COMPONENTS OF THE KIDNEY
Dialysis
Dialysis
 Dialysis is a common laboratory technique widely used for
removing contaminants from solution
 Dialysis technique is commonly used to remove small unwanted
molecules such as salts, reducing agents, preservatives, etc.
 Dialysis works by selective and passive diffusion through a
semipermeable membrane. 
 Dialysis can also be used for buffer exchange.
 The buffer used for dialysis is called dialysate
 The osmotic-type process that occurs in living systems.
 Process in which a semipermeable membrane allows the passage
of solvent, dissolved ions, and small molecules but blocks the
passage of colloidal-sized particles and large molecules.
 Solvent and small solute particles pass through an artificial
membrane.
 Large particles are retained inside.
 Waste particles such as urea from blood are removed using
hemodialysis (artificial kidney).
 There is a net movement of ions from a region of higher
concentration to a region of lower concentration.
RENAL ANATOMY AND PHYSIOLOGY
 Every time the heart beats, 25% of the cardiac output is sent to
the kidneys.
 The Kidney
 The kidney functions using three principles:
ultrafiltration, excretion, and reabsorption.
 The kidney consists of three parts:
1. The cortex (outer layer) contains 80% of the nephrons. These
nephrons filter the blood continuously to maintain balance.
2. The medulla (inner layer) contains 20% of the nephrons. These
nephrons also filter the blood, but have the added responsibility
to concentrate urine. This becomes an important diagnostic tool.
3. The renal pelvis is the start of the collecting system, containing
the collecting tubules and the ureter.
Additionally, ureters carry urine into the bladder where it is stored until
it is eliminated from the body through the urethra.
RESIDUAL KIDNEY FUNCTION
 The kidney is capable of maintaining the body's equilibrium until
about 50% of the nephrons are damaged
 After 50% loss of kidney function, the body begins to make trade-
offs to maintain homeostasis. For example, parathyroid hormone
(PTH) increases to compensate for increased excretion of
phosphorus. The patient will likely remain asymptomatic
 After 90% loss of kidney function, some form of renal
replacement therapy is necessary to preserve life
 With every heartbeat. 25% of the cardiac output goes to the
kidneys
 Blood enters the abdominal aorta and flows into the renal artery
 The renal artery branches until it becomes the afferent (entenng)
arteriole
 The afferent arteriole takes the blood into the glomerulus (the
filtering unit located in Bowman's capsule of the nephron)
 Because blood flows into Bowman's capsule faster than it
flows out. a resulting increase in pressure facilitates
filtration
 The efferent (leaving) arteriole takes the blood coming out of the
glomerulus and returns it to the venous system. The venous
system branches into larger vessels to become the renal vein
 The renal vein carries blood to the vena cava and returns it to the
heart
 • This process is continuous
KIDNEY FUNCTIONS
• The kidney has several functions (CRRT deals with the first four
functions):
1. Fluid balance
 Through ultrafiltration and reabsorption
2. Electrolyte balance
 Through reabsorption and excretion
3. Acid-base balance
 Through reabsorption and excretion
4. Excretion of drugs and by-products of metabolism
 Nitrogen
 Urea
 Creatinine
5. Synthesis of erythropoietin
 Stimulates the bone marrow to produce healthy red
blood cells and help them mature
6. Regulation of blood pressure
 Secretes rerun to help regulate blood pressure
7. Maintenance of calcium: phosphorus balance
 A normal ratio is 2:1
 The kidneys produce the active vitamin D and regulate
calcium
 The kidney also is the major excretor of phosphorus. If
the kidney does not function properly, phosphorus builds
up in the blood stream. As the body struggles to maintain
the 2:1 calcium: phosphorus ratio, it will steal calcium
from the bones by increasing parathyroid hormone (PTH)
production
 CRRT: DEFINITION

Continuous renal replacement therapy (CRIRT) is a therapy indicated for

continuous solute removal and/or fluid removal in the critically ti
patient. It allows for slow and isotonic fluid removal that results n better
hernodynamic tolerance even in unstable patients with shock and severe
fluid overload This process can be applied to both adults and children.

CRRT can be modified at any time of the day and right to allow
adaptation to the rapidly changing hemodynamic situation of critically ill
patients.

CRRT therapy indications may be renal, non-renal, or a combination of

both. It is the treatment of choice for the critically it patient needing
ULTRAFILTRATION
renal support and/or fluid management.
Ultrafiltration is the movement of fluid through a semi-permeable
 Removal of waste products
membrane along a pressure gradient
 Restoration of acid-base balance
 Correction of electrolyte abnormalities  Positive and negative prizsciires affect ultrafiltration
 Hemodynamic stabilization  Positive pressure is generated on the blood side of the
 Fluid balance membrane and negative pressure is generated on the fluid side
 Nutritional support  This gradient. positive to negative, influences the movement of
 Removal and/or modulation of septic mediators fluid from the blood side to the fluid side, resulting in a net
removal of fluid from the patient
DIFFUSION
 The ultrafiltration rate depends on the pressure applied to the
Diffusion is the movement of solutes through a semi-permeable filter, inside and outside the fibers
membrane from an area of higher concentration to an area of lower  Minimal solute clearance happens by convection during
concentration until equilibrium has been established. ultrafiltration
 Solutes move from a higher concentration to a lower
concentration
 In CRRT, diffusion occurs when blood flows on one side of the
membrane, and thaly_sate solution flows counter-current on the
other side
 The dialysate does not mix with the blood
 Efficient for removing small molecules but not large molecules
 Molecular size and membrane type can affect clearances
 Diffusion occurs during hemodialysis

ADSORPTION

Adsorption is the adherence of solutes and biological matter to the

surface of a membrane,

 High levels of adsorption can cause certain filters to clog and

CONVECTION
Convection is the one-way movement of solutes through a semi-
permeable membrane with a water flow. Sometimes it is referred to as
solvent drag.
 Efficient for both larger and smaller molecules
 The faster the substitution flow rate, the higher the clearance
 Pressure difference between the blood and ultrafiltrate causes
plas-ma water to be filtered across. This causes solvent drag for
small and large molecules across the membrane leading to
removal from the blood. The ultrafiltrate containing the solute
should be replaced by substitution solutions
 Substitution solutions must have near physiological levels of
electrolytes and buffer. and be sterile
 Solute molecular size and membrane type can affect clearances
 Convection is a hemofiltration principle
become ineffective
 Membrane type affects adsorptive tendencies /effectiveness
 Adsorption may also cause limited removal of some solutes (e.g..
82 microglobulins) from the blood
 In summary:
 Principles used in all CRRT/blood purification therapies are:
 Diffusion (hemodtalysis)
 Convection (hemofittration)
 Diffusion & convection (hemodiafdtration)
 Ultrafiltration (all therapies)
 Adsorption (all therapies)
In summary, the main goals of CRRT are removal of waste products,
restoration of acid/base balance, and correction of fluid and electrolyte
abnormalities, while maintaining hemodynamic stability. The goal of any
continuous renal replacement therapy is to replace. as best as possible.
the lost function of the native kidney. While CRRT provides a good option
for a patient with ARE nothing will replace the complete function of a
healthy kidney. The illustration below demonstrates how the CART
system attempts to mimic the function of the native kidney.
  

III. Properties of Water Solutions

Dialysis

a. Obtain a dialysis bag about 20 to 25 cm long and soak in clean water

for about 10 minutes.

b. Fill with 30 ml of 1% starch-NaCl mixture, tie the bag and rinse

thoroughly with water. Put the bag in a beaker containing deionized
water.

c. Adjust the setup such that the levels of fluids inside and outside the
bag are the same.

d. After 1 hour, test 1 ml of dialyzate (water in the beaker) with a few

drops of 0.1M AgNO3. Formation of a white precipitate of AgCl confirms
the presence of chloride ions in dialyzate.

Experiment Discussion

Water is important to all living systems. It serves as natural solvent for

mineral ions and other substances. It is also the dispersion medium for
colloidal cells like protoplasm. It serves as the medium for most
biochemical reactions, and is the most abundant component of the cells.
Except for bone tissues and enamel, water constitutes about 70 percent
of the human body. 

The objective of this experiment is to determine the properties of water

that make it a suitable medium for sustaining life in biological system.

The materials needed for this experiment are the following:

1% NaCl in Starch Solution

10% Sucrose Solution
250 ml Beaker (2)
CCl4
Cellophane
Citric Acid powder
CuSO4
Deionized Water
Dialysis Bag
Ethanol
Gelatin
Lard
0.1M AgNO 3
NaCl
NaHCO3 powder
String or Rubber Band
Sugar
Test Tube Rack
Test Tubes (6)
Thistle Tub

Procedure

I. Water: A Universal Solvent

a. Put about 0.5 grams of the following substances into six separate test
tubes: NaCl, sugar, gelatin, CuSO 4 , lard, and ethanol. Add 1 ml of water
to each test tube and shake vigorously to dissolve the substances. For
substances that did not dissolve, add another 1 ml of water and shake
again. For the solids that still did not dissolve, add another 1 ml water
and shake.
b. On a six separate test tube, Repeat the solubility test using CCl 4 ,
instead of water.
c. Describe solubility in both solvents as soluble, slightly soluble, and
insoluble. Record observations in the table.

II. Water: A Good Medium for Biochemical Reactions

a. Mix 0.1 gram of dry, powdered citric acid, and sodium bicarbonate
(NaHCO3) in a dry test tube. Observe if a chemical reaction occurs.

b. Add about 10 ml of water to the mixture and note what happens.

 Osmosis and diffusion
2. Hypotonic solutions
 has a lower osmotic pressure than red blood cells.
Osmosis  has a lower concentration than physiological solutions.
 causes water to flow into red blood cells.
 The passage of a solvent through a semipermeable membrane  causes hemolysis: RBCs swell and may burst.
separating a dilute solution (or pure solvent) from a more
concentrated solution.
 Semi-permeable membrane – a membrane that allows certain
types of molecules to pass through it but prohibits the passage of
other types of molecules.

3. Hypertonic solutions
 has a higher osmotic pressure than RBCs.
 has a higher concentration than physiological solutions.
 causes water to flow out of RBCs.
Osmotic Pressure  cause crenation: RBCs shrinks in size.

 The pressure that must be applied to prevent the net flow of solvent
through a semipermeable membrane from a solution of lower
solute concentration to a solution of higher solute concentration.
 produced by the solute particles dissolved in a solution.
 equal to the pressure that would prevent the flow of additional
water into the more concentrated solution.
 greater as the number of dissolved particles in the solution
increases.

Osmotic pressure of blood

Red blood cells

 have cell walls that are semi-permeable membranes.

 maintain an osmotic pressure that cannot change or damage occurs.
 must maintain an equal flow of water between the red blood cell
and its surrounding environment.

Three types of solutions

1. Isotonic solutions
 exerts the same osmotic pressure as red blood cells.
 is known as a “physiological solution”.
 of 5.0% glucose or 0.90% NaCl is used medically because
each has a solute concentration equal to the osmotic
pressure equal to red blood cells.

Pre-Lab Discussions

Osmosis
- is defined as the movement of water from higher water
concentration to lower water concentration through a semi-
permeable membrane.
 - is that the movement of water is affected by the amount of
substance dissolved to it.

Examples of Osmosis: Examples of osmosis include red blood cells swelling

up when exposed to fresh water and plant root hairs taking up water. To see
an easy demonstration of osmosis, soak gummy candies in water. The gel of
the candies acts as a semipermeable membrane.

Diffusion
- is the movement of particles from an area of higher concentration
to lower concentration? The overall effect is to equalize
concentration throughout the medium.

Examples of Diffusion: Examples of diffusion include perfume filling a whole

room and the movement of small molecules across a cell membrane. One of
the simplest demonstrations of diffusion is adding a drop of food coloring to
water. Although other transport processes do occur, diffusion is the key
player.

Key Point:

Diffusion and osmosis are both passive transport processes that act to
equalize the concentration of a solution.

Procedure

1. Stop the narrow end of a thistle tube with a finger and fill it with
sugar cane juice or a 10% sucrose solution until the solution reaches
up to the base of the tube.
2. Cover the mouth of the thistle tube with a cellophane membrane
and keep it in place with a rubber band.
3. Suspend the thistle tube in a beaker of water, making sure that the
levels of liquids inside and outside of the tube are equal.
4. Observe the difference in solution levels after minutes.