HOW DOES YOUR KIDNEYS WORK?
PRIMARY MODALITIES:
Your kidneys remove wastes and extra fluid from
your body. Your kidneys also remove acid that is produced
by the cells of your body and maintain a healthy balance of
water, salts, and minerals—such
as sodium, calcium, phosphorus, and potassium—in your
blood.
Each of your kidneys is made up of about a million
filtering units called nephrons. Each nephron includes a
filter, called the glomerulus, and a tubule. The nephrons
work through a two-step process: the glomerulus filters your
blood, and the tubule returns needed substances to your
blood and removes wastes.
As blood flows into each nephron, it enters a cluster
of tiny blood vessels—the glomerulus. The thin walls of the
glomerulus allow smaller molecules, wastes, and fluid—
mostly water—to pass into the tubule. Larger molecules,
such as proteins and blood cells, stay in the blood vessel.
A blood vessel runs alongside the tubule. As the
filtered fluid moves along the tubule, the blood vessel
reabsorbs almost all of the water, along with minerals and
nutrients your body needs. The tubule helps remove excess
acid from the blood. The remaining fluid and wastes in the
tubule become urine.
Blood flows into your kidney through
the renal artery. This large blood vessel branches into
smaller and smaller blood vessels until the blood reaches the
nephrons. In the nephron, your blood is filtered by the tiny
blood vessels of the glomeruli and then flows out of your
kidney through the renal vein.
Your blood circulates through your kidneys many
times a day. In a single day, your kidneys filter about 150
quarts of blood. Most of the water and other substances that
filter through your glomeruli are returned to your blood by
the tubules. Only 1 to 2 quarts become urine.
Without this balance, nerves, muscles, and other
tissues in your body may not work normally.
RENAL REPLACEMENT THERAPY
→ it is a procedure which help to clear accumulated
solutes, water or toxins from the blood by diffusion or
convection or both across a semi-permeable
membrane.
→ Technologies advances in the care of children with
ARF and CRF provide several renal replacement
therapies for maintaining excretory function in acute
disease and for prolonging life in those with ESRD
→ Renal failure important and independent factor
determines outcome in critically ill children-morbidity
and mortality.
 Hemodialysis
 Peritoneal Dialysis (PD)
 Hemofiltration
 Transplantation
DIALYSIS
→ it is the process of separating colloids and
crystalline substances in solution by the difference in their
rate of diffusion through semi-permeable membrane.
→ Three processes accomplish this movement across
the membrane:
 Osmosis – Passive movement of water from a
solution of lower concentration to a solution of higher
concentration of higher concentration of particles.
 Diffusion – Random movement of particles from an
area of greater concentration to an area of lower
concentration.
 Ultrafiltration – Process by which plasma water is
removed because of a pressure gradient between the
blood and dialysate compartments.
→ Methods of dialysis currently available for clinical
management of renal failure are:
 HEMODIALYSIS in which blood is circulated
outside the body through artificial cellophane
membranes that permit a similar passage of water
and solutes
 PD or PERITONEAL DIALYSIS wherein the
abdominal cavity acts as a semipermeable
membrane through which water and solutes of
small molecular size move by osmosis and
diffusion according to their respective
concentrations on either side of the membrane.
 HEMOFILTRATION in which blood filtrate is
circulated outside the body by hydrostatic pressure
exerted across a semi-permeable membrane and
replaced (simultaneously) by electrolyte solution.
INDICATIONS FOR DIALYSIS
In ARF (Acute Renal Failure):
G : Glomerulonephritis
A : Acidosis metabolic (pH < 7.2)
E : Electrolytes – Hyperkalemia (K >6.5 meq/L) or
rapidly rising K, 5.5 to 6.5 with EEC changes)
I : Ingestion – toxins and drugs
O : Oliguria (0.6ml/kg/hr)
U : Uremia – pericarditis, encephalopathy, bleeding
In CRF (Chronic Renal Failure):
• GFR <15 ml/min
• Severe hypertension
• Intractable intravascular volume overload
• Profound electrolyte abnormalities: hyperkalemia or
hyperphosphatemia

HEMODIALYSIS
→ Preferred dialytic method for children with acute
conditions such as life-threatening hyperkalemia.
→ Involves use of machine to clear waste products NURSING
from blood stream CONSIDERATIONS
→ Blood travels through tubes to an artificial kidney • Encourage family
machine and waste products and waste fluids are member to stay with
removed from the body, purified blood flows back the child
to the body through another set of tubes. • Weight child before
→ Best suited to the children who do not have the start of dialysis
someone in family who is capable of learning to • If patient has SQ graft
perform home dialysis and those who live close to a – check blood access
dialysis center site q2 for patency and
→ It is usually done 3 times a week x 3 to 5 hours signs of clotting –
depending on child’s size don’t use the arm with
→ Can cause muscle cramping and hypotension due to his site for BP or
rapid change drawing blood.
VASCULAR ACCESS • Monitor VS, clotting
 ARTERIOVENOUS GRAFT time, blood flow,
function of vascular
access site, arterial
and venous pressure
• Watch out for complications: embolism, hepatitis and
rapid Fluid and Electrolyte loss – Weight patient and
watch for F & E imbalances
• Use standard precaution when handling blood and body
fluids

PD (PERITONEAL DIALYSIS)
 ARTERIOVENOUS FISTULA
→ For acute conditions, PD is quick, relatively easy to
learn, and safe to perform and requires minimum
equipment with specially trained nurses.
→ slow, gentle process that decreases the stress on body
organs that can occur with the rapid chemical and
volume changes of hemodialysis.
→ Indicated for neonates, children with severe
cardiovascular disease or those who are poor risks for
vascular access.
→ Chronic PD is the preferred form of dialysis for
children and parents who are independent:
→ families who live in a long distance from the medical
center
→ adolescents who prefer fewer dietary restrictions and a
gentler from of dialysis
→ Chronic PD is most often performed at home.
→ Contraindications for the use of PD include:
→ Recent abdominal surgery or peritoneal adhesions or
scarring
→