This document discusses various abnormalities of renal function including proteinuria, polyuria, oliguria, uremia, acidosis, and hematuria. It then covers dialysis and renal transplantation. Specifically, it defines proteinuria, polyuria, oliguria, and anuria. It describes uremia and azotemia occurring in renal failure. It discusses the indications for and types of dialysis including hemodialysis and peritoneal dialysis. It provides details on the composition of extracellular fluid, dialysate, and the artificial kidney used for hemodialysis. Finally, it outlines renal transplantation including donor criteria and post-transplant drug administration.

1. Abnormalities of renal functions

2. Abnormalities of renal functions
1. Proteinuria OR Albuminuria
2. Polyurea & Nocturia
3. Oliguria & Anuria
4. Uremia & Azotemia
5. Acidosis
6. Haematuria

3. Abnormalities of renal functions [contd]
• 1] Proteinuria OR Albuminuria –
 Nephrotic syndrome  Excretion of [] large amount of protein
thro urine  inability of liver for complete [] resynthesis of
lost protein  Hypoproteinaemia   blood oncotic pressure
  plasma volume   fluid accumulation in tissues 
edema.
 Orthostatic proteinuria – on long standing. Cause not known.
Not pathological
• 2] Polyurea & Nocturia –
– Polyurea – in kidney diseases   in concentrating capacity
  vol of dilute urine   flow rate  urine output =
3L/day; urine osm =  250 mOsm/L
– Nocturia – waking up at night frequently to void urine.
• 3] Oliguria & Anuria –
– Oliguria –  urine vloume
– Anuria – no urine formation

4. Abnormalities of renal functions [contd]
• 4] Uremia & Azotemia – found in renal failure
i. Uremia –  in plasma urea level.
ii. Azotaemia - retention of nitrogenous waste
products e.g. urea, creatinine etc.
• Symptoms are –
nausea, vomiting, confusion, convulsions, even
death.
• Treatment –
haemodialysis followed by renal transplant
• 5] Acidosis - at plasma pH of 7.35
• 6] Haematuria

5. Abnormalities of renal functions [contd]
• Acidosis - at plasma pH of 7.35.
Metabolic acidosis Respiratory acidosis
1] Diabetic acidosis 1] Hypoventilation
[depression of resp center]
2] Diarrhea [ loss of alkali] 2] Pulmonary oedema
3] Renal failure
4] Lactic acidosis
5] Aspirin in large doses

6. Abnormalities of renal functions [contd]
• 6] Haematuria -
• Presence of plenty of [ ]RBCs in urine
 Due to damage to glomerular capillaries e.g.
glomeruloneprhtitis
 In renal stones, renal TB, trauma to kidney etc
• In urinary tract infections  Haematuria +
pyuria [presence of pus cells] + bacteriuria

7. DIALYSIS
• INDICATIONS –
• Need for dialysis – serum creatinine level > 6mg %
1. Acute renal failure [ damage to kidney is reversible] – e.g.
i. Acute nephritis,
ii. Poisoning with lead OR mercury.
iii. Circulatory shock,
iv. Severe transfusion reactions,
v. Ureteric obstructions
2. Chronic renal failure [ damage to kidney is irreversible . So
renal transplantation is treatment of choice] –e.g.
a) Chronic nephritis,
b) Severe hypertension.
c) Carcinoma of kidney
3. Snake bite
4. Poisoning

8. TYPES OF DIALYSIS
1. Haemodialysis -
PRINCIPLE –
 diffusion of substances across a semipermeable
membrane with blood on one side & dialysate
[cleansing solution] on other side.
 Waste materials from blood diffuse out &
desirable components of dialysate diffuse into
blood.
2. Peritoneal dialysis

10. Compositionof ECF & Dialysate
Substance ECF [m mol/L] Dialysate
Sodium 152 140 -145
Potassium 4.5 1-3
Calcium 1.5 1.5
Magnesium 0.5 0.5
Chloride 109 100 – 105
Bicarbonate 32 -38 32 -38
Glucose 5 0 -10

12. Artificial kidney [apparatus for dialysis] OR Dialyzer
• It is hollow fibre or capillary dialyzer.
• Blood flows inside capillaries & dialysating fluid outside.
• Flow of dialysate is parallel current to blood flow.
• Composition of dialysate = Composition of plasma.[ may
vary depending on need]
• 9 -12 hrs of dialysis/week.
• Before dialysis –
surgical arterio venous fistula by anastomosis in forearm
done.[radial art to cephalic vein]
Blood heparinised before entering dialyzer & deheparinised
by PROTAMINE before returning to body.
• Complications –
• Septicaemia, Embolization, intracranial haemorrhage
[due to heparinisation], hypotension, depression etc

13. 2] PERITONEAL DIALYSIS
• Principle - Peritoneal membrane acts as dialysis
membrane.
• Procedure –
i. Indwelling catheter in peritoneal cavity.
ii. Introduction of 2L of dialysate.
iii. Every 4 -6 hrs empty & replace the dialysate.
• Advantages –
a) Avoidance of heparinization.+ vascular surgery.
b) Useful in cardiac insufficiency.
• Complications – PERITONITIS.

14. RENAL TRANSPLANTATION
• Effective treatment in Chr. Renal diseases
• Donor must be
i. Histo compatible [HLA antigen] +
ii. Same blood group.
• Administration of drugs after transplant –
a) To prevent rejection of transplant, immuno
suppressive drugs e.g. azathioprine,
cyclosporine, & glucocorticoids
b) To prevent anaemia, Erythropoitin .