Carry out research using books and ICT to produce a word processed report on the problems and treatment of renal failure. Include a discussion of the issues associated with dialysis and organ transplantation.

Kidney failure may be an outcome of a variety of conditions including bacterial infection, external mechanical injury or high blood pressure. There are no symptoms in kidney failure until the glomerular filtration rate has fallen from 120ml per min to below 30ml per minute, that is half of the kidney is still functioning. Below this dietary requirements are needed. When the glomerular filtration rate has fallen from 120ml per minute to below 5ml per minute, control by diet alone is no longer effective, and an artificial kidney or kidney transplant is needed to maintain life.

There are two main forms of treatment that patients with kidney failure can undertake. These are either dialysis or kidney transplant. Dialysis is for people whose kidneys are either temporarily unable to function or have become badly damaged by long standing inflammation. In dialysis the functions of the kidneys are taken over by a machine. There are two forms of dialysis, Haemodialysis and peritoneal dialysis. Haemodialysis is carried out by a kidney machine and it filters the waste products from patient's blood. A minor operation is performed beforehand to enlarge the vein, usually in the arm by joining it to the artery forming a fistula. Here the blood is able to flow through at a higher pressure than blood flowing through a normal vein. Once the fistula has formed two needles can be inserted into it at each dialysis session. A semi-permeable membrane from a dialysing fluid separates the blood. The membrane allows the surplus inorganic salts and water to diffuse across the dialysing fluid, but prevents the passage of blood cells or plasma proteins. The blood returns to the body free of toxins via a forearm vein. The process needs to be carried out three times a week for approximately four hours each time. Haemodialysis is used in emergencies for acute renal failure. Sometimes however there is no time for a fistula to form and instead the tube is inserted into one of the large veins at the back of the neck, in order for the blood to reach the kidney machine.

Haemodialysis enables a patient with kidney failure to be kept healthy more or less indefinitely, providing that treatment is given three times a week. Strict regulation of diet and fluid intake has to be maintained. The process is very time consuming and may not be appropriate as they may not fit in with people's daily routines.

The other form of dialysis is peritoneal dialysis and is used for end stage renal failure. A thin plastic tube is inserted through the abdominal wall into the peritoneal space. A special dialysis fluid is then passed through the tube into the peritoneum. Waste products seep from the abdomen into the fluid, which is removed after six hours. This fluid is then replaced with fresh fluid.

Over a thousand patients in the past twenty years have had a kidney transplant in order for a better quality of life. Donor kidneys are mostly taken from people dying after accidents and brain haemorrhages for example or they donated by a living parent relative of the patient as they are able to maintain normal urinary function with only one kidney. Two thirds of kidney transplant patients have a functioning kidney two years later, the remaining have failed and thus have to revert back to dialysis. The kidney transplant is not difficult as the renal artery, renal vein and ureter are accessible without a complicated dissection. A transplanted kidney is usually placed in the pelvis. The blood supply is obtained from the iliac blood vessels. The ureter is inserted directly into the bladder.

The principle problem of tissue transplantation is rejection. The body is able to recognise its own tissue which it accepts but will reject any foreign tissue. A foreign tissue acts as an antigen and stimulates B-lymphocytes and their derivatives plasma cells to form an antibody. Other, T-lymphocytes, which have been synthesised in the thymus gland, do not release their antibody, but destroy foreign cells by direct contact. The antibody combines with the antigen, and this antigen-antibody reaction leads to the destruction of the antigen. A transplanted organ such as the kidney could be completely destroyed. Successful organ transplantation has only become possible with the development of means for holding back the rejection processes. These are aimed at reducing the number of circulating lymphocytes. Lymphocytes are formed by the lymphoid tissue and bone marrow. The lymphocytes can be reduced by irradiating the lymphoid tissue and by giving immunosuppressive drugs. But the reduction of these white cells increases the risk of the patient's liability to infection. The level of immunosuppressive drugs may be reduced after time but a maintenance dose may be required for the rest of the patient's life.

Dialysis and organ transplantation are two ways in which people's lives can be preserved or saved.