Renal Failure Treatments: New Developments

Kidney’s

Extended Research task

Kidneys act as the waste disposal system of the human body. These bean shaped organs filter the human blood supply about 12 times every hour, equivalenting to roughly 113 liters of blood every day (Australia, 2018). It separates the unnecessary water and toxins from the blood going through it using nephrons, the small filters of the kidney structure. Nephrons have two parts; the glomerulus is the part that strains the blood cells and any other large molecules from the unnecessary water and toxins. The left-over fluid then goes through the tubule which collects minerals that the body needs, such as sodium, calcium potassium and many others, and puts them back into the bloodstream ( (Bradford, 2016). The excess fluids, also known as urine, is then removed from the body through the urethra. Urine is made up of 95% water and the rest includes urea, chloride, potassium, creatinine and other dissolved ions (Projects, 2017). ‘Kidneys can also help to regulate blood pressure, blood volume and the chemical composition of the blood.’ (OPTN, n.d).

The renal system consists of the kidneys, ureters, urethra and urinary bladder. Within the kidney itself, there are several components; the renal capsule that is the outer layer of membrane around the kidney, the renal pelvis which is a basin like area that collects urine from the nephrons, the calyx is the extension of the renal pelvis, the cortex being the outer region of the kidney, nephrons, the medulla, the renal artery which carries blood into the kidney and the renal veins which removes the filtered blood (Schmidler, 2018).

Figure 1

‘Renal failure is when the kidneys are unable to remove waste or maintain electrolyte balance of the blood.’ (OPTN, n.d). Side effects of renal failure, other than the obvious inability to filter blood correctly, is fatigue, diminished urine output, anemia and sometimes heart complications. In most cases, kidney failure occurs due to long term impacts that happen gradually over time. Things such as diabetes and high blood pressure are the most common causes of end-term renal disease (ESRD). Kidney failure and acute kidney injury.

There are many treatments for renal failure, such as transplants or dialysis. A kidney transplant is when a healthy kidney is taken from a donor, living or diseased, a place into someone who is suffering from kidney failure (Baxter, 2018). Patients in need of a kidney transplant must be placed on a waiting list until a viable kidney that is a match for the patient becomes available. “In any one time, more than 1500 people are on Australian organ transplant waiting lists. The average waiting time for a kidney transplant from a deceased donor is over three years.” (Australia, 2018). In other cases, relatives or friends can donate their kidneys to the patient if they are a match. A match means they share the same blood type as the donor. Patients must be evaluated before they have a transplant, which searches for blood type (A, B, AB or O) and the human leukocyte antigen (HLA). “HLA is a group of antigens located on the surface of the white blood cells. Antigens are responsible for your body’s immune response.” (Healthline, 2018). There are only three outcomes to a kidney transplant, success, failure or rejection. As the body is being forced to introduce a foreign organ, it has potential to reject and try to damage the organ as a natural immune response, which is the transplant rejection. There are three types of rejection, ‘Hyperacute rejection (which occurs a few minutes after the transplant), Acute rejection (occurs from one week after to three months) and also chronic rejection (can take place over many years)’ (Medicine, 2018). Transplant failure and be caused by several things such as, ‘blood clots, fluid collection, infection, donor kidney problems, non-adherence.’ (Tushla, 2017). A successful outcome, would mean the kidney begins to filter the blood and continues to do so for weeks after the transplant, as it can sometimes change after a few days.

To prevent the outcome of the transplant being rejected, immunosuppressants are given to the patient. Immunosuppressants are drugs given to patients to reduce the body’s immune system from rejecting the new organ. It is these drugs that cause the most side effects after a kidney transplant. Immunosuppressants, as they are used to reduce rejection of foreign agents, can also increase the risk of infection throughout the body (NKF, 2017). They can also increase the risk of bone thinning, diabetes, high blood pressure, high cholesterol, puffiness and weight gain (Staff, 2018). “The Mayo Clinic estimates that 90 percent of transplant recipients who get their kidneys from a living donor, live for at least 5 years after surgery.” (Healthline, 2018).

Kidney dialysis is another treatment for kidney failure, which can be done in two ways, hemodialysis and peritoneal dialysis. Hemodialysis involves diverting blood to an external machine that filters the blood and then return it to the body. Peritoneal dialysis involves putting dialysis fluid into the abdomen to draw out the waste in the blood being circulated through (NHS, 2018). Dialysis only performs the filtering functions of the kidney; the other functions such as fluid balance, creating hormones to help produce red blood cells and regulating and filtering minerals from the blood, are left untouched by the dialysis treatment (Stephens & Healthline, 2018). Hemodialysis involves going to a hospital or clinic and spending around 4 hours on the dialysis machine, 3 times a week. ‘The patient is weighed, temperature taken, and blood pressure measured. Needles are placed into the patients AV fistula and the blood is then filtered through the Dialysis machine. The Dialysis machine works by monitoring the dialysate; which is the fluid that helps to remove the unwanted toxins and waste from the blood. During this process heparin is administered into the blood to prevent it from clotting.’ (S, 2018). Side effects of this type of dialysis is low blood pressure, anemia, cramping and can even lead to sudden cardiac death (Healthline, 2018). Low blood pressure can be caused when too much fluid is removed from the blood when it is filtered; this is also the reason why people experience cramping (Davita, 2018). Cardiovascular complications are often caused by “unsteadiness in the cardiovascular system balance” (Coppolino, et al., 2010). The patient’s veins can also begin to deteriorate due to constant breakage when needles are placed, which can cause further issues.

When undergoing the Peritoneal dialysis, there are two types: continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). CAPD is ongoing filtering throughout the day and APD can be done overnight. Both types can be done at home once the patient is trained correctly. “A cut (incision) is usually made just below your belly button…The catheter is permanently attached to your abdomen, which some people find difficult.” (NHS, 2018). Dialysis, in most cases, becomes a permanent situation for people using it as a treatment. Dialysis takes over the function of the kidney and unless other types of treatment are taken, will continue to function for the kidney. People who undergo long-term dialysis can be at risks of developing other conditions, such as amyloidosis (amyloid proteins build up in organs such as kidneys and liver) (Healthline, 2018).

In a long-term situation, kidney transplants are a better treatment than dialysis. Kidney transplants have a lower risk of failure and are never performed unless an adequate match is found for the recipient. Dialysis is a long-term treatment that remains constant throughout the patient’s life. It takes time and is a constant intrusion. Although biologically transplants present less risks of failure or illness, there is still a waiting time and requirement of matching blood types before anything can be progressed. Dialysis can be performed on any blood type and any stage of kidney failure.

Moving forward, specific research and experimentation is being undergone to try and improve kidney treatments and possibly find new treatments. Stem cell treatments are being investigated to aid in kidney repair. Mesenchymal stem cells are “Found in the bone marrow, these stem cells protect the kidneys from injury and accelerate healing.” (HSC, 2018). By administering these cells back into the kidney individually, there is a chance the kidney will begin to repair itself, reducing treatment times. This treatment is considered to be a short-term resolution, but a long-term treatment idea is recreating a nephron. “HSCI scientists plan to isolate kidney stem cells, mix them with soluble gels, and mold them into the architecture of a nephron” (HSC, 2018). This would be considered as an artificial organ transplant, making it a reality for humans, only previously being performed in experimentation on rats. Another new development in kidney treatments, is the creation of an artificial vein implanted into a CKD sufferers arm. If the vein proves to be effective, this will resolve blood clotting issues with patients that chose hemodialysis as a treatment. (KidneyBuzz, n.d).

Advancements such as these and the increasing survival rates of people undergoing kidney treatments, are demonstrating that treatment types are developing for the better as it moves into the future. As for the current situation, transplants and dialysis are a CKD suffers best hope. 

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Figure 1:

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