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Kidney Failure

Kidney (renal) failure can be acute or chronic. Acute kidney failure is produced by any condition which leads to a sudden and prolonged period of low blood pressure, such: as heavy blood loss or a heart attack.

There are numerous causes of chronic renal failure. A protracted case of acute renal failure or a renal disease may eventually become chronic. In some ten per cent of cases the cause is not discovered; and the patient may not notice anything wrong until the disorder is very advanced. At first he or she may notice an increase in the volume of urine excreted and general tiredness.

Treatment

The successful treatment of acute renal failure is complicated and, preferably, takes place in a specialized renal unit The kidneys usually improve after several weeks. With chronic kidney failure, where symptoms appear gradually, the kidneys become less and less efficient as damage to them increases. Close medical supervision can slow the progress of the disease. When the kidneys fail completely the only satisfactory form of treatment is one that performs the kidneys' functions, either dialysis or a kidney transplant. Treatment of kidney failure has been revolutionized by haemodialysis.

Haemodialysis

Haemodialysis, in which the patient's blood is cleaned artificially to remove all waste products, depends on the ability of a machine to do the work of the kidney. Even if a kidney transplant is considered, an artificial kidney machine must be used first, so that the new kidney is grafted into a healthy body. The normal kidney is composed of living tissue, giving it a versatility which no machine can have, and the artificial kidney is much more simple in design and operation. Nevertheless, it is able to perform most of the essential functions of the normal kidney and is responsible for saving and maintaining many lives.

The principle on which it relies, called dialysis, depends on the ability of small molecules to be separated from larger ones in the blood, by passing the blood through a thin barrier. Starting with a mixture of small and large molecules on one side of the barrier and water on the other, the small molecules go through the barrier into the water while the larger ones are left behind. In haemodialysis, the patient's blood is on one side of the barrier and on the other is a prepared solution of salts, approximately the strength of normal, clean blood. The waste products in the patient's blood cross the membrane into the other solution, which is continually being replaced. In this way the blood is cleaned of all substances which the kidneys would normally remove, leaving essential substances behind. The membrane has to be semi-permeable; that is, permeable to substances such as urea, uric acid, creatinine, sodium, potassium and water - the main components of normal urine - but not to proteins and other relatively large molecules.

For information on the use of a dialysis machine and on portable dialysis.

Kidney transplants

Many people dependent on dialysis look forward to the prospect of transplantation of a healthy kidney, from either a living or a dead donor. Modern methods of identifying different tissue types mean that a compatible transplant can be made that will reduce the risk of the body rejecting the new organ. The patient's own kidneys are often left in place during the operation, and the donated kidney placed low down in the pelvis. Sometimes the new kidney works straight away, or it may take a few days to start functioning. After the transplant the patient must take drugs to suppress the immune system, and minimize the chance of the body's natural defence system rejecting the kidney.

Although kidney transplantation is a major operation, the success of the technique has grown dramatically over the last decade, to allow patients to lead a near-normal life.

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