Fukuoka Chapter

Renal Failure and Hemodialysis

Kazue Fujino

2 May 2008

1. Where are kidneys? What are kidney functions?

• Behind intestines
• One kidney weighs about 120g.
• Broad bean shape
• 1L of blood flows into kidneys per minute.
• Functions of kidneys: remove waste（老廃物）from the blood into the urine. and return the purified blood to the heart（心臓）.
• Kidneys produce urine（尿）out of the waste.
• Kidneys adjust the level and the amount of the body fluid, the balance of the blood between acidity（酸性） and alkalinity（アルカリ性）.
• Kidneys activate vitamin D for bone-building.
• Kidneys produce renin（レニン）for maintaining blood pressure.
• Kidneys produces and secrete hormones（ホルモン）to stimulate RBC (red blood cells 赤血球) production.

2. Renal Failure

Renal failure or kidney failure is a situation in which the kidneys fail to function adequately due to some reasons. Renal failure can broadly be divided into two categories:

�@ Acute Renal Failure （急性腎不全） (ARF)
�A Chronic Renal Failure（慢性腎不全） (CRF)

�@Acute Renal Failure （急性腎不全） (ARF)
can be caused by bleeding, dehydration（脱水）, shock, acute glomerulonephritis (AGN)（急性糸球体腎炎）, renal vascular disorder（腎血管障害）, urinary tract obstruction（尿路閉塞）, taking too much alcohol（アルコールの多飲） etc.

�AChronic Renal Failure（慢性腎不全） (CRF)
can be caused by chronic glomerulonephritis (CGN), malignant hypertension（悪性高血圧）, connective tissue disease (CTD)（膠原病）, diabetic nephropathy（糖尿病性腎症）, multiple myeloma (MM)（多発性骨髄腫） etc.
Top cause for HD patients
RF （renal failure: 腎不全） develops:

Protein in urine, insomnia, nausea, swelling, uremia（尿毒症）
Patient with the end-stage renal failure needs dialysis to avoid falling uremia（尿毒症） by externally filtrating blood（外部的に血液をろ過）.
Dialysis consists of hemodialysis (HD:血液透析 or 人工透析) and peritoneal dialysis (PD: 腹膜透析). Here, the explanation is made mainly about hemodialysis (HD).

3. Hemodialysis

• Brief explanation of the difference between HD and PD

• Hemodialysis

Patient starting HD needs to create a shunt in his/her non-dominant arm.
Shunt: an artery（動脈）and a vein（静脈）of the patient are joined together by a vascular surgery （血管手術）so that blood flows rapidly.
☆ About 200 mL/minute of blood flow is necessary for HD.

1. Introduce two cannulas into large veins （大動脈）of the patient.
2. Blood is taken out from a canula on artery side（動脈側のカニューレ）.
3. Blood is circulated through a dialyzer（ダイアライザ：人工腎臓）, a cylindrical bundle of hollow fibers so that waste（老廃物）and water（水分） unnecessary in the blood are removed.
4. Blood is returned to the inside of the patient’s body from a canula on vein side.

• Blood-making medicine（増血剤）, iron drug（鉄剤）etc. are injected into blood circulation.
• Needle scars are compressed using thick cotton or its substitute （枕子：ちんし）a firmly rolled gauze used for stopping the bleeding.

Japan 4 hour treatments given 3 times a week are typical.
* 48 hours for normal people → 3-4 hours for the patients.→big load for the patient’s heart function.

↓

The longer one treatment takes, the better for the patients (load on the heart is decreased).

Dry Weight (DW): weight of a patient taking dialysis after a dialysis session when all the extra fluid in his/her body has been removed.→Weight gain should be ideally between 3〜4% of the patient’s weight per one day.

Blood pressure: both states of �@high blood pressure (HBP) or �Alow blood pressure (LBP) should be avoided.

�@ Removing too much fluid/or removing fluid too rapidly lowers blood pressure.
�A Fluid overload caused by drinking too much or not loosing enough increases blood pressure.

4. Drawbacks of Hemodialysis

Mental problems:

• Patients need to spend 4-5 hours per one cycle, 2-3 days a week for dialysis.→S/he cannot do anything but stay on a bed or a chair during the hours.
• Pain of sticking needles.

Physical problems:

• Due to the use of anti-blood-clotting drug to enhance circulation of the blood or make it smooth, it takes time to stop bleeding after dialysis.
• Lowering of BP, muscle cramps（けいれん）, headache, nausea（吐き気） etc.: dialysis disequilibrium syndrom（DDS: 不均衡症候群）
• Physical condition largely changes before and after dialysis.
• Strict restriction on water and food (mental problem?)
• Many complications （合併症）might appear in a long-term dialysis on other body parts or organs (differs from patient to patient).
  • Amyloidosis　アミロイドーシス
    HD cannot remove all the unnecessary protein from the patient’s body and it deforms into a substance called amyloid. It is deposited in bones, joints etc. of the patient and cause pain, deformation, movement disorder and so on. A typical example of this symptom is called carpal-tunnel syndrome（手根管症候群）.
  • Skeletal disorders　骨の障害
    Vitamin D is inactivated due to renal failure and calcium cannot be substantially taken into the patient’s body, thus causing many problems on his/her bones.
  • Arteriosclerosis　動脈硬化
    Uremic toxin（尿毒素）, calcium and phosphate（リン）value in blood become high, which influences to stimulate the patient falling arteriosclerosis（動脈硬化）.
  • Cardiac Failure (CF)　心不全
    As mentioned before, if a state of the patient’s body with excessive amount of water continues, it puts a strain on the patient’s heart and worsens its function.
  • Infections　 感染症
    A patient taking dialysis generally has a weakened immune system （免疫力低下）, which makes him/her susceptible to infections（感染症）.

References (websites):

1. Wikipedia: http://en.wikipedia.org/wiki/Main_Page
2. ウィキペディア　フリー百科事典（日本語）：
   http://ja.wikipedia.org/wiki/%E3%83%A1%E3%82%A4%E3%83%B3%E3%83%9A%E3%83%BC%E3%82%B8
3. 財団法人　日本腎臓財団： http://www.jinzouzaidan.or.jp
4. Goo ヘルスケア： http://health.goo.ne.jp/
5. Transplant Communication トランスプラント・コミュニケーション：
   http://www.medi-net.or.jp/tcnet/index.html
6. 英辞郎 on the WEB： http://www.alc.co.jp/index.html

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