renal end stage kidney disease for patient

End stage ckd

1. End-Stage Renal Disease
By
Jason Klein
BMB Seminar
May 3, 1999

2. Outline
I. Kidney: Basic structure and function
II. Scope of the Problem
III. Causes of End-Stage Renal Disease
IV. Metabolic consequences of End-Stage
Renal Disease
V. Treatment of End-Stage Renal Disease

3. Kidney: Basic Functions
Each kidney contains
about 1 million nephrons
which filter about 100
quarts of fluid every day
Juxtaglomerular
apparatus: produces renin
which raises angiotensin II
and aldosterone levels

4. Scope of the Problem
End-stage renal disease is the result of years of chronic
renal disease and is defined as the condition where the
kidney’s are only able to function at 5-10% of normal
capacity
Approximately 310,00 people in the U.S. are currently
being treated for end-stage renal disease with 70,000 new
cases reported each year
In 1995, the cost of treatment for these patients reached a
total of 13.1 billion dollars

5. Causes of End-Stage Renal
Disease
Over 50% of the cases of renal failure are either due to
diabetes mellitus(30%) or hypertension(25%)
1. Glomerulopathies(glomerulonephritis)
2. Tubulointerstitial nephritis(drugs,heavy metals)
3. Hereditary Diseases(Polycystic kidney disease)
4. Obstructive nephropathies
5. Vascular diseases
Progressive deterioration of glomeruli or renal tubules
leads to decreased GFR and End-Stage Renal Disease

6. Metabolic Consequences of ESRD
1. “Uremia”-fatigue, nausea, dizziness, coma,
death
2. Acid/Base disorders-pH of blood is
lowered(7.33-7.37)
3. Renal Osteodystrophy-bony pain, spontaneous
fractures that heal slowly
4. Anemia

7. Treatment of ESRD
Hemodialysis-remove metabolic wastes by
diffusion as blood is pumped through dialysis
machine
Fistula: Joined artery and vein that allows vascular
access to patient’s blood
3-4 hr sessions, 3 times/week , $46,000/yr

8. Dialysis(cont.)
Peritoneal Dialysis-peritoneal membrane is
“dialyzer”, patient’s blood is cleaned within the
body
More liberating for the patient and better for the
heart than hemodialysis
$41,000/yr

9. Transplantation
20,000 people currently living with kidney
transplants-more cost effective and preferred over
dialysis
In the U.S. in 1996-12,198 kidneys were
transplanted and 34,550 people were on the
waiting list
Immunosuppressive drugs-cyclosporine,
prednisone, azathioprine

10. Tissue Engineering
Harvest renal cells, expand them in culture, seed
them on biodegradable polymers, implant scaffold
into host
Experiments in mice: Renal cells replicated and
organized into nephron segments
Goal: Produce 3-dimensional renal units that
could eventually lead to full replacement of kidney
function

11. Bibliography
1. Amiel, Gilad(1999) Current and Future Modalities For Functional
Renal Replacement. Urol Clin North Am 26(1): 235-45.
2. Andreucci, M. et al.(1999) Diuretics in Renal Failure. Miner
Electrolyte Metab25(1-2): 32-38
3. Brest, Albert. Renal Failure. J.B. Lippincott Company, 1967.
4. Krupp, Marcus. Physician’s Handbook. 21st Ed. Lange Medical
Publications: Los Altos, 1985.
5. Larson, David Ed. Mayo Clinic Family Health Book. William
Morrow and Company Inc.: New York, 1990.
6. Marieb, Elaine. Human Anatomy & Physiology. 4th Ed. Addison
Wesley Longman Inc., 1998.
7. Martin-Mateo, MC et. al.(1999) Oxidative Stress in Chronic Renal
Failure. Ren Fail 21(2): 155-67.
8. McCarthy, JT(1999) A practical approach to the management of
patients with chronic renal failure. Mayo Clinic Proc 74(3): 269-73.