Functions of the Kidney

1. Plasma filtration
2. Excretion of waste products
3. Acid-base homeostasis
4. Hormone production
5. Vitamin D production

➢ PLASMA FILTRATION
The head of the nephrons is called the renal corpuscle
which is responsible for the removal (filtering) of plasma
from the blood

Plasma consists of the liquid part of the blood that consist

of the
1. Electrolytes
2. Nutireints
3. Proteins
4. Metabolic waste
5. Water

The kidneys main functional unit is the nephrons

There are about 1--- 1.5 million nephrons in the kidney
The nephrons consist of two major parts
1. The glomerulus or the Bowman’s corpuscle
2. The long Renal tubule
The section of the nephron within the cortex is made up of
1. Renal corpuscle
2. Proximal convoluted tube
3. Distal convoluted tube

The section of the nephron within the medullary is made up of

1. Loop of Henle
2. Collecting duct

CAUSES OF KIDNEY FAILURE

A condition in which the kidneys lose the ability to remove waste
and balance fluids.
Kidney failure has to do with glomerular dysfunction and tubular
dysfunction
There are two types of kidney failure

1. Acute renal failure

These include
• Pre-renal failure ---- Reduced flow of blood to
the kidney. It is caused by hypotension, shock

• Intra-renal ---- The acute damage of renal

structures which mostly caused by Acute Tubular
 Necrosis (ATN, the damaged of the tubule cells
of the kidney)

• Post-renal failure ---- Results from conditions

block of urine outflow. It is caused by calculi
(stones), prostatic hyperplasia (enlargement of
the prostate gland which leads to the blocking
of the outflow of urine.

2. Chronic renal failure

It refers to the progressive, irreversible destruction of the
kidney leading to the loss of renal function resulting in
uremia.

Causes
• Diabetes mellitus
• Hypertension
• Autoimmune diseases such as lupus,
• Tumors such as multiple myeloma
• Glomerulonephritis
• Heavy metal poisoning
DIALYSIS
Dialysis is a procedure to remove waste products and excess
fluid from the blood when the kidneys stop working properly.
There are three types of Dialysis
1. Peritoneal dialysis
2. Hemodialysis
3. Hemofiltration

HEMODIALYSIS
It is an extracorporeal medical procedure used to remove and
filter waste fluid and waste products from the body
It is also used to correct electrolyte balance

NB: Hemodialysis works on the principle of the diffusion of

solutes and ultra-filtration of fluid across the semi-permeable
membrane down a pressure gradient.
Hemodialysis is done using the following apparatus
1. Hemodialysis machine

2. Dialyzer (Artificial kidney)

• Plastic chamber that contains bundles of capillary
tube through which blood circulates while dialysis
solution travels outside the bundle in opposite
counter current direction
3. Dialysate
• Solution used in dialysis which has same solute
concentration as those in plasma.
Water used in the dialysate is purified by reverse
osmosis.
Contents of dialysate:
Na+ --- 136-140mmol/L
K+ --- 0-4 mmol/L
Mg++ --- 0.25-0.75 mmol/L
Ca+ --- 2.5-3.5mEq/L
Chloride --- 100-124 mEq/L
Bicarbonate --- 27-40mmol/L
pH --- 7.1-7.3
Dextrose --- 0-5.5 mmol/L

4. Blood delivery system

• Blood pump: Moves blood from access site through
the dialyzer and back to the patient
• It consists of the following
Heparin syringe pump
2 air traps
Air detector
Venous line clamp
 VASCULAR SITE
The vascular access site in order to access the bloodstream for
hemodialysis include
• Arteriovenous graft (a soft plastic tube called graft is
used to connect a vein to an artery)

• Arteriovenous fistula (a vein is connected or joined to

an artery to create a large blood vessel called fistula)

PROCEDURES
• Two needles are inserted into the AV fistula or graft to
allow the flow of blood from the body through to the
dialyzer.
• Within the dialyzer are filtering fibers and absorbent
cleaning solution called dialysate.
• The filtering fibers aid in the removal of waste and excess
fluid and electrolyte from the blood
• The filtered blood moves through the tubing into the body
through the second needle at the access site.
Peritoneal dialysis is a medical procedure that uses the
membrane linen in the abdomen called the peritoneum to clean
the blood without removing it

A soft tube called catheter is implanted in to the abdomen

through which the dialysate will pass through
Exchange

A solution i=of dialysate is filled into the abdomen for aperiod

of time
Waster products and excess fluid are continuously drawn out of
the blood into the dialysate
along with the waste materials absorbed, the dialysate drains
out of the abdomen into a disposal