Anatomy: The Renal System

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2 Anatomy: The Renal System Kidneys Ureters Enter at oblique angle Peristalsis Bladder Both prevent reflux Capacity ml Urethra Excretion; outside of body. In Males surrounded by prostate

3 Functions of the Renal System Elimination of Metabolic Wastes Regulation of RBC Production Regulation of Vitamin D & Calcium Regulation of Blood Pressure Regulation of Electrolyte, Acid-Base & Fluid Balances

4 Radiocontrast Agents Aminoglycosides Nonsteroidal Anti-Inflammatory Drugs (NAIDs) Angiotensin-Converting Enzyme Inhibitors (ACEIs) Lithium Nephrotoxic Drugs Crystal-Induced Acute Renal Failure Calcineurin inhibitors (Cyclosporine, Tacrolimus) Amphothericin B Chemotherapy

5 Nephrotoxic Drugs Patient- Related Risk Factors Age, Sex Previous renal disease Diabetes, Multiple myeloma, Lupus, Proteinuric disease Salt retaining diseases (Chirrosis, Heart Faiure, Nephrosis) Acidosis, potassium or magnesium depletion Hyperuricemia, Hyperuricosuria Kidney transplant

6 Nephrotoxic Drugs Drug - Related Risk Factors Inherent nephrotoxic effects Dose Duration, frequency and form of administration Repeated exposure Drug interaction (synergistic toxic effects)

7 Drug induced renal disorders: 1.Acute tubular necrosis(toxic) Gentamycin, mercury, contrast agents. 2.Acute tubulointerstitial nephritis (allergic) methicillin, thiazides. 3.Analgesic nepropathy (Phenacetin) chronic tubulointerstitial nephritis with papillary necrosis.

8 Classification of nephrotoxic drugs by their therapeutic use: Cardiovascular: Neuropsychiatric: ACEIs,CCBs,Mannitol, Methyldopa Triamterene,Warfarin Propranolol, Antimicrobial: Acyclovir,AG, Cephalosporin,Cipro AmphotericinB,TC Pentamidine,Vanco, TMP,Erythro,Penicillin Amoxapine,CBZ,Li,Pb, Phenytoin,VA Gastrointestinal: Cimetidine,Magnesium Ranitidine Phosphate enemas Immunosuppresiv: Corticosteroid Cyclosporine OKT3 Leukocyte A interferon Drugs to abuse: Amphetamine Cocaine Heroin Phencyclidine Rheumatolgic: Acetaminophen,ASA Allopurinol,NSAIDs D-penicillamine,Gold Cancer chemotherapy: Carboplatinum,Cisplatin Methotrexate, Mithramycin, IL2 Miscellaneous: Ascorbic acid Glyburide,Lovastatin Radiographic contrast

9 Renal Dialysis Cont., In 2001, 287,494 Americans with ESRD received dialysis. (ASN.org, 2005) Dialysis therapies are expensive; Medicare covers 80% of cost of dialysis. In 1997, the total cost of treatment for ESRD in the U.S. was 15 billion dollars. Types of Dialysis Therapies: Hemodialysis Continuous renal replacement therapies (CRRT) Peritoneal dialysis (various forms)

10 General Principles of Dialysis Cont., Ultrafiltration Removal of excess water by creating a pressure gradient between the positive hydrostatic pressure of the client s blood and the negative hydrostatic pressure (suctioning force) applied to the dialysate solution. More efficient water removal than osmosis

11 Main Types of Peritoneal Dialysis Continuous Ambulatory Peritoneal Dialysis (CAPD) Continuous Cycling Peritoneal Dialysis (CCPD)

12 General Principles of Dialysis Diffusion Toxins and waste products are moved from an area higher concentration in the client s blood to an area of lower concentration the dialysate solution. Osmosis Excess water is moved from a higher concentration in the client s blood to a lower concentration in the dialysate solution.

13 Hemodialysis Prescription Types of Dialyzer Low flux (KUF <10 ml/hr/mmhg) High flux KUF ml/mmhg Hallow fiber (capillary) Parallel Plate Types of Membranes Unmodified cellulose low flux Modified cellulose (Low & high flux) Synthetic (low & high flux) Synthetic noncellulose membranes are more biocompatible, size of dialyzer shouldn t exceed % of patient service area 13

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15 Physiochemical properties

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39 Questions?

40 Thanks for your attention