has a kidney transplant and lives to 80, roughly how much money would the NHS save?
A: Cost of dialysis: 60 years x £23,000 = £1,380,000. Cost of transplant: (60 years x £6,500) + £42,000 = £432,000. Saving: £948,000 – roughly one million pounds.

19. Construct a table of Advantages and Disadvantages of Kidney Transplants
Important: this topic needs to be handled with sensitivity. Please be aware that some students may have lost a friend or relative in tragic circumstances.
If appropriate, this is a chance to talk about why it is so important for anyone who joins the Organ Donor Register to discuss their decision with their close family.
Many organ donation opportunities are lost because next of kin are unaware of the deceased’s wish to donate, which places doctors in a very difficult position.
Most donor kidneys come from patients who have died while on a ventilator following a severe brain injury.
Q: Why do organs need to be removed from a dead person quickly?
A: Organs are made of living tissue which will die if it is not supplied with oxygen and glucose for cell respiration.

20. Construct a table of Advantages and Disadvantages of Kidney Transplants
Answers on p39
Important: this topic needs to be handled with sensitivity. Please be aware that some students may have lost a friend or relative in tragic circumstances.
If appropriate, this is a chance to talk about why it is so important for anyone who joins the Organ Donor Register to discuss their decision with their close family.
Many organ donation opportunities are lost because next of kin are unaware of the deceased’s wish to donate, which places doctors in a very difficult position.
Most donor kidneys come from patients who have died while on a ventilator following a severe brain injury.
Q: Why do organs need to be removed from a dead person quickly?
A: Organs are made of living tissue which will die if it is not supplied with oxygen and glucose for cell respiration.

21. Dialysis or Transplant?

22. Dialysis or Transplant
No longer consider yourself as chronically ill
Q: How long after a transplant would it be before the NHS starts saving money, compared to keeping the patient on dialysis?
A: About two and a half years.
Q: If a 20 year old has a kidney transplant and lives to 80, roughly how much money would the NHS save?
A: Cost of dialysis: 60 years x £23,000 = £1,380,000. Cost of transplant: (60 years x £6,500) + £42,000 = £432,000. Saving: £948,000 – roughly one million pounds.

23. Dialysis or Transplant
Have to carefully monitor your diet and fluid consumption
Q: How long after a transplant would it be before the NHS starts saving money, compared to keeping the patient on dialysis?
A: About two and a half years.
Q: If a 20 year old has a kidney transplant and lives to 80, roughly how much money would the NHS save?
A: Cost of dialysis: 60 years x £23,000 = £1,380,000. Cost of transplant: (60 years x £6,500) + £42,000 = £432,000. Saving: £948,000 – roughly one million pounds.

24. Dialysis or Transplant
Required to take immunosuppressants
Q: How long after a transplant would it be before the NHS starts saving money, compared to keeping the patient on dialysis?
A: About two and a half years.
Q: If a 20 year old has a kidney transplant and lives to 80, roughly how much money would the NHS save?
A: Cost of dialysis: 60 years x £23,000 = £1,380,000. Cost of transplant: (60 years x £6,500) + £42,000 = £432,000. Saving: £948,000 – roughly one million pounds.

25. Dialysis or Transplant
Can be performed at home
Q: How long after a transplant would it be before the NHS starts saving money, compared to keeping the patient on dialysis?
A: About two and a half years.
Q: If a 20 year old has a kidney transplant and lives to 80, roughly how much money would the NHS save?
A: Cost of dialysis: 60 years x £23,000 = £1,380,000. Cost of transplant: (60 years x £6,500) + £42,000 = £432,000. Saving: £948,000 – roughly one million pounds.

26. Dialysis or Transplant
Uses the peritoneum to filter the blood
Q: How long after a transplant would it be before the NHS starts saving money, compared to keeping the patient on dialysis?
A: About two and a half years.
Q: If a 20 year old has a kidney transplant and lives to 80, roughly how much money would the NHS save?
A: Cost of dialysis: 60 years x £23,000 = £1,380,000. Cost of transplant: (60 years x £6,500) + £42,000 = £432,000. Saving: £948,000 – roughly one million pounds.

27. Using urine samples in diagnostic tests

28. Pregnancy Tests
Test for hCG (human chorionic gonadotrophin hormone) which is made by an embryo after implantation
Pregnancy tests use monoclonal antibodies (antibodies made from one type of cell, specific to one complementary molecule) to bind to hCG

29. Pregnancy Tests Urine poured onto test stick
hCG binds to mobile antibodies attached to a blue bead
Mobile antibodies move down test stick
If hCG is present it also binds to fixed antibodies holding the blue beads in place, forming a blue line
Monoclonal antibodies with no hCG attached bind to another fixed site to form a blue control test line
Task: model how a pregnancy test works using playdoh (see p39)

30. Testing of anabolic steroids
Anabolic steroids increases protein synthesis within cells
Banned by all major sporting bodies
Have a half life of 16 hours
Small molecule that can easily enter the nephron
Identified by analysing urine samples with gas chromatography

31. PAG 9: Identifying Unknown Molecules
Success Criteria
Use of qualitative reagents to identify biological molecules
What you will be assessed on
Correct identification of biological molecules
Results shown in suitable table
Extension questions answered

32. Plenary PPQs

33. PPQ Kidney Failure
On print out

34. Markscheme

36. Markscheme

37. Markscheme continued

38. PPQ- Pregnancy Tests
On print out

39. Markscheme 2010