Renal dialysis

De-ionized Medium-pressure boilers For renal dialysis aluminium must BS 2489 1978... 

Once aluminium has reached the circulation, there seems little doubt that it can cross the blood-brain barrier - the best proof being that in renal dialysis patients... 

People on renal dialysis who have received high doses of aluminum in medications and in dialysate fluid for a number of years are at... 

Patients generally seek medical help because they want relief from disease. They have little interest in diagnosis—except in so far as it helps the doctor treat them more efficiently—and still less in the mechanism of their illness. Nevertheless, clinical chemistry traditionally has been more concerned with diagnosis and the elucidation of the mechanism of disease than with treatment. In only a few circumscribed areas, such as management of water and electrolyte imbalance, diabetic coma, and renal dialysis, has clinical biochemistry proved indispensable for treatment, the overall raison d etre of the health industry. 

Chronic renal dialysis Although serum ferritin is usually a good guide to body iron stores, the correlation of body iron stores and serum ferritin may not be valid in patients on chronic renal dialysis who are also receiving iron dextran complex. 

High-risk patients Hypertensive patients at risk of excessive hypotension include those with the following concurrent conditions or characteristics Heart failure, hyponatremia, high-dose diuretic therapy, recent intensive diureses or increase in diuretic dose, renal dialysis, or severe volume or salt depletion of any etiology. Single doses of enalaprilat as low as 0.2 mg have produced excessive hypotension in normotensive patients with these diagnoses. Because of the potential for an extreme hypotensive response in these patients, initiate therapy under very close medical supervision. The... 

However, in patients with renal failure there is a strange and currently unexplained observation in relation to non-renal clearance. If this is measured for some compounds it also is found to be depressed even though it is the kidney that is diseased and not the liver The picture becomes a little clearer if the same non-renal (presumed hepatic) clearance is measured again in patients after renal dialysis when the hepatic clearance has been found to have risen to control values. Recent animal experiments have demonstrated that the circulating inhibitor of hepatic cytochrome P450 may be parathyroid hormone. Parathyroidectomy of rats with chronic renal failure prevented the reduction in liver cytochrome activity (see Michaud et al., 2006). 

Finally, in countries where is it available, renal dialysis presents other challenges as many drugs are lost from the body in the course of peritoneal or haemodialysis. 

Single drug therapy is mostly adequate in lupus nephritis (LN) classified as renal biopsy WHO Class I and II. Single drug therapy in lupus nephritis Class III-V, and in particular Class VI is less or not effective. One immunosuppressant cannot suppress all aspects of autoimmune inflammation in the more serious forms of the disease. The SBC-5-IMNs is not required in Class I, IL and also not in Class VI. In Class VI nothing helps, except renal dialysis or renal transplantation. 

Staphylococcal vascular shunt infections in persons undergoing renal dialysis have been successfully treated with vancomycin. Vancomycin in oral form can also be used in patients in whom C. difficile colitis is not responding to metronidazole. 

Folic acid deficiency, unlike vitamin B12 deficiency, is often caused by inadequate dietary intake of folates. Patients with alcohol dependence and patients with liver disease can develop folic acid deficiency because of poor diet and diminished hepatic storage of folates. Pregnant women and patients with hemolytic anemia have increased folate requirements and may become folic acid-deficient, especially if their diets are marginal. Evidence implicates maternal folic acid deficiency in the occurrence of fetal neural tube defects, eg, spina bifida. (See Folic Acid Supplementation A Public Health Dilemma.) Patients with malabsorption syndromes also frequently develop folic acid deficiency. Patients who require renal dialysis develop folic acid deficiency because folates are removed from the plasma during the dialysis procedure. 

Parenteral administration of folic acid is rarely necessary, since oral folic acid is well absorbed even in patients with malabsorption syndromes. A dose of 1 mg folic acid orally daily is sufficient to reverse megaloblastic anemia, restore normal serum folate levels, and replenish body stores of folates in almost all patients. Therapy should be continued until the underlying cause of the deficiency is removed or corrected. Therapy may be required indefinitely for patients with malabsorption or dietary inadequacy. Folic acid supplementation to prevent folic acid deficiency should be considered in high-risk patients, including pregnant women, patients with alcohol dependence, hemolytic anemia, liver disease, or certain skin diseases, and patients on renal dialysis. 

Renal dialysis cartridge (c.g., Disscap 180SE, Hospal Ltd., Rugby, UK) (seeNote 2). 

Before seeding, the renal dialysis cartridges must be washed through with... 

Fig. 6. Circuit diagram for washing renal dialysis cartridge...

The hollow-fiber bioreactor is a stenle renal dialysis cartridge, and may be obtained from distributors or hospital supplies departments There are various sizes, but we find the most useful to have an internal volume of 50 or 150 mL. Not all dialysis cartridges are suitable for growing cells The fibers should be of regenerated cellulose, about 10,000 in number, and approx 200-jum diameter and 8-10-pm wall thickness. 

Calcitriol/ Calcijex/Abbott/ Management of hypokalcemia in patients undergoing chronic renal dialysis... 

Brief History. A.S. is a 47-year-old concert musician who experienced a progressive decline in renal function that ultimately led to renal failure. Kidney function was maintained artificially through renal dialysis until a suitable kidney transplant became available from a donor who died in an automobile accident. The kidney was transplanted successfully, and A.S. was placed on a prophylactic regimen of three different immunosuppressive drugs to prevent the rejection of the transplanted kidney. At the time of the transplant, cyclosporine was initiated at a dosage of 10 mg/kg of body weight... 

Aluminium is the third most abundant element in the earth s crust and is used widely in the manufacture of construction materials, wiring, packaging materials and cookware. The metal and its compounds are used in the paper, glass and textile industries as well as in food additives. Despite the abundance of the metal, its chemical nature effectively excludes it from normal metabolic processes. This is due largely to the low solubility of aluminium silicates, phosphates and oxides that result in the aluminium being chemically unavailable. However, it can cause toxic effects when there are raised concentrations of aluminium in water used for renal dialysis. These effects are not seen when aluminium is at the concentrations usually present in drinking water. There is currently much activity to examine the factors that influence uptake of aluminium from the diet. 

Roger SD, Harris DCH, Stewart JH. Possible relation between restless legs and anemia in renal dialysis patients. Lancet 1991 337 1551. 

Dedman DJ, Treffry A, Candy JM, et al. 1992. Iron and aluminum in relation to brain ferritin in normal individuals and Alzheimer s-disease and chronic renal-dialysis patients. Biochem J 287 509-514. 

Renal dialysis patients fed semipurified, liquid formulas as a sole nutrition source for 3 weeks showed significantly decreased blood plasma TAC (D6). TAC of blood plasma of children with kwashiorkor, a severe edematous manifestation of malnutrition, was below 50% of that of healthy controls (F4). 

D6. DiSilvestro, R. A., Blostein-Fujii, A., and Watts, B., Low phytonutrient, semipurified liquid diets depress plasma total antioxidant status in renal dialysis patients. Nutr. Res. 19,1173-1177 (1999). 

Lysaght, M.J., Ford, C.A., Colton, C.K. et al. (1977) Mass transfer in clinical blood ultrafiltration devices, in Technical Aspects of Renal Dialysis (ed. T.M. Frost), Pitman Medical, London, UK. 

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