TUTORIAL 5 ENT 318 Artificial Organs 1. What is the structure in kidney roles the main function of filtration?

State 3 phases of urine formation. Consists of about 1 million filtering units termed nephrons (basic structural and functional unit) Responsible for urine formation: Glomerular filtration Tubular reabsorption Tubular secretion 2. Discuss the function of kidney. Regulation of H2O and inorganic ion balance most important function! Regulation of body fluid volume and osmolality Regulation of electrolyte balance Regulation of acid-base balance Excretion of waste products (urea, ammonia, drugs, toxins) Production and secretion of hormones Regulation of blood pressure Excreted products: Product of the metabolism, Water, Hormones, Vitamins, Toxic substances 3. Explain the stages how urine and waste product (such as amino acid or from medication substance i.e diuretics) are excreted during urination. Draw the diagram to show the stages. Responsible for urine formation: 1. Glomerular filtration Nonselective passive process Water and solutes smaller than proteins are forced through capillary walls Proteins and blood cells are normally too large to pass through the filtration membrane Filtrate is collected in the glomerular capsule and leaves via the renal tubule The ability of a molecule to cross the membrane depends on size, charge, and shape Glomerular filtrate therefore contains all molecules not contained by the glomerular barrier - it is NOT URINE YET! 2. Tubular reabsorption The peritubular capillaries reabsorb useful substances;Water,Glucose,Amino acids,Ions. Some reabsorption is passive, most is active. Most reabsorption occurs in the proximal convoluted tubule. Materials not reabsorbed Nitrogenous waste products; Ureaprotein breakdown, Uric acidnucleic acid breakdown, Creatinineassociated with creatine metabolism in muscles

3. Tubular secretion Some materials move from the peritubular capillaries into the renal tubules a. Hydrogen and potassium ions b. Creatinine Process is important for getting rid of substances not already in the filtrate Materials left in the renal tubule move toward the ureter 1

Proximal tubule uric acid, bile salts, metabolites, some drugs, some creatinine Distal tubule Most active secretion takes place here including organic acids, K+, H+, drugs, Tamm-Horsfall protein (main component of hyaline casts).

4. Define the terms of clearance and ultrafiltration. Express the corresponding equation. Clearance Complete removal of a solute from blood during a single pass defines the dialyzer clearance for that solute as equal to dialyzer blood flow. Under condition of steady-state dialysis, mass conservation requirement is expressed as

N QB (CBi CBo ) QD (CDo CDi )

Dialyzer clearance is defined as mass transfer rate N divided by concentration gradient prevailing at the inlet of dialyzer.

N C Bi C Di

Filtration Ultrafiltration is defined as difference between blood flow entering the dialyzer and blood flow leaving the dialyzer. F QBi QBo Ultrafiltration can be enhanced by increasing resistance to blood flow at dialyzer outlet. Blood compartment pressure will be raised by subjecting dialysate to a negative pressure. When CDi=0 and CBo=CBi, blood dialysance will equal to filtration KB=F

5. Describe types of kidney failure. Classification : acute and chronic renal failure. Acute renal failure (ARF) is a rapid loss of renal function due to damage to the kidneys. Chronic renal disease is a progressive loss of renal function over a period of months or years. Acute Renal Failure 2

Resulting in retention of nitrogenous (urea and creatinine) and non-nitrogenous waste products that are normally excreted by the kidney. Kidney cannot exert any significant excretory. If patient omit protein foods from diet, urea still produced because of metabolic breakdown of bodys own tissue proteins. Thus, protein level in plasma will rise. Plasma bicarbonate will fall because acids are formed by oxidation of sulphur and phosphorus in protein.

Chronic Renal Failure Results in changes in body fluids which occur due to progressive decrease in number of functioning nephrons. Clearence of urea and other metabolic waste will decrease. On the other hand, plasma concentrations of these substances will rise. Kidney become less effective due to declination in number of functioning nephrons. Patient is liable to develop deficiencies or excess of body fluid water and sodium.

6. What is the treatment for kidney failures. Dialysis is a process of removing substances such as water, salts, and waste products (from the bodys normal metabolism), which build up in patients with failing kidneys. Used to provide artificial replacement for lost kidney function. Two forms of dialysis : hemodialysis and peritoneal dialysis. 7. Discuss the 3 components used in dialyzer Blood compartment. Dialysate compartment. Semipermeable membrane. Membrane support structure. 8. With an aid diagram, discuss the mechanism of transportation through the membrane of dialyzer.

Mechanisms of Transport through the Membrane Principle Operation Works on principles of diffusion of solutes and convection of fluid across semi-permeable membrane. Blood flows by one side of a semi-permeable membrane, and a dialysate flows by the opposite side. The concentrations of undesired solutes are high in the blood side. At dialysate side, concentration of undesired solution is kept low so that the dialysis process could occur continuously. Diffusion (true dialysis) movement due to concentration gradient

If concentration is higher in the blood and the species can pass through the membrane, transport occurs until the concentrations are equal Slow If dialysate concentration is higher, the flow goes toward the blood Diffusion Due to concentration gradient across membrane, waste product will pass through. Dialysate fluid free from waste product molecules. Thus, waste products in blood tend to distribute evenly throughout blood and dialysate. Movement of waste products from blood to dialysate results in cleaning of the blood Convection Massive movement of fluid across membrane Fluid carries dissolved or suspended species that can pass through the membrane Usually as a result of fluid pressure (both positive and suction pressure) Principal means of water and electrolyte removal (ultrafiltration) Can also remove water by adding glucose to dialysate (osmotic gradient) Convection Volume of body fluid cannot be controlled by dialysis. Ultra-filtration across membrane is employed. Positive pressure applied to blood compartment. Or negative pressure established in dialysate compartment. Thus, fluid (water and electrolytes) will move from blood compartment to dialysate. Degree of ultra-filtration depends on pressure difference across membrane and ultrafiltration characteristic of membrane.

9. Differentiate the types of dialyzer used in heamodialysis. Design Consideration of Dialyzer Can be classified according to three basic design considerations : parallel plate, coil and hollow fiber.

10. Suppose you are working in a haemodialysis specialist company and have been assigned to evaluate the requirements/considerations to optimize the competency of haemodialysis. Write the report by sketching the diagram and propose the suggestions for your assignment.

Dialyzers are disposable. Advantages of disposable dialyzers : - reduction in infection risk. - reduce operator set-up time. - eliminate dialyzer sterilization procedure.

Hemodialysis machine is used for production of warm dialysate which is then circulated through an external dialyzer assembly. 4

Also controls cycling of blood from patient to dialyzer and back to the patient. Continuously controls and monitors all important parameters. Automatically halts treatment if there is abnormality or in the event of parameters going out of preset limit. Pumps and controls flow of blood at pre-determined rate and pressure to ensure effective clearances and fluid removal. Also measures ultra-filtration rate. With all parameters known, operator could calculate, predict and control fluid removal during dialysis. Basic Functions of Hemodialysis Machine - Mixes the dialysate. - Monitors the dialysate. - Pump the blood and controls administration of anti-coagulants. - Monitors blood for presence of air. - Monitors ultra-filtration rate. Dialysate Temperature Control and Measurement Dialysis normally done at body temperature. Lower than body temperature, dialysis is less efficient and blood has to be warmed before return to patient. High temperature (>40oC) will damage components of blood. Thus, temperature of dialysate is monitored and controlled before supplied to dialyzer. Temperature control system used to raise temperature of dialysate to a required value. If temperature exceeds, safety cut-out will ensure heater switched off. Required temperature varied from 36 to 42oC Venous Pressure Measurement Measured at bubble trap. A tubing connects the trap to a strain gauge transducer. If pressure beyond limit, power to blood pump will be isolated and pump will not be used. Bubble trap Air embolism is serious hazard in dialysis. Air may be sucked in due to inadequate flow in the line in the pumped dialysis system. Bubble trap is equipped to diminish air embolism. Heparin Pump Usually of the plastic syringe type. Pump driven by stepper motor and drive screw mechanism. This drives the plunger of the syringe into its barrel which produces the pumping action. Stepper motor speed determined by computer based on heparin flow rate. Speed of stepper motor monitored using optical encoder. Blood Leak Detector Blood leakage across dialyzer membrane can be detected by using photo-electric transducer. Leak detector examines light absorption of dialysate at 560 nm i.e. absorption wavelength of haemoglobin.

Figure 1

11. To increase solute removal rate, dialyzers X and Y are operated in series (Figure 1). Their respective clearances are ClX and ClY. There is filtration and the blood solute concentrations are shown at the inlet and outlet locations of the dialyzers. Show that the overall clearance Cl of the series combination is given by: [ ]

Figure 2 12. A dialyzer of Cuprophan PM-150 has membrane area, S of 1.65 m2 is operated in a countercurrent flow configuration (Figure 2) with blood flow rate 200 ml/min and dialysate flow rate 500 ml/min. There is no ultrafiltration and dialysate is single pass with C Di = 0. Show the ratio of blood concentration at inlet, CBi and blood concentration at outlet, CBo as;

where z = QB / QD , and k o is the overall mass transfer coefficient. 13. Solute Urea Creatinine Vitamin B12 Cl (ml/min) 164 140 32

Given the following information in table are the clearances for each solute from dialyser. Determine overall resistance, Ro for each the solute, where Ro = 1/ko. (Hint: Derive ko from question 12).