Index

acetate in dialysis fluid 265, 266 ACSjNIH Transplant Registry 366 acid-base balance

ammonium excretion 66-8 bicarbonate measurement 70 fixed acid generation 62 measurement 70 normal 62-6 titratable acid excretion 68 in uraemia 66-71 see also buffer systems

acute lupus nephritis 27 acute renal failure 1-27

antibiotic use 21,22 diagnosis 6-13 diuretic phase 22, 23 hypercatabolism 18-21 induced 3 intensive care 1 management 13-24 metabolism 24 nutrition 15-18 obstetric cases 24 pathophysiology, theories 2-5 patients at risk 6 plasma exchange 25-7 prognosis 24 underlying condition 22

air embolism 300 capacitance monitor 260,261 causes 258 monitor types 258

alkaline phosphatase, bone turnover 49 allopurinol and hyperuricaemia 74 allograft nephrectomy 349, 350 amikacin

in acute renal failure 22 in chronic renal failure 133

381

amino acids, essential-keto analogues 107

aminoglycosides 21 in chronic renal failure 132--4 side-effects 132

ammonia and uraemic toxicity 73 ammonium excretion

factors affecting 67 in uraemia 66-8

amphotericin B 21 ampicillin

dose in chronic renal failure 129 side-effects 129

amyloidosis 325 anaemia 189

and androgens 124, 125 in chronic renal failure 78-82 severity and BUN 78 treatment and chronic renal failure

124, 125 in uraemia 75

anaesthesia, side-effects 198, 199 androgens

in anaemia 124 side-effects 124

angiography 8-11,335,346,354, 361 angiotensins 86, 87

and acute renal failure 4 anion gap 70, 71 antibiotics

in acute renal failure 21,22 in chronic renal failure 126--42 in renal transplantation 337

ARF see acute renal failure arginine, danger in chronic renal failure

61 arterial line pressure monitors 261 arteriography II

382 INDEX

arteriosclerotic retinopathy 89 arteriovenous fistulae 14,211-19

antecubital fossa, technique 212, 213

autogenous vein graft procedure 216 blood pressure taking 212 bovine heterografts 216, 217 Brescia-Cimino subcutaneous 290 care in anaesthesia 219 children 222 Cimino-Brescia radiocephalic 222 Dacron 217 disadvantages in leg 211 end-to-end 214 femoral artery-vein 214 Gortex 222 polytetrafluoroethylene (PTFE)

218,219 referral for 237,238 from Scribner shunt 213 Sparks Mandril 214,215 surgical techniques 212,216,219 umbilical vein 218

arteriovenous shunt ankle insertion 204, 205 children, techniques 220-2 clotting prevention 206 disconnection bleeding 206 and fistula creation . 211 home haemodialysis 289 infection 206, 208 insertion difficulties 205 insertion technique 203 postoperative care 205 removal 208

avascular necrosis 357, 358 azathioprine 326, 337, 348, 350

use in chronic renal failure 141 use in immunosuppression 324,

341,369

backflow of filtrate 3 bicarbonate reclamation process 64,

65 in uraemia 68, 69

bicarbonate regeneration process 66 bilateral cortical necrosis 5 bleeding tendency in chronic renal

failure 81, 82 J3-blockers 86

antihypertensive action 112, 360 cardioselective 111-13

uraemic hypertension 111 blood pressure and hypertension

treatment 110 blood transfusion before renal

transplantation 344, 345 blood urea nitrogen (BUN) 95-7

optimum level and diet 105 and protein intake 104

bone disease see orthopaedic complications

brain death 331, 332 British Kidney Patients Association

328 holiday centre 'the Grove' 270, 271

buffer systems 62, 63 biological 63 physiological 63, 64

bumetanide 42 BUN see blood urea nitrogen burning feet 84

calcification calcium phosphate deposition sites

57 and itching 58 metastatic 57-9 renal tissue 58, 59 types 59 vascular 58

calcitonin deficiency in chronic renal failure 49

calcium absorption defects 47 calcium in dialysis fluid 266 calcium metabolism in chronic renal

failure 47-51 malabsorption 47,48 and parathyroid hormone 50,51

calculi in renal allografts 356 calyceal-cutaneous fistulae 355 cancer in renal transplantation

treatment 360 types and incidence 359, 360

Candida spp. infections 20 cannulae 197

infection 200, 289, 290 Silastic-Teflon 289, 290

cannulation direct vessel 199 femoral artery 201 femoral vein 200 insertion 200,201 subclavian vein 199, 200

INDEX 383

carbenicillin dose in chronic renal failure 128,

129 side-effects 129 sodium 129

carbohydrate metabolism 77, 78 intolerance in chronic renal failure

77 cardiovascular system, signs of chronic

renal failure 85-92 catabolic rate, causes of increase

18-21; see also hypercatabolism catheter, acute (stylet) 169-71

complications 171 insertion 170

catheter, permanent peritoneal 171 complications 174, 175 insertion and preparation 172, 173 obstruction 174 types 173

catheters Fogartyembolectomy 208,213 Foley 337 Goldberg 173 in renal transplantation 340 sapheno-femoral in children 220 Tenchkoff 173

cefoxitin 131 active excretion and dose 132

cellulose 263 dialyser re-use 272

central venous pressure 6 cephalexin, dose in chronic renal failure

131 cephaloridine 131 cephalosporins, nephrotoxicity 22,

130 cephalothin, dose in chronic renal

failure 131 cephazolin 131 Ceratonia siliqua, locust bean gum 125 chloramphenicol, use in chronic renal

failure 135 chronic renal failure (CRF) 33--142

acid-base balance 62-71 anaemia 78-82 calcium metabolism 47-51 carbohydrate metabolism 77-9 cardiovascular signs 85-92 causes 34, 35 clinical assessment 92-101 diet 102-10

drug use 126--42 fertility 365, 366 effect on growth in children 370 management 101-26 metastatic calcification 57-9 neurological effects 82-5 phosphate metabolism 42-7 potassium metabolism 59-62 renal osteodystrophy 51-7 sodium metabolism 38--42 uraemic toxicity 71-7 water metabolism 35-8

cimetidine 328,329,361 clofibrate and cholesterol 109 clonidine, antihypertensive 115, 116 colistin 21

dose and toxicity 134 colonic disorders after renal trans­

plantation 361,362 constipation, peritoneal dialysis 189 copper

in dialysis fluid 277, 297 intoxication 297

cortical necrosis 12 co-trimoxazole, dose in chronic renal

failure 137 counselling 236 cramps 83 creatinine

clearance rates 330 determination 94, 95 and glomerular filtration rate 93--5 origin 93 serum in acute renal failure 7

CRF see chronic renal failure crush syndrome 2 cuprophan 263 cyclophosphamide

dose in chronic renal failure 140, 141

pretreatment of kidney donor toxicity 141

cytotoxic response, cells involved

Dean's prosthesis 171, 172 deficiencies in acute renal failure dehydration in peritoneal dialysis demyelination 84, 85 dental survey 234 dextrose in dialysis fluid 266 diabetes 229,231

peritoneal dialysis 190

333

318

18 185

384 INDEX

diabetes (continued) and renal transplantation 325

dialysate continuous regeneration 297 preparation and composition for

home 294-7 sterilization 296

dialysers choice 262-5 choice for home 292-4 circuits 265 coils 264 cost 264 disposables 248, 263, 264 fibrin formation 293 formalin sterilization and washout

272,273 hollow fibre 263, 264 Kiil 247,248,263,293,294 manufacturer 264, 265 non-disposable parallel flow 263 preparation, re-use 247, 248 re-use and loss of performance 271-3 size 264

dialysis and HBsAg antigenaemia 326 hepatitis policy 267-9 holiday facilities 269-71 management and acute renal failure

22,23 after renal transplantation 340 stopping in acute renal failure 23 time of starting 236 timing 267 see also haemodialysis, peritoneal

dialysis dialysis fluid

bacterial growth 252, 256, 276 concentrate choice 265-7 plasticizers 278 trace contaminants 276-8

diazoxide 87 diet

calcium 117 children in uraemia 106, 107 fat 103 ketoacids 105, 107 low protein in chronic renal failure

102-6 and metabolic acidosis 122 phosphate 117 potassium 120, 121

salt 109, 110 semisynthetic 105 vitamins 107, 108

digoxin, dose in chronic renal failure 140

dihydrotachysterol in osteomalacia 118 disequilibrium syndrome 185,278 disseminated intravascular coagulation

(DIC) and acute renal failure 5

doxycycline in chronic renal failure 135

drug card 237 drugs

antidepressants 142 antihypertensives 87, 11 0-16 dialysis unit 243, 244 effects in acute renal failure 20 elimination rates 127 treatment of transplant rejection 348 use in chronic renal failure 126-42 use in immunosuppression 341, 342 see also antibiotics, individual drugs

echocardiography 89, 90 uraemic pericarditis 92

economics, comparative of different treatments 367,368

EEC changes in uraemia 82 electrocution during dialysis 274 endotoxinaemia 5 erythrocyte

functions 80 life and uraemia 80 production decreased in chronic renal

failure 80,81 erythromycin, use in chronic renal

failure 136 erythropoietin 81

in anaemia 124 endogenous stimulation 124 extrarenal 81

ethambutol use and toxicity in chronic renal

failure 140 visual effects 140

European Dialysis and Transplant Association Registry 227,365,366

extracellular volume (ECV) expansion in chronic renal failure

36,37,39,41,86 and hypertension 86, 87

INDEX 385

family planning advice 234, 235 fibrin degradation products 5 fluid replacement and renal trans-

plantation 340 fluoride in dialysate 298 fosfomycin, use in chronic renal failure

136,137 furosemide 42, 44

and cephalosporin toxicity 130

gas gangrene 20 gastrointestinal bleeding in acute renal

failure, diagnosis and management 19

gentamicin 21 dose in chronic renal failure 133 plasma levels in acute renal failure

21 glomerular diseases causing chronic

renal failure 34 glomerular filtration rate 37

cephalosporins 131, 132 and creatinine 93, 94 penicillins 128, 130 and plasma urea 96 and protein intake 96, 103-5

glomerular nephritis, rapidly progressive

plasma exchange 26, 27 glomerulonephritis 34, 36, 325, 326 Goodpasture's syndrome

cause 25 plasma exchange 26

graft, cortico-iliac trouser 11 guanethidine, antihypertensive 116 guanidino compounds, uraemic toxicity

72, 73

haemodialysis in acute renal failure 14, 15 complications 274--9 frequency in acute renal failure 15 and peritoneal dialysis success 191 pyrogens 275,276 after renal transplantation . 340 and serum potassium 121 vascular access 14 see also home, hospital dialysis

haemoglobin blood urea correlation in chronic

renal failure 79

and creatinine clearance in chronic renal failure 79

haemolysis 80 haemorrhage 353 Henderson-Hasselbach equation 62 heparin

thrombosed shunt 207 use in renal transplantation 337,348

heparinization 273, 274 batch variability 273 home haemodialysis 293,301

hepatitis antigen detection 235 antiglobulin use 268, 269 carriers 268 cross-infection 242 epidemics 269 peritoneal dialysis 189 policy in dialysis 267-9 predialysis clinic 231 Rosenheim report 241,267,268 and renal transplantation 326 separation facilities 250, 251

HLA antigen detection 314 B8 and hepatitis carriers 268 and blood transfusion 344 D-Iocus antigens 315-17 D and DR antigen matching 320,

321 DR antigen 316 DR and Ia homology in mice 314 matching and graft survival 319-21 PL T cloning 317 primed LD typing (PL T) 316, 317 recognized loci 315 scheme in man 314,315

home haemodialysis 287-311 alarms 300 development 287,288 dialyser choice 292-4 dialysate preparation 294--7 disposable, re-use and cost 294 electrical safety 292 equipment needed 291-302 future prospects 310,311 heparin 301 home adaptations 301,302 monitoring 298-300 motivation 304, 309 needle type 290, 291 objectives 288, 289

386 INDEX

home haemodialysis (continued) organization 305-7 patient restrictions 307 patient selection 232, 302, 303 proportioning systems 295 psychological factors 303 pump and line types 300,301 rehabilitation 308 results 308-10 return to hospital 309 sterilization 296 training programme and personnel

304-7 water preparation 297,298

hormones in uraemic toxicity 76 hospital dialysis unit

air embolism monitor 258-61 area per patient 243 bed weighers 252 Bellco pump 262 blood pumps 259, 261 catering 249 design 238-51 desirable features 239, 240 dialysing area 242, 243 drug cupboard 243, 244 equipment 251-65 essential components 239,240 heparin pumps 258 hepatitis policy and quarantine

267-9 nurse: station ratio 242 operating and laboratory space 250 patient changing room 241,242 proportionating systems 252-8 reclining chairs and beds 251 scheme 240 seminar rooms 249, 250 staff facilities 242 technician's workshop 248, 249 toilet segregation 241 visitor preparation 241 waiting areas 242

hospital haemodialysis 227-79 expense 227 oversubscribed 233, 234 patient referral 228 preparation 234-8 rationing 228 reasons for 233 survival 227 water treatment 244-7

hydralazine in uraemic hypertension 112, 113

hydronephrosis 10, 11,99, 100 hypercalcaemia 182

contributing factors 356, 357 treatment 357

hypercatabolism, causes in acute renal failure 19-21

hyperkalaemia 61 treatment 120, 121

hypematraemia during dialysis 274, 275

hyperparathyroidism, secondary 356, 357

bone features 53--5, 75 in chronic renal failure 46, 50, 51,

53,83 and pancreatitis 362 skull appearance 54 tertiary 51

hyperphosphataemia treatment 117 hypertension

drugs 87,110-16 incidence in uraemia 85 indication for nephrectomy 329 and ocular disorders 363 rebound 115 after renal transplantation 354, 360 salt -dependent 42, 43

hypertension, uraemic 85-8 kidney damage 86 mechanism and drug action 86 salt dependent 88 salt and water retention 87, 88 treatment 11 0-16

hypertensive retinopathy 88, 89 hypertriglyceridaemia 189

in chronic renal failure 78 management 108,109 in uraemia and diet 108, 109

hyperuricaemia 73, 182 kidney function 74 treatment 74

hypoaldosteronism 61 hypokalaemia in peritoneal dialysis 185 hyponatraemia, acute in dialysis 274,

275 hypophosphataemia 117 hyporeninaemia 61 hypotension

in dialysis 279 postural 114

INDEX 387

hypothermia 182 hypothyroidism in uraemia 83

immune complex detection 26 immunosuppression

and cancer development 359 common scheme of therapy 341 dangers of 344 in paediatric renal transplantation

369 and pregnancy 365

infection in acute renal failure 17 arteriovenous shunt 206, 207 bovine heterografts 217 cannula 289 diagnosis and management in ARF

19,20 home haemodialysis 289 mortality 350, 352 permanent peritoneal catheter 174 after renal transplantation 350--2,

356 injured tissue removal in acute renal

failure 20 injury, metabolic response 21 insulin in acute renal failure 18 interstitial oedema and acute renal

failure 3 intravenous urography 98 isoniazid use and toxicity in chronic

renal failure 139 itching

in chronic renal failure 57, 58, 75 and parathyroidectomy 120 treatment 120

kanamycin in chronic renal failure 133 toxicity 133

ketoacids, nitrogen load 105 kidney function 72

vasodepression 88 kidney rupture 353 Kussmaul breathing 71

labetalol, a,- and f3-blocking effects 112,113

laboratory tests, predialysis clinic 235, 236

left ventricular hypertrophy 89, 90

Legionnaire's disease 351 lincomycin, use in chronic renal failure

135,136 lipoprotein 78 Listeria monocytogenes 351 Looser's zone 52 lymphocoele, after renal transplantation

353,354 lymphocyte

response to MHC antigens 319 T cytotoxic 319 T helper 319

magnesium in dialysis fluid 266, 267 major histocompatability complex

(MHC) cell response to antigens 313 coded antigens 313 see also HLA

metabolic acidosis clinical signs 71 and decalcification 69 diet 122 evaluation 69, 70 sodium bicarbonate infusion 122 sodium lactate 122, 123 treatment 121-3 in uraemia 69

methicillin 128, 129 dose in chronic renal failure 129

methyldopa antihypertensive effects 115 sedation 116

methylprednisolone 12,333,337,341, 348

metoprolol 112 middle molecules

peptide hormones 77 and uraemic toxicity 76, 77

minoxidil 112 side-effects 113 use in hypertension 113

mixed lymphocyte culture (MLC) 313, 314

mortality acute renal failure 17, 24 and post renal transplantation

disorders 350, 352, 360, 361, 370 hepatitis 268

muzolimine sodium and urine output 42, 44

myoglobin casts 2

388 INDEX

nalidixic acid, use in chronic renal failure 138

nerve conduction block 84 neurological disorders

cerebral signs 82, 83 in chronic renal failure 82-5 peripheral neuropathy 83--5

nickel in dialysis fluid 277,278 nitrofurantoin dose in chronic renal

failure 138 nocturia 35 nutrition

in acute renal failure amino acid solutions energy source 17 intravenous 17 parenteral 16

15-18,24 17, 18

ocular disorders after renal trans­plantation

causative factors 363 types and incidence 363

oligourea, acute renal failure 4 oral hypoglycaemics 142 oral sorbents 125 orthopaedic complications after renal

transplantation 357-9 osteitis fibrosa

bone features cystic lesions skull features

53--6 54,56 54

see also secondary hyperparathyroid­Ism

osteomalacia 51-3 causes 52 definition 51 and diet 52, 118 25-0HD3 119 pseudofracture (Looser's zone) 52 treatment 118, 119 in untreated uraemia 49

osteoporosis 56, 57 senile 56

osteosclerosis 55, 56 bone thickening 55 rugger jersey sign 55

overheating, dialysis fluid 274 oxolinic acid, dose in chronic renal

failure 138, 139 oxygen, factors affecting transport

124, 125

paediatric renal transplantation 368-71 assessment criteria 368 choice of donor 369 and growth 370 immunosuppression 369 mortality 370 results, factors affecting 370,371

pain in peritoneal dialysis 185 pancreatitis after renal transplantation

362,363 parathyroidectomy 188

incidence 120 in uraemia 119,120

parathyroid gland and impotence 83 suppressIOn 76

parathyroid hormone 35 action on bone 55 and calcium metabolism 50, 51 effects 50 immunoreactive 46 and pathogenesis in uraemia 75 and phosphate reabsorption 45 uraemic toxin 75, 76

parenteral feeding 16 penicillins

G, dose and effects 127, 128 hazards 22 salts 128 side-effects 128, 129

pericarditis 189 peripheral neuropathy 83--5

asymptomatic 84 demyelinating 84 dying back 84

peritoneal clearance 179-81 factors affecting 180

peritoneal dialysate, Baxter-Dianeal 178,179

peritoneal dialysis 169--93 acute, indications 182, 183 in acute renal failure 14 advantages 14 and age 184 chronic, indications 184 chronic national usage 183 complications 184--90 contraindications 183 in diabetes 184 diabetes, prognosis 190 drug removal 181, 182 heparin use 181

INDEX 3S9

peritoneal dialysis (continued) in hepatitis 189 history 169 home 183, 191 peritonitis 186-8 after renal transplantation 340 reverse osmosIs 169--77

peritoneal dialysis, continuous ambulatory (CAPD) 170, 191-3, 238, 310, 311

complications 192, 193 disadvantages 191 patient selection 232,233 technique 192, 193 Toronto General Hospital Technique

191 peritoneal dialysis machines 175-8

cyclers 175 Lasker 175, 176 physio-control reverse osmosis 177,

178 peritoneal membrane area and

clearance 179 peritonitis

antibiotic lavage 186 aseptic and bacterial 186 management 186-8 in peritoneal dialysis 186-8 type of infection and protocol 187

pharmacokinetics in chronic renal failure 126, 127

phenacetin in chronic renal failure 142 phosphate

absorption 44 fractional excretion in uraemia 46 reabsorption inhibition 47 regulation of dietary 117

phosphate metabolism in chronic renal failure 42, 44-7 and glomerular filtration rate 45 normal serum levels 42, 44 reduced nephrons 45

pipemidic acid use in chronic renal failure 139

plasma exchange in acute renal failure 25 factors removed 25

plasticizers in dialysis fluid 278 polycystic kidney 99--101, 329, 330,

336 potassium

deficiency 60

depletion 60 in dialysis fluid 265 dietary control 120, 121 distribution changes 61 exchange resins 121 pseudodepletion 60 serum level significance 60 sources and loads 61, 62

potassium excretion 59 in chronic renal failure 59, 60 faecal and glomerular filtration rate

60 potassium metabolism in chronic renal

failure 59--62 and acid-base balance 61

prazosin mechanism in hypertension 114, 115 side-effect 114

predialysis clinic patient selection 229-34 problem card 230 procedure checklist 229 transplantation suitability 231 yellow units 231

prednisolone 341, 348 pregnancy 365, 367 proportionating units 252-8

alarms 255, 256 bubble trap 256 choice 253 concentrate tank 253 conductivity monitor 255 effluent pump wear 257 electrical safety 253 flow monitor 254 fluid temperature monitor 254, 255 Lucas Mark 2 253-7 Nycotran ADPAC 256,257 output return connection 255 pasteurization 255, 256 pressure control 254 single patient 252 types 257,258 venous pressure monitor 254, 255

propranolol 112 prostacyclin, heparin substitution 273 prostaglandins 4

in acute renal failure 4, 5 protein

requirements in childhood 106, 107 restriction in chronic renal failure

102-6

390 INDEX

pyrexia and bacterial counts 276 in dialysis unit 275, 276

receptors, J3-types 111 Registry of the European Dialysis

Transplant Association 34, 365, 366

rejection therapy 87 renal artery stenosis 354 renal biopsy

in acute renal failure 11-13 in transplant rejection

renal cyst 99, 100 renal failure, incidence renal function

347

324

clinical assessment 92-101 recovery in acute renal failure 23

renal haemodynamics and acute renal failure 3,4

renal osteodystrophy in peritoneal dialysis 188 treatment 116-20 see also individual conditions

renal preservation techniques 334 renal stone 100, 101, 189 renal transplant donors 330--6

cadaver 330-4 live 232,324,334-6 pretreatment 332, 333 protection of kidneys 331 removal of kidneys 333, 334, 336 tumour-bearing 359

renal transplant recipients 324-30 actuarial graft and patient survival

related to donor source 367 age factor 333, 334 assessment 328, 329 economic factors 367,368 paediatric 368 removal of kidney 329,330 results, factors affecting 366, 367

renal transplantation 311,313,323--71 age factor 324, 325 alimentary tract complications 360,

363 allograft nephrectomy 349 blood transfusion 344, 345 bone disease 357-9 and cancer development 359, 360 cadaver donor 330-4 constraining factors 331

contraindications 326 follow-up care 340, 341 history 323 HBsAg antigenaemia 326 HLAmatching 319--21 hypercalcaemia 356, 357 hypertension 87, 360 ileal urinary diversion 327, 328 incidence 324,331 live donor 232, 324, 334-6 and multisystem diseases 325 and neuropathy 85 ocular complications 363 orthopaedic complications, type/

incidence table 358 paediatric 368-71 patient selection 229,231,232,323,

324 peritoneal dialysis 190, 191 postoperative infection 350-2 postoperative management 339,340 preservation of kidneys 334 pregnancy 365,367 public attitudes and cooperation 332 rehabilitation 364-6 rejection 324, 345-9 sexual function 365, 366 technique 336-9 urological complications 354-6 vascular complications 352--4

renal tubular acidosis, type II 123 renal vessels, anastomosing methods

338,339 renin

in acute renal failure 3, 4 in uraemic toxicity 76

renography 346 isotope 10

restless legs syndrome 83 retinopathy, classification 88, 89; see

also hypertensive rickets 51,52 rifampicin, use in chronic renal failure

137 salt-losing nephritis 42 Schwartzmann reaction, catecholamine

release 5 sexual function 75,365,366

in chronic renal failure 75, 82, 83 peritoneal dialysis J 89

shock lung 20 shunt 197

INDEX 391

shunt (continued) Allen Brown 197,209,210 Buselmeier 197,201,203,210,211 care in anaesthesia 219 checking; look, touch and listen 206 children 220-2 femoral saphenous 209 ideal, properties 210 infections 206, 208 insertion 203--5, 209 Quinton-Scribner 197,201,202,

211 Ramirez 15, 197,201,202 Scribner conversion to fistula 213,

214 Silastic wrist 14, 15 S-T 202 Thomas 197, 201, 208, 209 thrombosed, management 207,208 see also arterio-venous shunt

single needle apparatus 261,262 sisomicin 133 skull, ground glass/salt and pepper 54 single nephron glomerular filtration

rate 3 Slow-Sodium tablets 22 sodium

basal excretion 11 0 in dialysis fluid 265 dietary in chronic renal failure 109,

110 fractional excretion in chronic renal

failure 39 fractional excretion and intake 40,

41 urinary in acute renal failure 7

sodium metabolism in chronic renal failure 38-42 limits to excretion 41 nephrotic syndrome 42

soil bacteria, enzymes in uraemia 125, 126

SONAR 98 spironolactone

side-effects III in uraemic hypertension III

streptomycin dose and toxicity 134

T cell growth factor 317,318; see also lymphocytes

tetracyclines danger in renal failure 20, 135

use in chronic renal failure 134, 135 thrombosis 352, 353

management in shunt 207, 208 ticrynafen, uricosuric III tissue grafting 313--21; see also renal

transplantation tobramycin 133 trace elements in dialysis fluid, effects

27fr8,297,298 transmembrane pressure monitoring

299,300 transplant rejection 345-9

in children 369, 370 diagnosis 345-7 treatment 348, 349, 350 types and indications 345, 346

triglyceride metabolism in acute renal failure 17

tuberculosis 351, 352 tubular obstruction and acute renal

failure 2 tubulo-interstitial disease and chronic

renal failure 34

ultrafiltration, need for understanding 293,299

ultrasonic renography 98 hydronephrosis 99, 100 normal kidney 99 polycystic kidney 99-101 renal cyst 99, 100 renal stone 10 1

ultrasound 7, 346 and urinary tract obstruction 10, 11

ultraviolet photometry 120 upper gastrointestinal tract disorders

after renal transplantation 360, 361

uraemia diluting capacity 38 EEG changes 75 emotional effects 75, 76 experimental and calcium deposits

76 obligatory sodium excretion 41 phosphate excretion 46 symptoms 92, 93

uraemic neuropathy 83--5, 188 mechanisms 84, 85

uraemic pericarditis 90,91 and dialysis 90, 91 electrocardiogram 92

392 INDEX

uraemic toxicity 71-7 urea

in acute renal failure 6, 7 excretion 95 glomerular filtration rate and dietary

protein 96 plasma (PUN) 95 production and diet 103 tubular and reabsorption 97 in uraemic toxicity 72 see also BUN

ureteric obstruction 355, 356 ureterocutaneousfistula 355 ureteroneocystostomy 339,355 uric acid

excretion 73 in uraemic toxicity 73, 74

urinary sediment in acute renal failure 7

urinary tract obstruction 7 infection 356 obstruction 7, 355

urine concentrating 23 in chronic renal failure 35 countercurrent multiplication 36

urine culture, count and infection 97 urine output, normal diurnal rhythm

35 urine/plasma osmolality in acute renal

failure 7 urine volume

acute renal failure 6 chronic renal failure 35

urochromogens and skin pigmentation 76

urography, intravenous high~dose 7-9 safety 8

urokinase 207

Vamin 17,18 vascular access

adult 199-219 anaesthesia 198, 199 children 219-22 home haemodialysis 289-91 see also cannulae, shunts, arterio­

venous fistulae and shunts 197-223

vascular diseases and chronic renal failure 34

very low density lipoprotein (VLDL) 78

vesicocutaneous fistula 354, 355 vesicoureteric reflux 356 vitamin

diet supplement 107, 108 in uraemia 119

vitamin D calcium transport 47 metabolism 48-50 resistance in chronic renal failure

48,49 sources in man 48 uraemia treatment 118, 119

vitamin D2 resistance 118 25-0H vitamin D3 46,48,49, 116

in osteomalacia 119

Warfarin 337 wasting syndrome 102 water metabolism

in chronic renal disease 35-8 in uraemia 35

water softeners 267,297 bacterial growth 298

water treatment cost 245 dialysis 244-7, 297, 298 home haemodialysis 297, 298 materials used 247 reverse osmosis 244-6, 272 softening 267, 297 system at RVI, Newcastle 246

weight and salt retention 43 WHO Expert Committee on Energy

and Protein Requirements 107

X-ray uraemic lung 89 uraemic pericarditis 90, 91

zinc in dialysis fluid and chronic renal failure 277