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The first patient is a 62-years-old Caucasian male, affected by adult polycystic kidney disease in extracorporeal hemodialysis through an arterio-venous native fistula. The subject had presented fever for about a month and a half before being admitted.

The article presents the results of analyses of the complex study of the functional condition of the kidneys, indices of central hemodynamics (CH) and homeostasis, determination of the urea level with the help of a set of reactive glomerular filtration for clearance of endogenous creatinine and tubular reabsorption of biochemical analyses of blood and urine, radiographic and ultrasound of kidneys in patients with acute kidney failure in the pathology of pregnancy and genus.

More than 800,000 patients suffering from end-stage renal disease (ESRD) are today treated with renal replacement therapy (RRT), including renal transplantation [1]. The dialytic forms of RRT include hemodialysis and peritoneal dialysis, with the former being used in a large majority of patients in most countries [2]. Extracorporeal hemodialysis has undergone a series of developments in the last three decades mostly related to improvements in biomaterials and enhancement of the design of the critical disposable devices and machines. In particular, while the initial hemodialysis systems were developed piecemeal by dedicated artisans, who were also engineers and physicians, the most recent devices and machines are highly sophisticated and rely on large production series and standardized manufacturing procedures [3, 4]. This evolution has taken place in conjunction with a significant reduction of hemodialyzer dimensions. An important part of this process has been the significantly better understanding of the physiological effects and consequences of dialysis at a micro-scale level, leading to adequate blood circuit design, smooth and biocompatible blood pathways, standardized thickness and porosity of membranes, and accurate alarm systems and failure controls [5–7]. As a result of this enhanced understanding and technical sophistication, we operate today with hemodialyzers with minimal blood priming required, constant and reproducible performance, and minimal dialytic losses of protein compounds, even in the presence of significantly high sieving coefficients for large molecules [8, 9]. One may argue that as we continue to increase dialyzer efficiency, we are getting close to the limits imposed by available or potential membranes and by the commonly utilized mass separation processes. For these reasons, a new interest is growing in hyper-selective barrier separation processes made possible by specifically designed synthetic membranes. Similarly, selective solid separation processes based on the use of newly designed adsorbent materials are under evaluation for newer and more efficient blood purification techniques. The evolution of biomaterials and dialytic techniques has paralleled the evolution of other technologies, including computers and biotechnology [10]. Computers have evolved beyond any expectation, increasing speed, memory, and analytical capabilities, while decreasing in physical size. From the large main frames whose operational time had to be shared among scientists of different institutions, hardware has evolved to highly efficient personal computers, handheld devices, and potent microchips with enormous capacity for data storage and management. Computers have also become key tools in accelerating processes that are occurring in the field of biotechnology, while different biological processes are providing new models for the development of new hardware and software (i.e. DNA-based computers). This process of interaction between biology and electronics/mechanics has been defined ‘bionic convergence’ and may result in a tremendous impact on medicine. In February 1997, researchers created Dolly, a lamb cloned from the DNA of an adult sheep. What was considered impossible in the past, proved feasible, and demonstrated the growing power of new biotechnologies. Further examples could be repre

Negli ultimi anni si assiste a un rinnovato interesse per l'emodialisi domiciliare nel trattamento dell'insufficienza renale cronica, anche grazie alle recenti innovazioni tecnologiche che consentono di effettuare tale trattamento più agevolmente che in passato. Il revival di questa metodica suscita un interessante dibattito nella comunità scientifica e tale dibattito ultimamente, in Italia, ha visto l'espressione di alcune posizioni critiche nella piattaforma NephroMEET. In questo contributo, si sottolineano le principali evidenze cliniche e gli effetti psicologici e sociali di questa metodica, attraverso un approfondimento della letteratura più recente e grazie all'analisi conversazionale di un caso di successo. La prospettiva da cui si parte è quella relativa al concetto di salute, come definito dall'OMS. Si evidenzia come l'emodialisi extracorporea domiciliare presenti importanti vantaggi sia clinici che psicosociali, configurandosi come una valida alternativa dopo il trapianto e la dialisi peritoneale.

Diffusion and convection are the main mechanisms involved in the membrane separation processes occurring in extracorporeal hemodialysis. Operational parameters should be optimized in hollow fiber hemodialyzers to achieve the maximal efficiency. The nature of blood which is a non Newtonian fluid, requires specific attention in the design of dialyzers to ensure that the blood compartment operates properly. Similar attention must be placed in the design of the dialysate compartment to ensure a homogeneous distribution of the fluid and to prevent blood to dialysate flow mismatch. Finally, the membrane represents the third component of the hemodialyzer. Membrane performance depends on the used biomaterial, its biocompatibility, the thickness, the hydrophilic-hydrophobic mixture, the hydraulic permeability and the number and diameter of the pores. In this setting, diffusion and convection tend to reciprocally interfere, producing a final result that depends on the prevalence of one or the other mechanism for every specific solute.

Background/Aim: The ultrasonic transit time is currently the best method for measuring the blood flow rate in the extracorporeal hemodialysis circuit. The purpose of this study was to analyze the differences between blood flow as indicated by the hemodialysis blood roller pump (prescribed blood flow) and by an ultrasonic flowmeter (delivered blood flow). Methods: The ultrasonic blood flow was measured in 20 patients on chronic hemodialysis who were dialyzed through an arteriovenous fistula. During each dialysis session the ultrasonic blood flow was measured at three different blood roller pump flow rates (300, 350, and 400 ml/min). In order to analyze the influence of inflow and outflow pressures on blood flow, this study was conducted during nine consecutive dialysis sessions during which needles of different sizes were used. Results: The ultrasonic flow was always lower than indicated by the blood roller pump: 265 ± 12, 304 ± 15, and 341 ± 19 ml/min for blood roller pump flow rates of 300, 350, and 400 ml/min, respectively (variability: –11.6, –13.1, and –14.8%, respectively). An univariate regression analysis showed that the reduction in flow recorded ultrasonically correlated with both venous blood line pressure (r = –0.2679, p < 0.001) and negative arterial blood line pressure (r = 0.6773, p < 0.001). By multivariate analysis, only the arterial blood line pressure has a predictive value. When all measurements were grouped by arterial blood line pressure ranges, the variability between ultrasonic blood flow and blood roller pump flow was found to be similar in those groups with the same arterial blood line pressure, regardless of the blood roller pump flow rate. Conclusions: The blood flow indicated by the dialysis blood roller pump is always greater than the delivered blood flow, and this difference is in turn conditioned by the negative pressure induced by the blood roller pump in the arterial blood line.

The Authors evaluated the behavior of protein C activity, factor X and factor VII coagulant activity and serum lipoprotein(a) before and after dialytic treatment in patients on maintenance hemodialysis. They observed depressed protein C activity that significantly (p

Extracorporeal hemodialysis (HD) has been shown to increase energy turnover by about 10%.(1) It was thus of interest to consider energy turnover under intermittent peritoneal dialysis (IPD). Energy turnover was measured by direct calorimetry before and immediately after the PD procedure.

Symptoms during treatment with extracorporeal hemodialysis are an unpleasant fact of life maintained by the artificial kidney. During hemodialysis, a common clinical pattern is dizziness, malaise, nausea, and cramps accompanied by a fall in blood pressure, requiring some form of therapeutic intervention by the nurse or technical team. Such symptomatic hypotension occurs in approximately 25% of hemodialysis treatments. For some patients, symptomatic hypotension recurs frequently enough to make maintenance dialysis a nightmare. This review is an effort to fit into some kind of reasonable pathophysiologic schema the large body of information on symptomatic hypotension.

Presentation of Case A 41-year-old woman was admitted to the hospital because of cough and chest pain. There was a long history of repeated urinary-tract infections. Seven years before admission an intravenous pyelographic examination with nephrotomograms disclosed polycystic renal disease. Mild hypertension was treated with methyldopa. During the next seven years her renal function gradually deteriorated. Eight months before admission extracorporeal hemodialysis was begun. One month thereafter a cadaver renal allograft was implanted, and the patient was maintained on azathioprine and prednisone. The allograft failed to function, and hemodialysis was continued for the next 36 days. Fever developed, and cultures . . .

Application of hemodialysis to dogs has been complicated by an acute reaction consisting of hypotension, bradycardia and respiratory depression followed by instability and a mortality rate of about 30 per cent. This reaction appears to be a response to homologous blood used to fill the dialyzers. Sensitization occurs in survivors, and accentuated reactions with marked hemolysis are noted on subsequent challenge. Cross matching the donor and recipient bloods has not permitted an adequate determination of compatibility under the conditions of hemodialysis. Satisfactory hemodialysis may be accomplished in dogs by using autogenous blood or blood substitutes to fill the dialyzers.

EEG-Kontrollen bei 36 Hamodialysen (28 Patienten) ergaben vor der Hamodialyse in Abhangigkeit vom Ausmas der Niereninsuffizienz masige bis schwere Allgemeinveranderungen. Bei Dialyseende kam es bei den Patienten mit akutem Nierenversagen vorwiegend zu einer Besserung des hirnelektrischen Befundes, wahrend bei den Patienten mit chronischer Niereninsuffizienz in der Mehrzahl der Falle eine Verschlechterung des EEG-Befundes eingetreten war. Als Ursache dieser Verschlechterung werden hamodynamische Veranderungen wahrend der Hamodialyse bei verminderter Anpassungsfahigkeit des cerebralen Kreislaufs infolge vorbestehender vascularer Schaden, bei schlechtem pramorbidem Allgemeinzustand und bei ausgepragter Anamie diskutiert. Bestimmungen der Osmolalitat in Blut und Liquor ergaben nur einen sehr geringen osmotischen Gradienten an der Blut-Liquorschranke, so das eine intrakranielle Drucksteigerung durch Hydratation des Liquorraumes als Ursache der hirnelektrischen Storung unwahrscheinlich ist.

The host-parasite relationship in human derma tophytic infections has been a subject of interest for over 45 years, particularly because of the remarkable restriction of the growth of these fungi to keratinized structures despite their generally non-fastidious growth requirements when cultured. Clinical observation has shown that systemic involvement with dermatophytes occurs with extreme rarity even in patients with marked impairment of general defensive mechanisms against bacterial or deep fungal infections.

Attention has been focused on many new and old techniques for preventing and treating poisonings arising from the ingestion of substances against which no specific antidotes are established. Aside from symptomatic and general supportive care, the nonspecific measures of value in clinical toxicology are of two types: those employed to minimize absorption by terminating the toxic exposure and those designed to promote the excretion of poisons already absorbed. In the first category, the induction of emesis, gastric lavage, the ingestion of adsorbents, and the administration of cathartics are recognized. In the second category are techniques for accelerating renal and biliary excretion, as well as extracorporeal hemodialysis, peritoneal dialysis, gastric dialysis, and related procedures. Considerably more information is desirable about each of these measures, how and when it should he used, and what advantages and disadvantages can be anticipated in its adoption. On the basis of recent studies, specific topics of promise for future investigation are suggested. Developments in these areas will probably prove to be more important than new systemic antidotes in terms of improving patient care in clinical toxicology.

SINCE the clinical application of extracorporeal hemodialysis requires the addition of an anticoagulant to the blood, hemorrhagic complications may occur in the patient. In the usual procedure, 6000 to 9000 U.S.P. units of heparin sodium (about 60 to 90 mg.) are added to the blood used to prime the artificial kidney. When the dialyzer is connected to the patient, there is a systemic effect. Anticoagulant activity is monitored by serial determinations of clotting times by the Lee and White method. When the clotting time falls below sixty minutes, 1000 to 2000 U.S.P. units (about 10 to 20 mg.) . . .

The procedure employed in the dialysis of a 13 kg boy with salicylate intoxication is described. Clinical and chemical data are presented which demonstrate the effectiveness and safety of this procedure. The arguments in favor of dialysis rather than exchange transfusion in the treatment of salicylate intoxication are discussed and the indications for the use of hemodialysis are enumerated.

The alteration (delta Z0) of transthoracic electrical impedance (TEI) during extracorporeal hemodialysis (EHD) was investigated in two Groups of patients with acute renal and acute respiratory failure, that differed with respect to the severity of respiratory insufficiency. Group I had moderate respiratory failure (FiO2 0.31 +/- 0.10, PaO2 84 +/- 14 mmHg), and Group II had severe respiratory failure (FiO2 0.75 +/- 0.17, PaO2 77 +/- 14 mmHg). There was a significant correlation between increase in TEI (delta Z0) and decrease in body weight (delta BW) in each individual patient, but the slope of regression lines was remarkably flattened in Group II. In Group I, delta TEI was 1.9 +/- 0.9 omega, the calculated TEI for 500 gr decrease in BW (delta Z0-500 gr) was 0.59 +/- 0.21 omega, and a significant correlation existed between pooled data of delta Z0 and delta BW. In Group II TEI increased less significantly, delta TEI was 0.6 +/- 0.3 omega (P less than 0.001), delta Z0-500 gr was 0.26 +/- 0.27 omega (P less than 0.01), and there was no correlation between pooled data of delta Z0 and delta BW. Increase of TEI in Group II could be completely attributed to increase in hematocrit. It is concluded that patients of Group I with acute renal failure and moderate respiratory failure lost intrathoracic fluid during EHD, whereas patients of Group II with severe respiratory failure did not. TEI during EHD may serve as a test for detection of fixed fluid within the pulmonary interstitium indicating a poor prognosis of the acute respiratory failure.

For the past 25 years, dialysis has been advocated as an artificial replacement therapy for the functional loss of kidneys. Thousands of patients with chronic renal failure have been kept alive who otherwise would-have died. At present, in excess of 80 000 persons in the United States are on dialysis, a dramatic increase from the 2398 of 15 years ago [1]. This increase, in large measure, is due to the technological and treatment advances in renal replacement therapy. However, technologies such as automated dialysis systems [2, 3], bacteriologically safe catheters [4], and modified peritoneal dialysis procedures such as CAPD [5] or its automated nocturnal form, ‘prolonged dwell’ peritoneal dialysis [6], do more than sustain life. They enhance patients’ physical status and tolerance for home treatment [7] and free them from the constraints of extracorporeal hemodialysis [8], thus contributing to overall improvement in patients’ cognitive acuity and psychosocial functioning [9–12].

Extracorporeal hemodialyses were carried out in a female patient with severe diquat intoxication. Diquat clearance was on average, 3.17 ml/min. Only 0.84 mg diquat could be eliminated from the blood serum by 11.5 hrs of dialysis. Hemodialysis is therefore not an efficient technique for removing amounts of diquat from the organism that are toxicologically relevant one day after ingestion.

There are toxic states in which the eliminating organs of the body, specifically the kidneys, are incapable of removing from the body at an adequate rate the natural or unnatural substances whose accumulation is detrimental to life. Though extrarenal methods of treatment of renal failure vary, extracorporeal hemodialysis remains the most efficient and rapid method. It is our purpose to present a double-lumen catheter as an important adjunct in hemodialysis, when the catheter is used as a venous cannula. Methods and Material The double-lumen catheter is made of a nontoxic vinyl plastic.* It is 60 cm in length with the distal 20 cm consisting of a single-lumen extension (Figure). The inside diameter of both lumina is 2.3 mm. The diameter of the double-lumen section is 6.6 mm. The catheter is made to fit the connectors of the Kolff disposable twin-coil unit. The catheter is inserted through a single cut-down incision

Acute renal failure was treated by hemodialysis in 15 patients. Five of these underwent more than one period of treatment. The apparatus used operates as an ultrafilter as well as a hemodialyzer and is portable. Methods of sterilizing and testing the apparatus, preparing the solution for perfusion, administering anticoagulants and anesthetics, cannulating the blood vessels (radial or brachial artery and long saphenous vein), and regulating the flow are described in detail. In each case the hemodialysis was instituted primarily because of the appearance of the uremic syndrome; in nine cases hyperkalemia was prominent. Biochemical analyses showed that the hemodialysis materially lowered the level of the plasma potassium during the first hour and that the removal of urea continued steadily as long as six hours. A blood flow of approximately 200 ml. per minute was sought, with a urea clearance of about 150 ml. per minute. The period of dialysis was six hours in all but four cases. Preexisting complications made recovery impossible in eight cases, even though the immediate biochemical and clinical results of the hemodialysis were fair to excellent. In the remaining seven cases the hemodialysis carried the patient through the period of renal insufficiency, and recovery followed.

The use of extracorporeal hemodialysis in a patient who drank an extremely large quantity of isopropanol (isopropyl "rubbing" alcohol), described below, afforded us an opportunity to study blood, u...

Excerpt Chronic intermittent extracorporeal hemodialysis became practical with the development of the external arteriovenous shunt by Quinton, Dillard, and Scribner in 1960 (1). With the use of the...

THE ORIGIN of clinical dialysis can be traced to the work of Abel, Turner and Rowntree 1 who in 1913 dialyzed uremic dogs using an extracorporeal circuit and a semipermeable membrane made of colodion. To prevent clotting in the circuit, hirudin, an extract from leeches, was used. There was not much activity in this field until 1943 when Willem Kolff 2 used an extracorporeal dialyzer ("Rotating Drum") to dialyze a patient with clinical uremia. This was done in the Netherlands during World War II. Dr. Kolff truly established himself as the father of clinical dialysis. After the war, impetus was again generated and dialysis was recommended for the treatment of acute renal failure (ARF) and poisonings. The concept of using extracorporeal hemodialysis primarily for ARF prevailed until the end of the 1950 to 1960 era. During this time an occasional patient who had chronic renal disease was dialyzed, but only

Currently there is high interest in determining the pathophysiologic importance of molecules of intermediate molecular weight (500 to 5000) in the clinical syndrome of uremia [1, 2]. For extracorporeal hemodialysis, the efficiency with which these solutes are removed depends on the area and permeability characteristics of the dialysis membrane, as well as the time spent on dialysis [3, 4]. When contrasting peritoneal with extracorporeal hemodialysis, it becomes important to know how the area and permeability characteristics of the peritoneal membrane compare with conventional cellulosic hemodialysis membranes. It is widely held from the anatomical work of Wegner (1877) [5], cited by Boen [6] in his monograph on peritoneal dialysis, that peritoneal membrane area approximates skin surface area. Applying the nomogram of Dubois [7] for determining the skin surface area for a standard 70kg (154 lb) body weight, 170cm (5' 7") height patient would yield a 1.8 m2 area; that for an 80kg (175 lb), 183cm (6') patient would yield a 2.0 m2 area. A similar but unestablished estimate is provided by Miller and Tassistro, in an unreferenced comment [8], indicating that peritoneal membrane area is "approximately that of the glomerular capillaries." Pappenheimer [9] estimates the latter area to be between 0.5 and 1.5 m2/100 g of kidney. Given an average single kidney weight of 150 g, peritoneal membrane area according to this method of estimation would be between 1.5 and 4.5 m2.

Durch die extracorporale Hamodialyse kommt es zu einer Ausscheidung des freien Plasmacortisols in das Dialysat. Dies bewirkt ein starkeres Absinken des Plasmacortisolspiegels, was einen Gegenregulationsmechanismus auslost, der uber vermehrte ACTH-Ausschuttung zur vermehrten Cortisolproduktion in einem ungefahr vierstundigen Rhythmus fuhrt.

Excerpt To the editor: Continuous ambulatory peritoneal dialysis, widely used as an alternative to extracorporeal hemodialysis in patients with chronic renal failure, often has been complicated by ...

In a patient who had bilateral nephrectomy, methoxyflurane anesthesia produced elevated serum levels of inorganic fluoride and nonvolatile organic fluoride. The concentrations of both types of fluoride were significantly reduced by extracorporeal hemodialysis.

Vividialysis has proved itself useful in adults with renal disorders in which the fluid disturbances of uremia threaten life before reparative processes can restore kidney function. Two methods of dialysis have been employed: (1) lavage of a membrane within the body, either the peritoneum or an isolated loop of bowel, by dialyzing fluid,* and (2) extracorporeal hemodialysis in an artificial kidney using cellophane to separate the patient's blood from the lavage fluid.† Although the number of such dialyses performed in adult subjects can now be counted in hundreds,‡ the use of either method in therapy of children with far-advanced renal failure has been relatively infrequent. Peritoneal lavage in three uremic children was described by Swan, in 1949.14However, due to various difficulties reported, such as occlusion of the siphon apparatus, loss of body protein, inability to regulate transfers of water and of electrolytes, and the danger of infection, we

METHYPRYLON, a nonbarbiturate sedative hypnotic, has been in clinical use since 1956. Approximately 36 cases of overdosage have been reported in varying detail but little information is available on its metabolism and toxicology. 1-10 No reports discuss its renal clearance, or suitability for hemodialysis. The purpose of this report is to present our experience with a patient who ingested 30 gm of methyprylon, was treated by extracorporeal hemodialysis, and in whom renal and dialysis clearance were determined. Report of a Case A 39-year-old housewife was transferred to Meadowbrook Hospital on Dec 5, 1965, four hours following ingestion of 30 gm of methyprylon. She informed her husband of the act and lapsed into unconsciousness while being transported to the emergency room of another hospital. Upon arrival at the referring hospital, the patient received gastric lavage, nalorphine hydrochloride, metamphetamine hydrochloride and metaraminol bitartrate. She became totally unresponsive to external stimuli and was

During a time span of 4½ years, 43 patients have been treated by extracorporeal hemodialysis. Approximately 1,500 dialyses are accomplished each year, mostly on patients with end-stage renal disease. During this time, we have used two major modes of vascular access. During the first 2½ years, the Quinton-Scribner shunt was used almost exclusively. 1 All of the patients currently on maintenance dialysis have had buried-subcutaneous fistulas established. About half of 16 patients have two buried fistulas, one in each upper extremity. With this arrangement, we can alternate arms; or if there is difficulty in placing two needles in one arm, the contralateral extremity can be used for access. Nurses are instructed to place the cannulae as far apart as possible and alternate needle sites to allow healing before a previous site is used for puncture. They are also instructed to perforate the vein at approximately 1 to 1.5 cm distant

THIOCYANATES have been used in the treatment of hypertension since 1903. The replacement of thiocyanate by newer agents useful in hypertension has resulted in a lack of familiarity with this method of treatment and with the toxicity of the thiocyanate ion. Toxic psychosis caused by thiocyanate overdosage may be misinterpreted as a symptom of hypertensive or cerebral vascular disease. The following case is reported to illustrate the fact that thiocyanate psychosis may still occur and to confirm a previous report of the success of extracorporeal hemodialysis in its treatment. Report of a Case A 68-year-old woman entered the State University of Iowa Hospitals on Sept. 21, 1960. Relatives stated that she had been in excellent mental and physical health until about 6 weeks before when she had consulted her physician because of a minor injury to the leg. She was found to have a blood pressure of 230/115 mm. Hg.

Excerpt Extracorporeal hemodialysis is often lifesaving in the treatment of acute renal insufficiency, but the procedure itself is not without danger. Heparinization may be accompanied by hemorrhag...

A case of methyprylon (Noludar®) poisoning treated with extracorporeal hemodialysis is reported. The patient showed dramatic clinical improvement with concomitant lowering of serum methypr...