Dialysis : principle, types, working ,dietary management its drawbacks and prevention Urolithiasis :types , causes, most prone regions, diets for recovery and further prevention and treatment.

1. DIALYSIS.
Syeda Yousra

2. It is performed when a person experiences 95%
kidney failure.
Like healthy kidneys, dialysis keeps the body in
balance by removing waste products including
salt and excess fluids and controlling blood
pressure

3. Why is it necessary????
When there is kidney damage or kidney disease, and
the kidneys are not able to filter waste efficiently,
there will likely be a rise in creatinine levels in the
blood. For adults with kidney disease, dialysis is
recommended when creatinine levels reach 10.0
mg/dL. For babies with kidney disease, dialysis is
recommended when their creatinine level is 2.0
mg/dL.

4. Principle
• Principle of dialysis - Diffusion of solutes
and ultrafiltration of fluid across a semi-permeable
membrane.
– Diffusion is a property of substances in water; substances in
water tend to move from an area of high concentration to an
area of low concentration.Blood flows by one side of a semi-
permeable membrane, and a dialysate, or special dialysis fluid,
flows by the opposite side.
– Smaller solutes and fluid pass through the membrane, but the
membrane blocks the passage of larger substances (for
example, red blood cells, large proteins). This replicates the
filtering process that takes place in the kidneys, when the blood
enters the kidneys and the larger substances are separated from
the smaller ones in the glomerulus.

5. TYPES
• Haemodialysis.
• Peritoneal Dialysis.

6. Haemodialysis
• Here an artificial kidney, haemodialyser is
used to remove the waste products from the
blood and restore the body’s chemical
balance.

7. How is it done?
• A blood vessel with a rapid flow of blood that
is also close to the skin is needed.
• It does not exist naturally, an access has to be
made during a short surgery.

8. Fistula and Graft.
• A Fistula is made by connecting a vein to a
nearby artery.
– Blood flows rapidly into the vein making it larger.
It takes weeks/months before a fistula is ready for
use.
• A Graft is sewn between the artery and vein.
– Blood flows rapidly into through the graft from the
artery to the vein. This is usually ready for use
within a week or two.

10. Working of haemodialysis.
• Plastic tubing attached to the needles
connects the patient to the artificial kidney.
• This contains two compartments, one for the
patient’s blood and one for a cleaning solution
called dialysate.
• A thin porous membrane seperates these
compartments.

11. • Blood cells, protein and other important
substances in the blood remain in their
compartments as they are larger.
• The smaller waste products like urea and
creatinine in the blood and excess water pass
through the holes of the membranes and are
washed away.
• The clean blood now enters the patients body.
• Haemodialysis is done approximately for 3-4
hours and is usually three times a week.

12. Characteristics of haemodialysis
• Takes only 3-5 hours per treatment.
• Requires only 3 treatments weekly.
• Requires surgical creation of vascular access
between circulation and dialysis machine.
• Requires complex water treatment, expensive
dialysis equipment and highly trained personnel.
• Requires large dose of heparin.
• Confines patient to special treatment unit.
• Risk of complication.

13. Peritoneal dialysis.
• Here the patients blood is cleaned continously
within the body, the blood stays in the blood
vessels which line the patients
andominal(peritoneal) space. The lining of the
space acts like a membrane in the artificial
kidney.

14. Working of peritoneal dialysis.
• A catheter is surgically placed to create an
access.
• The dialysate is slowly filled through the
catheter.
• The exchange of waste products and chemical
balancing take place.
• Once the exchange is completed, the used
dialysate is drained from the peretonial cavity.

15. • This type of dialysis is mostly performed by
the patients themselves.
• There are 3 types
– CAPD –Continuous Ambulatory Peretonial Dialysis
is done for 4-5 hours and is usually 4-5 times a day
– CCPD- Continuous Cycling Peretonial Dialysis lasts
about 1hour 30 minutes and is done several times
a night
– IPD- Intermittent peritoneal dialysis is the oldest
form and lasts about 10-12 hours, 3 times a week.

16. Characteristics
• Can be performed immediately.
• Requires less complex equipment and less
specialised personnel.
• Requires small amount of heparin or none at all.
• Can be performed by patient anywhere without
assistance.
• Allows patient independence without long
interruption in daily activities.
• Allows for more liberal diet.
• Costs less.

17. Dietary management.
• Requirement for haemodialysis
– Energy – 35 kcal/kg body weight
– Protein – 1.1g/kg
• For CAPD/CCPD
– Protein 1.3g/kg
• Dietary salt, potassium, phosphorus and water
intake should be restricted to
– Salt 3-4g, k+ 50-70mEq/day, phosphorus 1g/day and
water according to the urine output of the patient.

18. Drawbacks.
• Dialysis can only control the kidney failure and
does not cure the diseased kidneys.
• Patients with chronic kidney failure need to
continue dialysis throughout their lives or until
they receive kidney transplant.
• Discomfort is seen when needles are inserted for
haemodialysis.
• Patients may also experience a drop in blood
pressure accompanied by nausea, vomitting,
headaches and cramps.
• Dialysis is very expensive.

19. Prevention
• Treating diabetes mellitus and hypertension
with lifestyle modification is essential to
prevent kidney damage.

20. Urolithiasis or Urinary Calculi
• These are found, lodged in the urinary tract
namely, kidney, ureters, bladder or urethra.
• Sometimes there is blood in the urine and the
stones can cause intense pain.
• Renal stones are prevalent between 30-45
years of age. Relapse is common.

21. Causes
• May be due to nutritional status, dietary
habits and environmental factors like
temperature and humidity.
– Climate : In warm climates, the urine volume is
low and concentrated with urates, oxalates and
calcium salts. In India this is found in Rajasthan,
Saurashtra and Punjab may be due to excessive
heat or water scarcity.

22. – Occupation : people who work directly under the
sun and perspire a lot ,pass concentrated urine.
– Infection of urinary tract : frequent infection of
the urinary tract which causes puss cells formation
and epithelial cells may form a focus around which
the stone may be formed.
– Dietary habits : intake of foods rich in oxalates,
calcium, purines and phosphates may predispose
to form calculi. Diets rich in sodium, fats ,meat
and sugar and low in fibre, vegetable protein and
unrefined carbohydrate increase the risk.

23. – Heridity.
– Vitamin A and B complex deficiency.
– hyperthyroidism

24. Types
• Calcium phosphate
• Calcium oxalate
• Uric acid or magnesium ammonium
phosphate.

25. Calcium oxalate calculi
• Formation of calculi depends upon the
balance between the concentration of
precipitating substances like calcium
phosphate, oxalic acid, uric acid, Mg and
crystal inhibitors in urine.
• Volume and pH of urine
• High intake of animal protein like meat, fish
and poultry.

26. • Pyridoxine deficiency increases the production
of oxalic acid in the body and its excreation in
the urine.
• Excess intake of vitamin C
• Foods rich in oxalates like spinach, cabbage
and tomatoes
• People residing in rocky areas are more prone
because the drinking water may be hard or
may contain some elements.

27. Studies conducted.
• Studies conducted at NIN, Hyderabad (1982)
reported that in Punjab the incidence of
Urolithiasis is higher where fluoride content of
drinking water is high and this helps in the
growth of urinary calculi.

28. Diet for the prevention of renal calculi
• Low oxalic acid and purine content
• Calcium and phosphates should be reduced to
moderation
• Large amount of fluids to increase urine
output to 2-2.5 litres per day.
• High ratio of Mg to Ca foods such as brown
rice, bananas and oats to be given

29. • Mg supplementation may decrease the size of
and existing stone and prevent further
formations.
• Foods to avoid
– Alcohol , antacids, excessive protein, dairy, salt,
carbonated beverages, caffeine and refined white
flour, coffee, iced tea,cola etc

30. Treatment.
• Acid or alkaline ash diet is not very effective in
bringing about solution of stones formed but
may prevent the recurrence of stones.
• Planning Acid ash diet
– Liberal fluid intake
– Salt in moderation
– The fruits and vegetables should not contribute
more than 25ml of base daily.

31. • Planning Alkaline-ash diet.
– For uric acid stones- alkaline producing foods like -
fruits, vegetables and milk. Acid producing foods
like meat, eggs and cereals to be restricted.
• Planning low oxalate diets
– Food sources of oxalates to be omitted like beans,
beet greens, chocolate, cocoa, dried figs,plums,
potatoes, spinach, tea and tomatoes.

32. Dietary management
• Fluids – supply adequate fluids like water
coconut water and barley water fruit juice and
light tea for the passage of over 2000 ml of
urine per day.
• Foods- avoid foods rich in Ca, oxalate or uric
acid.