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
Renal Transplantation
Dr S Chakradhar

2. 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. 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

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.g incisional
Dr S Chakradhar

5. 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

6. 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

7. Dr S Chakradhar

8. 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

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