Chapter 1: introduction to kidney world

1.1 overview and function of kidney

The kidneys are two bean-shaped organs located in the lower back, one on each side of the spine.
They are responsible for a number of important functions, including:

Filtering the blood: The kidneys filter about 1.5 liters of blood every
minute, removing waste products and excess water.
Regulating blood pressure: The kidneys produce hormones that help to
regulate blood pressure.
Figure 1 3D illustration of human
Maintaining fluid balance: The kidneys help to keep the body's fluid levels kidneys with cross-section
in balance by regulating the amount of water that is excreted in the urine.
Maintaining electrolyte balance: The kidneys help to keep the body's
electrolyte levels in balance by regulating the amount of sodium, potassium,
and other electrolytes that are excreted in the urine.
Making red blood cells: The kidneys produce a hormone that helps to
stimulate the production of red blood cells.
Converting vitamin D to its active form: The kidneys convert vitamin D to itsFigure
active form,
2 kidney structure
which is necessary for calcium absorption.
Breaking down drugs and toxins: The kidneys help to break down drugs and toxins that are in
the blood.

1.2 what is kidney failure

Kidney failure is a condition in which the kidneys can no longer adequately filter waste products
from the blood, functioning at less than 15% of normal levels. When the kidneys fail, waste
products and excess fluids accumulate in the body, leading to serious health complications.

1.3 types of kidney failure & symptoms

Kidney failure is classified as either acute kidney failure, which develops
rapidly and may resolve; and chronic kidney failure, which develops slowly and
can often be irreversible. Symptoms may include leg swelling, feeling tired,
vomiting, loss of appetite, and confusion. Complications of acute and chronic
failure include uremia, hyperkalaemia, and volume overload. Complications of
chronic failure also include heart disease, high blood pressure, and anaemia
Figure 3 early symptoms of kidney failure
1.3.1 causes of Acute kidney failure
 Low blood pressure
 Blockage of the urinary tract
 Certain medications
 Muscle breakdown
 Hemolytic uremic syndrome

1.3.2 causes of Chronic kidney failure

 Diabetes
 High blood pressure
 Autoimmune diseases
 Kidney infections
 Polycystic kidney disease
 Kidney stones
 Medications

1.4 stages of kidney failure

There are five stages of kidney failure, which are determined by a test called the glomerular
filtration rate (GFR). The GFR measures how well the kidneys are filtering waste from the blood.
The five stages of kidney failure are:
1. Stage 1: In this stage, the GFR is normal, but there may be signs of kidney damage. This stage
is often asymptomatic and may go unnoticed.
2. Stage 2: In this stage, the GFR is slightly reduced, and there
may be mild kidney damage. Like stage 1, this stage is often
asymptomatic.
3. Stage 3: In this stage, the GFR is significantly reduced, and
there is moderate kidney damage. Symptoms may begin to appear, Figure 4 kidney failure stages
including fatigue, swelling, and changes in urination.
4. Stage 4: In this stage, the GFR is severely reduced, and there is a high risk of complications,
such as anemia, bone disease, and cardiovascular disease. Symptoms may include severe fatigue,
nausea, vomiting, and swelling.
5. Stage 5: This stage is also called end-stage renal disease (ESRD), and the GFR is less than 15
mL/min/1.73m². The kidneys are no longer able to function, and dialysis or kidney transplant is
necessary to sustain life.
1.5 kidney dialysis treatment
Kidney dialysis is a treatment for kidney failure, in which a machine filters waste and excess
fluids from the blood, a function normally performed by the kidneys. There are two types of
kidney dialysis: hemodialysis and peritoneal dialysis.

1. Hemodialysis: In this type of dialysis, a machine called a dialyzer is used to filter the blood. A
small tube, called a catheter, is inserted into a vein in the arm or leg, and the blood is pumped
through the machine, which filters out waste products and excess fluids. Hemodialysis is
typically done three times a week, and each session lasts about four hours.

2. Peritoneal dialysis: In this type of dialysis, a catheter is placed into the abdominal cavity, and a
special fluid is pumped in and out to filter the blood. The lining of the abdomen, called the
peritoneum, acts as a natural filter, and the fluid is drained out after several hours. Peritoneal
dialysis can be done at home, and the patient can do it themselves after being trained by a
healthcare professional.

Both types of dialysis have their advantages and disadvantages, and the choice of treatment
depends on the patient's medical condition and preferences. Dialysis is a life-saving treatment for
kidney failure, but it's important to note that it's not a cure, and it can have side effects, such as
low blood pressure, infections, and anemia. Kidney transplant is another option for some patients
with kidney failure, and it can provide a better quality of life than dialysis.

1.6 History of kidney disease

Kidney disease has been recognized for thousands of years, with evidence of kidney stones
found in Egyptian mummies dating back to 4400 BCE. Ancient Greek physician Hippocrates
was also aware of kidney disease and wrote about it in his medical texts.

In the 19th century, French physician Dr. Richard Bright described a syndrome that involved
proteinuria, edema, and hypertension, which later became known as Bright's disease. This
syndrome was later found to be associated with chronic kidney disease.

During the early 20th century, researchers began to understand the role of the kidneys in
regulating the body's fluid balance and electrolyte levels. They also discovered that kidney
disease could be caused by various factors, including infections, autoimmune disorders, and
hypertension.
In the 1950s, with the development of dialysis, researchers gained a better understanding of
kidney function and the mechanisms of kidney disease. This led to the development of new
treatments for kidney disease, including immunosuppressive drugs, which could slow the
progression of the disease.

In recent years, there has been a growing recognition of the global burden of kidney disease. It is
estimated that over 700 million people worldwide have some form of kidney disease, and it is
one of the leading causes of death worldwide. There has been a focus on improving prevention,
early detection, and treatment of kidney disease, as well as increasing access to kidney
transplantation for those with end-stage kidney disease.

1.7 history of kidney dialysis

The first kidney dialysis machine was developed in the 1940s by Dr. Willem Kolff, a Dutch physician. His
machine, called the Kolff-Brigham artificial kidney, used a drum filled with a cellophane membrane to
filter the blood. The patient's blood was pumped through the drum, and a salt solution was pumped
around the outside of the drum. This allowed waste products to pass through the membrane and be
removed from the blood.

Figure 5 kloff rotating drum kidney (1943)

Figure 2 willem kloff (1911-2009)
Over the years, kidney dialysis machines have evolved significantly, becoming more efficient and safer for
patients. Here are some of the major milestones in the evolution of kidney dialysis machines:

1. In the 1950s, the first commercially available dialysis machine was developed, which used an
improved cellophane membrane and a more efficient pumping system.

2. In the 1960s, the first artificial kidney machine was developed, which used a more advanced dialysis
membrane and a computer-controlled system to monitor the patient's blood pressure and other vital
signs.
3. In the 1970s, the first continuous ambulatory peritoneal dialysis (CAPD) machine was developed,
which allowed patients to perform peritoneal dialysis at home.

4. In the 1980s, the first hemodialysis machines were developed that used biocompatible materials, such
as polysulfone membranes, to reduce the risk of blood clots and infections.

5. In the 1990s, the first hemodialysis machines were developed that used online monitoring and
feedback systems to ensure that the patient received the optimal amount of dialysis.

6. In recent years, there have been significant advances in the development of wearable and portable
dialysis machines, which allow patients to receive dialysis treatment while going about their daily lives.

Overall, the evolution of kidney dialysis machines has been a remarkable success story, enabling millions
of people with kidney failure to live longer and more productive lives.

Introduction

Kidney dialysis is a medical treatment used to remove waste and excess fluid from the blood
when the kidneys are unable to do so. Traditional in-center dialysis requires patients to travel to a
medical facility and sit for several hours while connected to a machine. This can be time-
consuming, disruptive, and limiting for patients who may have to miss work or social activities.

Fortunately, advances in technology have made portable kidney dialysis a reality. Portable
dialysis machines are small and lightweight, allowing patients to receive treatment in the comfort
of their own homes or while traveling. This technology has revolutionized the way patients
manage their kidney disease, providing them with greater flexibility and independence.

This project graduation book aims to provide a comprehensive overview of portable kidney
dialysis. We will explore the history and development of this technology, its benefits and
limitations, and the impact it has had on patients and their families. We will also delve into the
technical aspects of portable dialysis machines and how they work, as well as the training and
support required for patients to use them safely and effectively.
Overall, this project graduation book will serve as a valuable resource for anyone interested in
learning more about portable kidney dialysis. Whether you are a healthcare professional, a
patient, a caregiver, or simply curious about this innovative technology, we hope this book will
provide you with the knowledge and insight you need to understand and appreciate the benefits
of portable dialysis.