Renal Dialysis
Hemodialysis Units, Hospital
Capital Expenditures
Dithioerythritol
Kidney Failure, Chronic
Peritoneal Dialysis
Dialysis
Dialysis Solutions
Peritoneal Dialysis, Continuous Ambulatory
Peritonitis
Peritoneum
Catheters, Indwelling
Hemodialysis Solutions
Ultrafiltration
Kidney
Renal Insufficiency
Uremia
Hepatic Insufficiency
Central Nervous System Diseases
Late referral of end-stage renal failure. (1/8259)
We studied all new patients accepted for renal replacement therapy (RRT) in one unit from 1/1/96 to 31/12/97 (n = 198), to establish time from nephrology referral to RRT, evidence of renal disease prior to referral and the adequacy of renal management prior to referral. Sixty four (32.3%, late referral group) required RRT within 12 weeks of referral. Fifty-nine (29.8%) had recognizable signs of chronic renal failure > 26 weeks prior to referral. Patients starting RRT soon after referral were hospitalized for significantly longer on starting RRT (RRT within 12 weeks of referral, median hospitalization 25.0 days (n = 64); RRT > 12 weeks after referral, median 9.7 days (n = 126), (p < 0.001)). Observed survival at 1 year was 68.3% overall, with 1-year survival of the late referral and early referral groups being 60.5% and 72.5%, respectively (p = NS). Hypertension was found in 159 patients (80.3%): 46 (28.9%) were started on antihypertensive medication following referral, while a further 28 (17.6%) were started on additional antihypertensives. Of the diabetic population (n = 78), only 26 (33.3%) were on an angiotensin-converting-enzyme inhibitor (ACEI) at referral. Many patients are referred late for dialysis despite early signs of renal failure, and the pre-referral management of many of the patients, as evidenced by the treatment of hypertension and use of ACEI in diabetics, is less than optimal. (+info)Impaired lysosomal processing of beta2-microglobulin by infiltrating macrophages in dialysis amyloidosis. (2/8259)
BACKGROUND: Macrophages may participate in amyloid fibril formation by processing the protein precursor. Although this theory seems to apply for amyloidosis, in which proteolytic cleavage is a prerequisite for amyloid fibril formation, it has not been demonstrated for beta2-microglobulin (beta2m) amyloidosis. We aimed to establish the role played by macrophages in beta2m amyloidosis. METHODS: We used a double immunogold electron microscopy technique, including mouse antihuman CD68, rabbit antihuman beta2m, amyloid P component, and lysosome-associated membrane protein (LAMP-1) antibodies. Differential density labeling studies of beta2m and amyloid P component were performed extra- and intracellularly to assess protein processing by macrophages. RESULTS: The cells surrounding amyloid fibrils were found to be mostly CD68 positive, suggesting that they were of monocyte-macrophage lineage. Intracellular accumulation of amyloid fibrils was also observed; these fibrils were constantly surrounded by LAMP-1-linked gold particles, demonstrating that intracellular beta2m was almost exclusively lysosomal. The rough-surface endoplasmic reticulum was not labeled by beta2m antibody, suggesting that there was no active synthesis of beta2m by the cells. As a marker of endocytosis, protruded cytoplasmic processes in close relation with the intracellular accumulations of beta2m amyloid fibrils were observed. No difference in density labeling (extracellular vs. intracellular) was observed for beta2m, whereas intracellular P component labeling was significantly decreased. CONCLUSIONS: All of these data are strongly suggestive of phagocytosis and not synthesis of amyloid fibrils by macrophages. Further, they demonstrate an impaired lysosomal processing specific for beta2m, as other compounds of the amyloid fibrils (P component) are significantly cleared. (+info)Septicemia in dialysis patients: incidence, risk factors, and prognosis. (3/8259)
BACKGROUND: Infection is second to cardiovascular disease as a cause of death in patients with end-stage renal disease (ESRD), and septicemia causes a majority of these infectious deaths. To identify patients at high risk and to characterize modifiable risk factors for septicemia, we examined the incidence, risk factors, and prognosis for septicemia in a large, representative group of U.S. dialysis patients. METHODS: We conducted a longitudinal cohort study of incident ESRD patients in the case-mix study of the U.S. Renal Data System with seven years of follow-up from hospitalization and death records. Poisson regression was used to examine independent risk factors for hospital-managed septicemia. Cox proportional hazards analysis was used to assess the independent effect of septicemia on all-cause mortality and on death from septicemia. Separate analyses were performed for patients on peritoneal dialysis (PD) and hemodialysis (HD). RESULTS: Over seven years of follow-up, 11.7% of 4005 HD patients and 9.4% of 913 PD patients had at least one episode of septicemia. Older age and diabetes were independent risk factors for septicemia in all patients. Among HD patients, low serum albumin, temporary vascular access, and dialyzer reuse were also associated with increased risk. Among PD patients, white race and having no health insurance at dialysis initiation were also risk factors. Patients with septicemia had twice the risk of death from any cause and a fivefold to ninefold increased risk of death from septicemia. CONCLUSIONS: Septicemia, which carries a marked increased risk of death, occurs frequently in patients on PD as well as HD. Early referral to a nephrologist, improving nutrition, and avoiding temporary vascular access may decrease the incidence of septicemia. Further study of how race, insurance status, and dialyzer reuse can contribute to the risk of septicemia among ESRD patients is indicated. (+info)Hemodialysis with high-calcium dialysate impairs cardiac relaxation. (4/8259)
BACKGROUND: During hemodialysis (HD), serum ionized calcium is directly related to the dialysate calcium concentration. We have recently shown an acute induction of hypercalcemia to impair left ventricular (LV) relaxation. In the current study we sought to establish whether changes in serum Ca++ also affect LV function during HD. METHODS: We echocardiographically examined the LV relaxation and systolic function of 12 patients with end-stage renal disease before and after three HD treatments with dialysate Ca++ concentrations of 1.25 mmol/liter (dCa++1.25), 1.5 mmol/liter (dCa++1.50), and 1.75 mmol/liter (dCa++1.75), respectively. Age- and sex-matched healthy controls were also examined echocardiographically. RESULTS: The LV posterior wall thickness and the interventricular septum thickness, and the LV end-diastolic dimension and the end-systolic dimensions were significantly greater in the patients when compared with the controls, and the LV fractional shortening, the ratio of peak early to peak late diastolic velocities (E/Amax), and the isovolumic relaxation time (IVRT) showed impairment of LV relaxation and systolic function in the patients. Serum ionized calcium increased significantly during the dCa++1.5 HD (1.24 +/- 0.10 vs. 1.34 +/- 0.06 mmol/liter, P = 0. 004) and dCa++1.75 HD (1.19 +/- 0.10 vs. 1.47 +/- 0.06 mmol/liter, P = 0.002), and plasma intact parathyroid hormone decreased significantly during the dCa++1.75 HD (medians 8.2 vs. 2.7 pmol/liter, P = 0.002). LV systolic function was not altered during any of the treatments. The changes in E/Amax and IVRT suggested impairment of relaxation during all sessions, but only during the dCa++1.75 HD was the impairment statistically significant (E/Amax 1. 153 +/- 0.437 vs. 0.943 +/- 0.352, P < 0.05; IVRT 147 +/- 29 vs. 175 +/- 50 msecond, P < 0.05). CONCLUSION: HD with high-calcium (dCa++1. 75 mmol/liter) dialysate impairs LV relaxation when compared with lower calcium dialysate (dCa++1.25 and dCa++1.5 mmol/liter) treatments. (+info)Activation of the kallikrein-kinin system in hemodialysis: role of membrane electronegativity, blood dilution, and pH. (5/8259)
BACKGROUND: The kallikrein-kinin system activation by contact with a negatively charged surface has been promulgated to be responsible for hypersensitivity reactions. However, to explain the low frequency and heterogeneity of hypersensitivity reactions, we hypothesized that not only the electronegativity of the membrane, but also other physicochemical parameters could influence the activation of the contact phase system of plasma assessed by the measurement of kallikrein activity and bradykinin concentration. METHODS: Plasma kallikrein activity using chromogenic substrate (S2302) and plasma bradykinin concentration (enzyme immuno assay) were measured during the perfusion of human plasma (2.5 ml/min) through minidialyzers mounted with six different membranes [polyacrylonitrile (PAN) from Asahi (PANDX) and from Hospal (AN69), polymethylmethacrylate (PMMA) from Toray, cellulose triacetate (CT) from Baxter, cuprophane (CUP) from Akzo and polysulfone (PS) from Fresenius]. RESULTS: A direct relationship was shown between the electronegativity of the membrane assessed by its zeta potential and the activation of plasma during the first five minutes of plasma circulation. With the AN69 membrane, the detection of a kallikrein activity in diluted plasma but not in undiluted samples confirmed the importance of a protease-antiprotease imbalance leading to bradykinin release during the first five minutes of dialysis. With PAN membranes, the use of citrated versus heparinized plasma and the use of various rinsing solutions clearly show a dramatic effect of pH on the kallikrein activity and the bradykinin concentration measured in plasma. Finally, increasing the zeta potential of the membrane leads to a significant increase of plasma kallikrein activity and bradykinin concentration. CONCLUSIONS: Our in vitro experimental approach evidences the importance of the control of these physicochemical factors to decrease the activation of the contact system. (+info)Practice patterns, case mix, Medicare payment policy, and dialysis facility costs. (6/8259)
OBJECTIVE: To evaluate the effects of case mix, practice patterns, features of the payment system, and facility characteristics on the cost of dialysis. DATA SOURCES/STUDY SETTING: The nationally representative sample of dialysis units in the 1991 U.S. Renal Data System's Case Mix Adequacy (CMA) Study. The CMA data were merged with data from Medicare Cost Reports, HCFA facility surveys, and HCFA's end-stage renal disease patient registry. STUDY DESIGN: We estimated a statistical cost function to examine the determinants of costs at the dialysis unit level. PRINCIPAL FINDINGS: The relationship between case mix and costs was generally weak. However, dialysis practices (type of dialysis membrane, membrane reuse policy, and treatment duration) did have a significant effect on costs. Further, facilities whose payment was constrained by HCFA's ceiling on the adjustment for area wage rates incurred higher costs than unconstrained facilities. The costs of hospital-based units were considerably higher than those of freestanding units. Among chain units, only members of one of the largest national chains exhibited significant cost savings relative to independent facilities. CONCLUSIONS: Little evidence showed that adjusting dialysis payment to account for differences in case mix across facilities would be necessary to ensure access to care for high-cost patients or to reimburse facilities equitably for their costs. However, current efforts to increase dose of dialysis may require higher payments. Longer treatments appear to be the most economical method of increasing the dose of dialysis. Switching to more expensive types of dialysis membranes was a more costly means of increasing dose and hence must be justified by benefits beyond those of higher dose. Reusing membranes saved money, but the savings were insufficient to offset the costs associated with using more expensive membranes. Most, but not all, of the higher costs observed in hospital-based units appear to reflect overhead cost allocation rather than a difference in real resources devoted to treatment. The economies experienced by the largest chains may provide an explanation for their recent growth in market share. The heterogeneity of results by chain size implies that characterizing units using a simple chain status indicator variable is inadequate. Cost differences by facility type and the effects of the ongoing growth of large chains are worthy of continued monitoring to inform both payment policy and antitrust enforcement. (+info)Ex vivo evaluation of a Taylor-Couette flow, immobilized heparinase I device for clinical application. (7/8259)
Efficient and safe heparin anticoagulation has remained a problem for continuous renal replacement therapies and intermittent hemodialysis for patients with acute renal failure. To make heparin therapy safer for the patient with acute renal failure at high risk of bleeding, we have proposed regional heparinization of the circuit via an immobilized heparinase I filter. This study tested a device based on Taylor-Couette flow and simultaneous separation/reaction for efficacy and safety of heparin removal in a sheep model. Heparinase I was immobilized onto agarose beads via cyanogen bromide activation. The device, referred to as a vortex flow plasmapheretic reactor, consisted of two concentric cylinders, a priming volume of 45 ml, a microporous membrane for plasma separation, and an outer compartment where the immobilized heparinase I was fluidized separately from the blood cells. Manual white cell and platelet counts, hematocrit, total protein, and fibrinogen assays were performed. Heparin levels were indirectly measured via whole-blood recalcification times (WBRTs). The vortex flow plasmapheretic reactor maintained significantly higher heparin levels in the extracorporeal circuit than in the sheep (device inlet WBRTs were 1. 5 times the device outlet WBRTs) with no hemolysis. The reactor treatment did not effect any physiologically significant changes in complete blood cell counts, platelets, and protein levels for up to 2 hr of operation. Furthermore, gross necropsy and histopathology did not show any significant abnormalities in the kidney, liver, heart, brain, and spleen. (+info)Hepatitis virus infection in haemodialysis patients from Moldavia. (8/8259)
BACKGROUND: Although the epidemiology of hepatitis B (HBV) and C (HCV) now seems well established for Western European countries, in Central and Eastern Europe < 50% of all dialysis centres routinely test for hepatitis C antibodies since testing is not available or is not applied to all patients. This study describes the prevalence, risk factors and clinical significance of HBV and HCV infection for the haemodialysis population of the North Eastern region of Romania, Moldavia. METHODS: The presence of HBV antigens was determined with an ELISA kit (Wellcome, Abbot) and HCV antibodies with the ELISA-3 Ortho-HCV, third generation test. The following individual data were collected: gender, age, duration of dialysis, rural/urban domicile, actual and previous HBV status, actual HCV status, known acute, clinically evident hepatitis episodes in the last 3 years, monthly alanine aminotransferase (ALAT) and aspartate aminotransferase (ASAT) levels, complete biochemical hepatic assessment at the time of the study, transfusions for the past 3 years and family history. RESULTS: HBV and HCV prevalences were 17% (stable over the last 3 years) and 75%, respectively; co-infection was seen in 10% of the subjects. Hospitalization (nosocomial infection) for HBV, blood transfusions and duration on dialysis for HCV, emerged as the main risk factors for hepatitis infection. Socio-economic conditions appear to be equally important for HCV infection, since the prevalence was significantly higher among patients from rural, underdeveloped areas than urban areas (80.8 vs 60.3%), and infection was already present in a large proportion of patients (47%) before starting dialysis, without being related to previous disease duration or blood transfusions. HBV and/or HCV was not associated with a worse clinical or biochemical profile at the time of the study. However, infected patients had significantly more previous cytolytic episodes, with higher, transient increases in ALAT and ASAT levels. CONCLUSIONS: HCV infection is endemic among dialysis centres in Moldavia. Apart from previously well-known risk factors for hepatitis infection, our study demonstrates the negative impact of socio-economic underdevelopment. Simple measures such as enforced general asepsia rules, careful disinfection and equipment sterilization, routine testing of patients from economically disadvantaged areas and monthly, serial determination of hepatic enzymes should be the common practice in dialysis centres in Romania. (+info)Renal dialysis is a medical procedure that is used to artificially remove waste products, toxins, and excess fluids from the blood when the kidneys are no longer able to perform these functions effectively. This process is also known as hemodialysis.
During renal dialysis, the patient's blood is circulated through a special machine called a dialyzer or an artificial kidney, which contains a semi-permeable membrane that filters out waste products and excess fluids from the blood. The cleaned blood is then returned to the patient's body.
Renal dialysis is typically recommended for patients with advanced kidney disease or kidney failure, such as those with end-stage renal disease (ESRD). It is a life-sustaining treatment that helps to maintain the balance of fluids and electrolytes in the body, prevent the buildup of waste products and toxins, and control blood pressure.
There are two main types of renal dialysis: hemodialysis and peritoneal dialysis. Hemodialysis is the most common type and involves using a dialyzer to filter the blood outside the body. Peritoneal dialysis, on the other hand, involves placing a catheter in the abdomen and using the lining of the abdomen (peritoneum) as a natural filter to remove waste products and excess fluids from the body.
Overall, renal dialysis is an essential treatment option for patients with kidney failure, helping them to maintain their quality of life and prolong their survival.
Hemodialysis units in a hospital setting are specialized departments or facilities that provide hemodialysis treatment to patients with kidney failure. Hemodialysis is a process of purifying the blood of waste products and excess fluids using a machine (hemodialysis machine) and a semi-permeable membrane (dialyzer). The procedure typically involves accessing the patient's bloodstream through a surgically created vascular access, such as a fistula or graft, and passing the blood through the dialyzer to remove waste products and excess fluids.
Hospital hemodialysis units are staffed by trained healthcare professionals, including nephrologists (kidney specialists), nurses, technicians, and support personnel. These units provide inpatient and outpatient services for patients who require hemodialysis due to acute or chronic kidney failure, as well as those who need dialysis while hospitalized for other medical conditions.
Hospital hemodialysis units may offer various types of hemodialysis treatments, including conventional hemodialysis, high-flux hemodialysis, hemofiltration, and hemodiafiltration. They also provide education and support to patients and their families regarding dialysis treatment options, lifestyle modifications, and long-term management of kidney disease.
Capital expenditures, also known as capital expenses or CapEx, refer to the funds used by a company to acquire, upgrade, and maintain physical assets such as property, buildings, machinery, and equipment. These expenditures are considered long-term investments and are intended to enhance the company's ability to generate future revenue and profits.
Capital expenditures are typically significant in amount and are recorded on a company's balance sheet as assets, rather than being expensed immediately on the income statement. Instead, the cost of these assets is gradually expensed over their useful life through depreciation or amortization.
Examples of capital expenditures include purchasing new manufacturing equipment, constructing a new building, renovating an existing facility, or upgrading computer systems and software. These types of expenses are often necessary for a company to remain competitive and grow its business over time.
Dithioerythritol is a chemical compound with the formula (HOCH₂)₂SS(CHOH)₂. It is a colorless, viscous liquid that is used as a reducing agent and antioxidant in various industrial and laboratory applications. In the medical field, it has been studied for its potential use as an anti-inflammatory and antiviral agent, although it is not currently approved for use as a drug. It may also be used as a reagent in diagnostic tests and as a solvent in pharmaceutical preparations.
Chronic kidney failure, also known as chronic kidney disease (CKD) stage 5 or end-stage renal disease (ESRD), is a permanent loss of kidney function that occurs gradually over a period of months to years. It is defined as a glomerular filtration rate (GFR) of less than 15 ml/min, which means the kidneys are filtering waste and excess fluids at less than 15% of their normal capacity.
CKD can be caused by various underlying conditions such as diabetes, hypertension, glomerulonephritis, polycystic kidney disease, and recurrent kidney infections. Over time, the damage to the kidneys can lead to a buildup of waste products and fluids in the body, which can cause a range of symptoms including fatigue, weakness, shortness of breath, nausea, vomiting, and confusion.
Treatment for chronic kidney failure typically involves managing the underlying condition, making lifestyle changes such as following a healthy diet, and receiving supportive care such as dialysis or a kidney transplant to replace lost kidney function.
Peritoneal dialysis is a type of renal replacement therapy used to treat patients with severe kidney dysfunction or end-stage renal disease. It is a process that utilizes the peritoneum, a membranous sac lining the abdominal cavity, as a natural semipermeable membrane for filtering waste products, excess fluids, and electrolytes from the bloodstream.
In peritoneal dialysis, a sterile dialysate solution is infused into the peritoneal cavity via a permanently implanted catheter. The dialysate contains various substances such as glucose or other osmotic agents, electrolytes, and buffer solutions that facilitate the diffusion of waste products and fluids from the blood vessels surrounding the peritoneum into the dialysate.
There are two primary types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). CAPD is performed manually, several times a day, while APD is carried out using a cycler machine overnight.
Peritoneal dialysis offers certain advantages over hemodialysis, such as better preservation of residual renal function, fewer dietary restrictions, and greater flexibility in scheduling treatments. However, it also has potential complications, including peritonitis (inflammation of the peritoneum), catheter-related infections, fluid imbalances, and membrane failure over time.
Dialysis is a medical treatment that is used to remove waste and excess fluid from the blood when the kidneys are no longer able to perform these functions effectively. This life-sustaining procedure uses a specialized machine, called a dialyzer or artificial kidney, to filter the blood outside of the body and return clean, chemically balanced blood back into the body.
There are two main types of dialysis: hemodialysis and peritoneal dialysis.
1. Hemodialysis: In this method, a patient's blood is passed through an external filter (dialyzer) that removes waste products, toxins, and excess fluids. The cleaned blood is then returned to the body with the help of a specialized machine. Hemodialysis typically requires access to a large vein, often created by a surgical procedure called an arteriovenous (AV) fistula or graft. Hemodialysis sessions usually last for about 3-5 hours and are performed three times a week in a clinical setting, such as a dialysis center or hospital.
2. Peritoneal Dialysis: This method uses the lining of the patient's own abdomen (peritoneum) as a natural filter to clean the blood. A sterile dialysate solution is introduced into the peritoneal cavity via a permanently implanted catheter. The solution absorbs waste products and excess fluids from the blood vessels lining the peritoneum through a process called diffusion. After a dwell time, usually several hours, the used dialysate is drained out and replaced with fresh dialysate. This process is known as an exchange and is typically repeated multiple times throughout the day or night, depending on the specific type of peritoneal dialysis (continuous ambulatory peritoneal dialysis or automated peritoneal dialysis).
Both methods have their advantages and disadvantages, and the choice between them depends on various factors, such as a patient's overall health, lifestyle, and personal preferences. Dialysis is a life-saving treatment for people with end-stage kidney disease or severe kidney dysfunction, allowing them to maintain their quality of life and extend their lifespan until a kidney transplant becomes available or their kidney function improves.
Dialysis solutions are fluids that are used during the process of dialysis, which is a treatment for patients with kidney failure. The main function of these solutions is to help remove waste products and excess fluid from the bloodstream, as the kidneys are no longer able to do so effectively.
The dialysis solution typically contains a mixture of water, electrolytes (such as sodium, potassium, chloride, and bicarbonate), and a small amount of glucose. The composition of the solution may vary depending on the individual patient's needs, but it is carefully controlled to match the patient's blood as closely as possible.
During dialysis, the patient's blood is circulated through a special filter called a dialyzer, which separates waste products and excess fluids from the blood. The used dialysis solution, which contains these waste products and excess fluids, is then discarded. Fresh dialysis solution is continuously introduced into the dialyzer to replace the used solution, creating a continuous flow of fluid that helps remove waste products and maintain the proper balance of electrolytes in the patient's blood.
Overall, dialysis solutions play a critical role in helping patients with kidney failure maintain their health and quality of life.
Peritoneal dialysis, continuous ambulatory (CAPD), is a type of renal replacement therapy used to treat patients with end-stage kidney disease. It is a form of peritoneal dialysis that is performed continuously, without the need for machines or hospitalization. CAPD uses the patient's own peritoneum, a thin membrane that lines the abdominal cavity, as a natural filter to remove waste products and excess fluids from the bloodstream.
In CAPD, a sterile dialysis solution is introduced into the peritoneal cavity through a permanent catheter implanted in the patient's abdomen. The solution remains in the peritoneal cavity for a dwell time of several hours, during which diffusion occurs across the peritoneal membrane, allowing waste products and excess fluids to move from the bloodstream into the dialysis solution.
After the dwell time, the used dialysis solution is drained from the peritoneal cavity and discarded, and a fresh batch of dialysis solution is introduced. This process is typically repeated four to five times a day, with each exchange taking about 30 minutes to complete. Patients can perform CAPD exchanges while going about their daily activities, making it a convenient and flexible treatment option for many patients with end-stage kidney disease.
Overall, CAPD is a highly effective form of dialysis that offers several advantages over other types of renal replacement therapy, including improved quality of life, better preservation of residual kidney function, and lower costs. However, it does require careful attention to sterile technique and regular monitoring to ensure proper functioning of the peritoneal membrane and adequate clearance of waste products and fluids.
Peritonitis is a medical condition characterized by inflammation of the peritoneum, which is the serous membrane that lines the inner wall of the abdominal cavity and covers the abdominal organs. The peritoneum has an important role in protecting the abdominal organs and providing a smooth surface for them to move against each other.
Peritonitis can occur as a result of bacterial or fungal infection, chemical irritation, or trauma to the abdomen. The most common cause of peritonitis is a rupture or perforation of an organ in the abdominal cavity, such as the appendix, stomach, or intestines, which allows bacteria from the gut to enter the peritoneal cavity.
Symptoms of peritonitis may include abdominal pain and tenderness, fever, nausea and vomiting, loss of appetite, and decreased bowel movements. In severe cases, peritonitis can lead to sepsis, a life-threatening condition characterized by widespread inflammation throughout the body.
Treatment for peritonitis typically involves antibiotics to treat the infection, as well as surgical intervention to repair any damage to the abdominal organs and remove any infected fluid or tissue from the peritoneal cavity. In some cases, a temporary or permanent drain may be placed in the abdomen to help remove excess fluid and promote healing.
The peritoneum is the serous membrane that lines the abdominal cavity and covers the abdominal organs. It is composed of a mesothelial cell monolayer supported by a thin, loose connective tissue. The peritoneum has two layers: the parietal peritoneum, which lines the abdominal wall, and the visceral peritoneum, which covers the organs.
The potential space between these two layers is called the peritoneal cavity, which contains a small amount of serous fluid that allows for the smooth movement of the organs within the cavity. The peritoneum plays an important role in the absorption and secretion of fluids and electrolytes, as well as providing a surface for the circulation of immune cells.
In addition, it also provides a route for the spread of infection or malignant cells throughout the abdominal cavity, known as peritonitis. The peritoneum is highly vascularized and innervated, making it sensitive to pain and distention.
Indwelling catheters, also known as Foley catheters, are medical devices that are inserted into the bladder to drain urine. They have a small balloon at the tip that is inflated with water once the catheter is in the correct position in the bladder, allowing it to remain in place and continuously drain urine. Indwelling catheters are typically used for patients who are unable to empty their bladders on their own, such as those who are bedridden or have nerve damage that affects bladder function. They are also used during and after certain surgical procedures. Prolonged use of indwelling catheters can increase the risk of urinary tract infections and other complications.
Hemodialysis solutions are sterile, pyrogen-free fluids used in the process of hemodialysis, a renal replacement therapy for patients with kidney failure. These solutions are formulated to remove waste products and excess fluid from the blood by means of diffusion and osmosis across a semipermeable membrane.
The primary components of hemodialysis solutions include:
1. Electrolytes: Sodium, potassium, chloride, calcium, and magnesium ions are present in concentrations that aim to restore normal levels in the body or to correct for abnormalities in patients' serum electrolyte levels.
2. Buffer: Bicarbonate or acetate is added as a buffer to maintain the pH of the dialysate and prevent acidification of the blood during hemodialysis.
3. Glucose: A small amount of glucose may be included in the solution to provide energy for the patient.
4. Water: Ultrapure water is used to prepare the solution, free from microbial contaminants and endotoxins.
Hemodialysis solutions are available in different concentrations and formulations to address individual patient needs and specific clinical situations. The composition of these solutions must be carefully controlled to ensure their effectiveness and safety during hemodialysis treatments.
Ultrafiltration is a medical process that separates fluids and dissolved solutes based on their size and charge. It's a type of membrane filtration that uses a semipermeable membrane with pores small enough to allow the passage of water and low molecular weight solutes, while retaining larger molecules and cells.
In clinical practice, ultrafiltration is often used in patients with acute or chronic kidney failure to remove excess fluid from the bloodstream, a process known as renal replacement therapy or dialysis. During this procedure, the patient's blood is passed through a hollow fiber membrane, and pressure differences across the membrane cause water and small solutes to move through the pores, while larger molecules such as proteins and cells are retained.
Ultrafiltration can also be used in other medical contexts, such as plasma exchange or therapeutic apheresis, where specific components of the blood are removed for therapeutic purposes.
A kidney, in medical terms, is one of two bean-shaped organs located in the lower back region of the body. They are essential for maintaining homeostasis within the body by performing several crucial functions such as:
1. Regulation of water and electrolyte balance: Kidneys help regulate the amount of water and various electrolytes like sodium, potassium, and calcium in the bloodstream to maintain a stable internal environment.
2. Excretion of waste products: They filter waste products from the blood, including urea (a byproduct of protein metabolism), creatinine (a breakdown product of muscle tissue), and other harmful substances that result from normal cellular functions or external sources like medications and toxins.
3. Endocrine function: Kidneys produce several hormones with important roles in the body, such as erythropoietin (stimulates red blood cell production), renin (regulates blood pressure), and calcitriol (activated form of vitamin D that helps regulate calcium homeostasis).
4. pH balance regulation: Kidneys maintain the proper acid-base balance in the body by excreting either hydrogen ions or bicarbonate ions, depending on whether the blood is too acidic or too alkaline.
5. Blood pressure control: The kidneys play a significant role in regulating blood pressure through the renin-angiotensin-aldosterone system (RAAS), which constricts blood vessels and promotes sodium and water retention to increase blood volume and, consequently, blood pressure.
Anatomically, each kidney is approximately 10-12 cm long, 5-7 cm wide, and 3 cm thick, with a weight of about 120-170 grams. They are surrounded by a protective layer of fat and connected to the urinary system through the renal pelvis, ureters, bladder, and urethra.
Renal insufficiency, also known as kidney failure, is a medical condition in which the kidneys are unable to properly filter waste products and excess fluids from the blood. This results in a buildup of these substances in the body, which can cause a variety of symptoms such as weakness, shortness of breath, and fluid retention. Renal insufficiency can be acute, meaning it comes on suddenly, or chronic, meaning it develops over time. It is typically diagnosed through blood tests, urine tests, and imaging studies. Treatment may include medications to control symptoms, dietary changes, and in severe cases, dialysis or a kidney transplant.
Uremia is not a disease itself, but rather it's a condition that results from the buildup of waste products in the blood due to kidney failure. The term "uremia" comes from the word "urea," which is one of the waste products that accumulate when the kidneys are not functioning properly.
In uremia, the kidneys are unable to effectively filter waste and excess fluids from the blood, leading to a variety of symptoms such as nausea, vomiting, fatigue, itching, mental confusion, and ultimately, if left untreated, can lead to coma and death. It is a serious condition that requires immediate medical attention, often involving dialysis or a kidney transplant to manage the underlying kidney dysfunction.
Hepatic insufficiency, also known as liver insufficiency, refers to the reduced ability of the liver to perform its vital functions due to damage or disease. The liver plays a crucial role in metabolism, detoxification, synthesis, storage, and secretion. When it becomes insufficient, it can lead to various complications such as:
1. Impaired metabolism of carbohydrates, fats, and proteins
2. Buildup of toxic substances in the blood due to reduced detoxification capacity
3. Decreased synthesis of essential proteins, including clotting factors
4. Reduced glycogen storage and impaired glucose regulation
5. Fluid accumulation in the abdomen (ascites) and legs (edema) due to decreased production of albumin and increased pressure in the portal vein
6. Impaired immune function, making the individual more susceptible to infections
7. Hormonal imbalances leading to various symptoms such as changes in appetite, weight loss, and sexual dysfunction
Hepatic insufficiency can range from mild to severe, and if left untreated, it may progress to liver failure, a life-threatening condition requiring immediate medical attention.
Central nervous system (CNS) diseases refer to medical conditions that primarily affect the brain and spinal cord. The CNS is responsible for controlling various functions in the body, including movement, sensation, cognition, and behavior. Therefore, diseases of the CNS can have significant impacts on a person's quality of life and overall health.
There are many different types of CNS diseases, including:
1. Infectious diseases: These are caused by viruses, bacteria, fungi, or parasites that infect the brain or spinal cord. Examples include meningitis, encephalitis, and polio.
2. Neurodegenerative diseases: These are characterized by progressive loss of nerve cells in the brain or spinal cord. Examples include Alzheimer's disease, Parkinson's disease, and Huntington's disease.
3. Structural diseases: These involve damage to the physical structure of the brain or spinal cord, such as from trauma, tumors, or stroke.
4. Functional diseases: These affect the function of the nervous system without obvious structural damage, such as multiple sclerosis and epilepsy.
5. Genetic disorders: Some CNS diseases are caused by genetic mutations, such as spinal muscular atrophy and Friedreich's ataxia.
Symptoms of CNS diseases can vary widely depending on the specific condition and the area of the brain or spinal cord that is affected. They may include muscle weakness, paralysis, seizures, loss of sensation, difficulty with coordination and balance, confusion, memory loss, changes in behavior or mood, and pain. Treatment for CNS diseases depends on the specific condition and may involve medications, surgery, rehabilitation therapy, or a combination of these approaches.
Acute kidney injury (AKI), also known as acute renal failure, is a rapid loss of kidney function that occurs over a few hours or days. It is defined as an increase in the serum creatinine level by 0.3 mg/dL within 48 hours or an increase in the creatinine level to more than 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days, or a urine volume of less than 0.5 mL/kg per hour for six hours.
AKI can be caused by a variety of conditions, including decreased blood flow to the kidneys, obstruction of the urinary tract, exposure to toxic substances, and certain medications. Symptoms of AKI may include decreased urine output, fluid retention, electrolyte imbalances, and metabolic acidosis. Treatment typically involves addressing the underlying cause of the injury and providing supportive care, such as dialysis, to help maintain kidney function until the injury resolves.