1. LIPIDs :

. They regulate membrane permeability.

• They provide shape & smooth appearance to the body.
• They serve as a source of fat soluble vitamins (not water soluble vitamins).
• They act as fuel in the body to produce energy.

2. Triacylglycerols:

• Triacylglycerols are the esters of glycerol with fatty acid.
• Adipocytes are specialized for storage of triacylglycerol.
• Non polar & insoluble in water.
• Glycerol & soaps are formed when TAG are hydrolyzed by alkali.

3. The iodine number of fat molecules increases with the increase in degree of unsaturation.

4. Coconut Oil:

• Has a lower iodine number than sunflower oil.
• It mainly contains saturated fatty acid .
• Has a higher saponification number than human fat.

5. Phospholipids are complex or compound lipids containing phosphoric acid in addition to fatty acids, nitrogenous base and alcohol (eg. Lecithin,Plasmogens and Cardiolipin).

6. Cholesterol: has one hydroxyl group at C3 & a double bond C5 & C6 position. An 8 carbon aliphatic side chain is attached to C17. It contains a total 5-methyl groups.

7. Constituents of gangliosides are Sialic acid, Hexose sugar & sphingosine. (gangliosides are the derivatives of cerebrosides and contain one or more molecules of N-acetylneuramic acid, the most important sialic acid. Cerebrosides contain ceramide [sphingosine attached to a fatty acid] and one or more sugar).

8. Cardiolipin (phospholipid) possesses an antigen property.

9. Oleic acid is an example of monounsaturated fatty acid.

10. Cerebrosides contain sphingosine.

11. PUFA undergoes autoxidation.

12. Hexose Sugar: C17H29 CO OH.

13. Linoleic acid is a dietary essential fatty acid.

14. Accumulation of increased amount of sphingomyelin in liver & spleen is found in Niemann-Pick disease.

15. Dipalmitoyl Lecithin acts as lung surfactant.

16. Trans-fatty acids are present in certain foods, arising as a byproduct of the saturation of the fatty acids during hydrogenation. Hydrogenation increases the trans fatty acid.

17. Arachidonic acid contains 4 double bonds. (Linoleic acid is found in soyabean oil. Linolenic & linoleic acids are cis derivatives containing double bonds. Monoenoic acids contain one double bond at 9th position.)

18. Omega-3 fatty acid is a cardioprotective fatty acid.

19. Maximum source of linoleic acid is sunflower oil.

20. Fatty acid:

• Polyunsaturated fatty acid is essential for membrane structure.
• Biologically arachidonic acid is essential to life.
• Hydrogenated vegetable oils contain trans fatty acid.

21. Docosahexaenoic acid is found exclusively in breast milk.

22. Gangliosides contain alcohol-sphingosine, sialic acid and long chain fatty acid (Phosphate is absent)

23. Chemically, lecithin is a phosphatidic acid with choline as the base.

24. Arachidonic acid contains 4 double bonds.

25. Esterification of cholesterol occurs at C3 position.

26. Reichert meissl [RM] number is defined as the number of ml 0.1 N KOH required to completely neutralize the soluble volatile fatty acid 5g fat. Any adulteration of butter can be easily tested by this sensitive RM number.

27. Arachidonic acid is a fatty acid

28. Lipid binding protein is called lipoprotein.

29. Choline is a lipotrophic factor.

CARBOHYDRATES

1. Ribosome and deoxyribose differ in C2 structure around a single carbon.
2. Fructose is not an aldose. However, Glucose, Galactose and Mannose are aldose.
3. Heparin: the glycosaminoglycan that can serve as an anticoagulant .
4. Cellulose is polysaccharide which is composed of beta-glycosidic bonds.
5. The carbon atoms involved in the osazone formation is 1 & 2.
6. Fructose is the sweetest among sucrose, glucose and lactose.
7. Sorbitol is a Sugar alcohol.
8. D-mannose & L-mannose are enantiomers.
9. Epimer combination are D-glucose & D-mannose
10. Insulin like fructans are used as prebiotocs in the upper GI tract results from Beta configuration of anomeric C2.
11. Monosaccharides:

. Ribose-structural elements of nucleic acids and coenzyme

. D-Arabinose-constituent of glycoproteins

. D-Ribulose-intermediate in prntose phosphate pathway

12. Example of tetroses is D-Erythrose.

13. C1 of the glucose is known as anomeric carbon.

14. D & L forms of sugars are differentiated by configuration of H and OH groups around the carbon atom just adjacent to the termina primary alcohol carbon.

15. In osazone formation, monosaccharide (Mannose, Glucose, Fructose) form needle shaped crystals except Galactose.

16. Glycosidic bond present in lactose is beta [1 — — 4].

17. Homopolysaccharides are Starch, Lactose and Sucrose.

18. Inulin is non-reducing sugar.

19. Erythrodextrin is the hydrolytic product of Starch.

20. Glycogen is the storage form of carbohydrate in animal.

21. Glycosaminoglycans are made up of Uronic acid + amino sugar.

22. Glycosides are Ouabian, Streptomycin, and Cardiac glycosides but not Chondrosamine.

23. Hyaluronic acid is a heteropolysaccharise which act as a lubricant and shock absorber in joints.

24. Blood group substances are neutral mucopolysaccharide.

25. N-acetylneuraminic acid (carbohydrate) is present in glycoprotein.

CELLS

1. Agranular cytoplasmic reticulum is involved in synthesis of Lipid.
2. Glycolysis occurs in Cytosol.
3. Force generating proteins are Dynein and Kinesin.
4. Fatty acid oxidation, Electron transport chain and Citric acid cycle takes place in mitochondria.
5. Protein synthesis occurs in Rough ER.
6. Intracellular sorting and packing done in Golgi apparatus.
7. SGOT (AST) live enzyme is predominantly mitochondrial.
8. Marker for plasma membrane is 5-Nucleotidase.
9. Marker enzyme of mitochondria is Glutamic dehydrogenase.
10. Enzyme marker for golgi apparatus is Galactosyltransferase.
11. Catabolism of H2O2 is carried out by Peroxidase.
12. Microtubules are Dynamic instability, Polarity and Charged.
13. Cell’s shape and motility are produced by Microtubules.
14. DNA is more stable than RNA.
15. Adenosine triphosphate (ATP) can be termed the universal energy currency in life because it traps energy released from the oxidation of different classes of food molecule.
16. Water constitutes about 70% of a typical cell. Water is able to form hydrogen bonds, which are: weak electrostatic bonds between partially charged hydrogen and oxygen atoms.
17. The synthesis of protein involves polymerization of Amino acid.
18. A ribosome is a class of RNA molecules that can catalyze chemical reaction.
19. The most common elements in biological systems are Carbon, nitrogen, oxygen and hydrogen.
20. Chromatin is the complex of DNA and protein from which chromosomes are composed.

Simply, Biotechnology is the use of living organisms to develop useful products or any technological application that uses living systems, to make or modify products or processes for specific use.

Old form of Biotechnology,

Making Bread

Making Yogurt

Making Vinegar, with the help of microbes

*Application of fermentation in production of wine and other alcoholic beverages is also a biotechnological technique.

Principle of Biotechnology

Two important techniques which enable development of modern biotechnology:

1. Alteration of chemistry of DNA and RNA to introduce into host organism to change phenotype of host — Genetic Engineering
2. Maintenance of sterile ambience to enable growth of desired microbes/eukaryotic cells in large quantities for manufacturing of biotechnological products like vaccine, enzymes, beverages, drugs etc. — Chemical Engineering

Basic Steps Involved in the process

Tools Involved to Carry out Biotechnological Process

1. Restriction Enzymes: restriction endonuclease and restriction exonuclease. Restriction endonuclease cuts the DNA from center to end point which is most commonly used in biotechnology where the restriction exonuclease cuts the DNA from end point to center.
2. Polymerase Enzymes
3. Ligase
4. Vector
5. Host

Restriction Enzymes (RE)

• Are enzymes which cut DNA at specific points.
• Those specific points or sequences of base pairs are called recognition sequences.
• Which are palindromic and 4–6 bp long.
• First isolated in 1963 from E. coli.
• First RE is Hind-II.
• Restriction enzymes are also known as molecular scissors.
• Total 900 RE are isolated from bacterium 230 strains.

Palindrome in DNA — sequence of base pairs that reads the same on two strands when orientation of reading is kept the same, i.e. 5’ in both strands.

Bacterial Strains and Enzyme

Bacillus amyloliquefaciens H — Bam H1

Escherichia coli Ry13 — Eco R1

Providencia stuartii 164 — Pst 1

Serratia marcescens SB — Sma H1

Rhodopseudomonas sphaeroides — Rsa 1

DNA Ligase

• It’s also known as molecular glue.
• Forms bond between the sugar and phosphate backbone of the DNA molecule.
• Example, T4 DNA ligase.

DNA Polymerase

These enzymes synthesize new DNA strands complementary to existing DNA templates in 5’ to 3’ direction using a primer. Example, DNA polymerase I.

Agarose Gel Electrophoresis:

• Allows separation of DNA on the basis of size.
• Can visualize DNA to determine exactly how large it is.
• Action of RE result fragments of DNA — separated by gel electrophoresis.
• Depends on negative nature DNA.
• External electric field is applied to the medium — DNA move to anode.
• Medium or matrix used is agarose gel- natural polymer extracted from seaweed.
• Medium: acts as sieve and separate DNA according to their sizes.
• Separated DNA — stained with Ethidium Bromide(highly cancerous dye) and exposed to UV radiations, brings orange coloured bands of DNA in gel.
• Separated bands of DNA- cut out from agarose gel and extracted from gel piece Elution.
• Purified DNA fragments- constructing recombinant DNA by joining them with cloning vectors.

Vector

Vectors are those DNA molecules that can carry a foreign DNA fragment when inserted into it. A vector must possess certain minimum qualifications to be an efficient agent for the transfer, maintenance and amplification of the passenger DNA.

Types,

• Plasmid Vector: Circular extrachromosomal DNA that autonomously replicates inside the bacterial cell.
• Phage Vector: Linear DNA molecules derived from bacteriophage lambda.
• Cosmids Vector: DNA sequences are usually from lambda phase.
• Bacterial Artificial Chromosomes
• Yeast Artificial Chromosomes
• Human Artificial Chromosomes

Host

Host cells are bacterial cells which take up the recombinant DNA. The most common host used in Biotechnology is E. coli,other bacteria may be used as hosts for gene cloning experiments, with examples including species of Bacillus, Pseudomonas, and Streptomyces.

1. Isolation of genetic material DNA
2. Fragmentation of DNA by restriction endonuclease
3. Isolation of desired DNA fragments
4. Amplification of gene of interest using polymerase chain reaction(PCR)
5. Ligation of DNA fragments into a vector
6. Transferring Recombinant DNA (rDNA) into host
7. Culturing host cells in a medium at large scale
8. Isolation of genetic material

In the case of humans, DNA is a genetic material. In blood samples, only Leukocyte has genetic material, it’s a nucleated blood cell where Erythrocyte and Thrombocyte are not having genetic material.

* Cells are lysed by using : Lysozyme in bacteria, Cellulase in plant cells, Chitinase in fungus

*Macromolecules are treated with specific enzymes to removes: RNA→Ribonuclease, Proteins →Protease

2. Fragmentation of DNA by restriction endonuclease

Purified DNA or gene of interest (GOI) is incubated with specific restriction enzymes for the process of cutting it at specific recognition sequence.

Progression of restriction enzyme digestion is checked by Agarose Gel Electrophoresis.

Restriction enzymes

Restriction enzymes are Nucleases which can cleave the sugar-phosphate backbone of DNA,found in bacteria. As they cut within the molecule, they are commonly called restriction endonucleases. They specifically cleave the nucleic acids at specific nucleotide sequence called restriction sites to generate a set of smaller fragments .

3. Isolation of desired DNA fragments

• Action of Restriction Endonuclease result fragments of DNA by Agarose Gel Electrophoresis.
• Depends on the negative nature of DNA.
• External electrical field is applied to the medium — DNA moves to anode.
• Medium or matrix used is agarose gel- natural polymer extracted from seaweed.
• Medium: acts as sieve and separate DNA according to their sizes.
• Separated DNA — stained with Ethidium Bromide and exposed to UV radiations, brings orange coloured bands of DNA in gel.
• Separated bands of DNA- cut out from agarose gel and extracted from gel piece Elution.
• Purified DNA fragments- constructing recombinant DNA by joining them with cloning vectors.

4. Amplification of gene of interest using polymerase chain reaction

Polymerase Chain Reaction (PCR): Helps to make copies of a small sample of DNA.

Steps :

i. Denaturation: DNA melted at 94 degree celsius so that the two strands separate.

ii. Annealing: (54 degree celsius) Primers are short DNA sequences that are complementary to the ends of the DNA. Primers are added to the mixture upon which new DNA strands can be made. The primers line up with their complementary bases on the separated strands. Added dNTPs and heat-resistance DNA polymerase.

iii. Extension: (72 degree celsius) A heat resistance DNA polymerase and nucleotides are part of the mixture. This enzyme adds nucleotides to the primers, using the original DNA as a template. This creates exact copies of the original DNA.

This process (steps i — iii) is repeated many times. Each cycle doubles the amount of DNA, until the original DNA has been amplified into identical copies.*1 clone DNA can make 1 billion copies in 30 cycles (2n).

Requires:

• Primers: Two synthetic short strands of DNA that are complementary to each of the two DNA sequences that flank the gene or DNA to be copied.The direction of primer is from 5’ prime →3’ prime.
• Heat-resistance DNA polymerase.
• Nucleotides ( usually dNTPs — dinucleoside triphosphates)
• Mg2+

5. Ligation of DNA fragments into a vector using DNA ligase and creating recombinant DNA

DNA fragments with either sticky ends or blunt ends can be inserted into vector DNA with the aid of DNA ligases. In the case of humans, T4 DNA ligase is used.

6. Insertion Recombinant DNA (rDNA) into host/organism

Insertion of rDNA is only possible by making the host ‘Competent’

• Achieved by- chemical treatment, microinjection, biolistic/ gene gun, electroporation, disarmed pathogens and PolyEthylene GLycol (PEG) methods (PEG is a only vectorless method of gene transfer).
• Phenotypes of organisms alter when rDNA is transferred to the host.

7. Culturing host cells in a medium at large scale

The multiple number of recombinant DNA can be cultured in the nutritive culture media. Which can be used for different purposes like, production of vaccines and protein therapies such as human insulin, interferon and human growth hormone. It is also used to produce clotting factors for treating haemophilia and in the development of gene therapy.

It is considered as the primary alloantigens relevant to transplant rejection. HLA proteins are encoded by genes on the short arm of chromosome 6. HLA are clustered into loci and divided into class I (HLA-A, B and C) and class II (HLA-DR, DQ and DP) based on function. They are named by the letter of their loci followed by a number designating their serological type, for example, HLA A24, HLA DR7.

About HLA Markers

HLA markers are proteins that are found on most cells in the body. There are three general groups of HLA, they are HLA-A,HLA-B and HLA-DR and different people can have different patterns of the markers. HLA markers are inherited (passed from a mother and father to their child), so your close family members (siblings, parents, and children) are most likely to have a pattern of HLA markers that’s like yours.

HLA in Kidney Transplantation

Kidney transplant is the gold standard therapeutic strategy of replacing renal dysfunctions that offers the best survival to the patients with end-stage renal failure. In 1954, the first successful kidney transplantation was performed between identical twins in Boston. It is the transfer of living cells, tissues, or an organ from one individual to another (allograft).Kidney donors could be either deceased or living sources. The law of transplantation indicates that grafts between genetically identical individuals survive and grafts on genetically different individuals fail. Usually, transplant rejection of the kidney occurs when the immune response of the recipient recognizes the new kidney as being a harmful object. This remains a major immunological barrier to organ transplantation therapy. Thus, prior knowledge of the existing anti-HLA antibodies circulating among potential kidney recipients is important to set protective measures before transplantation.Nowadays, the transplant is also possible even though HLA is not matching.

HLA Sensitization

HLA sensitization refers to the presence of antibodies in the potential recipient against HLA molecules of the selected donor. Exposure to nonself HLA can cause the production of HLA-directed antibodies. Alloantibodies recognize antigenic epitopes displayed by the HLA molecule on the transplanted allograft and contribute to graft damage. There is a clear association between previous exposure to foreign HLA and the occurrence of a high degree of panel reactive antibody (PRA). The percentage of PRA estimates the likelihood of positive crossmatch to potential donors, and patients with greater quantities of preformed DSA have the highest likelihood of graft loss. Donor-specific anti-HLA antibodies (DSA) identified by single-antigen bead (SAB) arrays are questioned for their sensitivity and lack of event prediction after transplantation. Despite known technical limitations of SAB assay, it appears to be a highly useful tool for posttransplant monitoring of HLA antibodies and surveillance of antibody-mediated rejection.

The impact of sensitization in a potential recipient results in longer waiting time for transplantation, post-transfusion complications, exposure to more adverse effects of immunosuppressant drugs, and finally graft rejection. The common causes of HLA-sensitizing events include previous transplants, pregnancies, and blood transfusions that lead to the development of DSA. The risk of sensitization increases as there is exposure to more than one sensitizing factor.

Mechanisms of Graft Rejection

Rejection is defined as an immune response that mediates injury and destruction of transplanted tissues. Kidney transplant rejection is a complex process, and the graft could be viewed as a one-way process in which host immune cells destroy a defenseless allograft. HLA molecules expressed on the surface of the donor cells induce an antigenic stimulus recognized by the recipient’s immune system which triggers graft rejection. The immune response to an allograft rejection involves both the innate and the acquired immune systems. The innate immune system predominates in the early phase of response through recognizing host-derived molecules which results from tissue damage. Proinflammatory damage-associated molecular patterns, hypoxia-inducible factors, adhesion molecules, dysfunction of the renal vascular endothelium, chemokines, cytokines, and Toll-like receptors are involved in the activation and recruitment of immune cells into injured kidneys. Immune cells of both the innate and the adaptive immune systems such as neutrophils, dendritic cells, macrophages, and lymphocytes contribute to the pathogenesis of renal injury. Initiated inflammatory events by chemokines and cell adhesion molecules play essential roles, not only for leukocyte migration into the graft but also for facilitating dendritic cells and T-cells trafficking between lymph nodes and transplants. The mechanisms of allograft rejection mainly depend on the adaptive immune system mediated by a complex interplay of cellular and humoral immunity.

Cellular Graft Rejection

T-cells are critical in graft rejection. T lymphocytes can directly recognize and respond to foreign HLA molecules. Subsequently, T-cells and cells of innate immunity function synergistically to reject the allograft. Toll-like receptors and the complement systems are well-characterized components of innate immunity which are central to graft injury.

Non-HLA Antibodies and Acute Rejection

In the absence of circulating donor-specific HLA antibodies, non-HLA antibodies were shown to cause graft rejection. The antigenic targets of non-HLA antibodies may be minor histocompatibility antigens, vascular receptors, adhesion molecules, and intermediate filaments. The major histocompatibility class I-related chain genes are non-HLA proteins with some homology to HLA class I molecules and are frequent targets of the alloimmune humoral responses. Different non-HLA antibody types were identified as anti-endothelial monocytes, anti-activated endothelial cells, or anti-epithelial cells among patients who have rapidly rejected multiple renal allografts.

Non-DSA functions as complement and non-complement-fixing antibodies which induce acute and chronic allograft injuries. Non-HLA antibodies can be directed against polymorphic or nonallelic proteins. Antibody development against non-polymorphic targets results from inflammations that break humoral tolerance to autoantigens. Moreover, HLA genes are risk factors for most autoinflammatory diseases, which predispose humoral responses against self-antigens. On the other hand, exposure to pathogens (such as bacterial and viral antigens) may trigger cross-sensitization and allograft rejection by enhancing the immune response to allogeneic HLA. Therefore, the effect of non-HLA antibodies on allograft rejection is a complex matter and the mechanisms of graft injury remain unclear.

Kidney Function Test (KFT): is the initial investigation that helps to find out whether your kidney is functioning or not. It includes,urea, creatinine, uric acid, potassium, sodium and calcium.

Glomerular Filtration Rate (GFR): is a technique to evaluate the kidney functions. The normal GFR in young adults approx. 120 ml/min.

Complete Blood Count (CBC): also known as full blood counts that give information about the cells in a person’s blood. It measures red blood cells, white blood cells, hemoglobin, hematocrit, platelets. If hemoglobin is low, that means the lack of erythropoietin (EPO) hormone secreted by kidneys.

ABO Blood Grouping: there are 8 different blood types,and the type you have is determined by genes inherited from your parents. If the blood is not matching between donor and recipient , it’s incompatible but if matching, it’s compatible. Compatible kidney transplant has less chance of rejection than incompatible kidney transplant.

Anti Blood Group Antibody Titre: when the blood group is incompatible. The anti-A and anti-B antibody titers (IgG and IgM) were estimated by column agglutination technology. This technique uses glass beads and reagent contained in a column of the cassette which, upon centrifugation, trap agglutinated red blood cells and allow non-agglutinated red blood cells to travel to the bottom of the column. The pooled “A” cell and “B” cell suspension were prepared fresh every day. The separated serum samples from patients were serially diluted for doubling titers with normal saline as 1:2, 1:4, 1:8, 1:16, 1:32, 1:64, 1:128, 1:256, and 1:512,…etc. Reagent addition, sample addition, incubation (only for IgG), and centrifugation occur inside the automated instrument using software which also gives gradation readings of the agglutination reaction in the column well.

HLA- A,B, & DR DNA typing: the term HLA refers to the human leukocyte antigen system, which is controlled by genes on the short arm of chromosome six.The HLA loci are part of the genetic region known as the major histocompatibility complex (MHC). HLA- A, B & DR loci play a role to prove the relationship between the donor & the recipient so this is the preferable test for kidney transplant.

Blood Culture: a blood culture is a medical laboratory test used to detect bacteria or fungi in a person’s blood. Blood is normally sterile, and the presence of microorganisms in the blood often indicates a serious infection.

Urine Routine Examination (R/E) and Culture: urine examination in renal science to investigate proteinuria, and glycosuria, and in urine culture, we see the bacterial and fungal infection.

Tacrolimus Test: tacrolimus is an immunosuppressive drug that is believed to prevent rejection in transplantation patients. The Tacrolimus test is used to measure the amount of drug in the blood to determine whether the concentration has reached a therapeutic level and is below the toxic level.

Kidney failure, also called end-stage renal disease (ESRD), is the last stage of chronic kidney disease. When your kidneys fail, it means they have stopped working well enough for you to survive without dialysis or a kidney transplant.

Five Stages of Kidney Failure

Stage 1- kidney damage with normal or increased GFR ≥90 ml/min

Stage 2- kidney damage with mildly decreased GFR 60–89 ml/min

Stage 3- moderately decreased GFR 30–59 ml/min

Stage 4- severely decreased GFR 15–29 ml/ml

Stage 5- kidney failure <15 or on dialysis

Causes of chronic kidney failure

• Diabetes (most common cause)
• Hypertension (second most common cause)
• Autoimmune diseases, such as lupus and IgA nephropathy
• Genetic disease, such as polycystic kidney
• Nephrotic syndrome
• Age >65 year

Causes of acute kidney failure

Sometimes the kidneys can stop working very suddenly. This type of kidney failure is called acute kidney injury or acute renal failure. Common causes of an acute renal failure include:

• Heart attack
• Illegal drug use and drug abuse
• Urinary tract problems

Symptoms of chronic kidney failure

• Muscle cramps
• Nausea and vomiting
• Loss appetite
• Swelling in your feet and ankles
• Too much urine (pee) or not enough urine
• Trouble catching your breath
• Trouble sleeping

Symptoms of an acute kidney failure

• Abdominal pain
• Back pain
• Diarrhea
• Fever
• Vomiting

Clinical findings

1. Kidney functions test (Blood Urea, Creatinine, Uric Acid, Potassium, Sodium)
2. Urine examination (Urine R/E, Urine C/S)
3. USG — Kidney
4. Biopsy
5. GFR Test
6. 24 hours urine protein and more

Treatment

Dialysis

Dialysis is also called renal replacement therapy. They are of two types:

a. Hemodialysis: blood is put through a filter outside the body in a machine. The dialyser removes the excess fluids and wastes from the blood & returns the filtered blood to the body. This is done either at a dialysis center or at home. Hemodialysis needs to be performed 2 or 3 times a week according to patient situations, and each session lasts 3–5 hours.

A hemodialysis session will, on average, result in the use of 120–160 liters of water to be used for the dialysate. The water must not be contaminated and is purified in most renal units through reverse osmosis.

This is achieved by a dialysis machine, which takes blood from the patient and pumps it towards the semi-permeable membrane. The dialysate is pumped from the opposite direction to create a larger concentration gradient.

The main function of haemodialysis is to reduce the volume of uremic toxins in the blood, especially small and medium sized molecules, through diffusion. It also decreases the patient’s fluid volume via ultrafiltration and manages metabolic disturbances (e.g. maintaining the acid-base balance).

b. Peritoneal dialysis: blood is cleaned inside the body. A special fluid is put into the abdomen to absorb waste from the blood that passes through small vessels in your abdominal cavity. The fluid is then drained away. This type of dialysis is typically done at home.

Kidney Transplant

A kidney transplant is a surgical procedure to place a healthy kidney from a living or deceased donor into a person whose kidneys no longer function properly.

A kidney transplant is often the treatment of choice for kidney failure, compared with a lifetime on dialysis.

But for certain people with kidney failure, a kidney transplant may be more risky than dialysis.

• Advanced age
• Severe heart disease
• Active or recently treated cancer
• Poorly controlled mental illness
• Alcohol or drug abuse

Any other factor that could affect the ability to safely undergo the procedure and take the medications needed after a transplant to prevent organ rejection

Complications of the procedure

Kidney transplant surgery carries a risk of significant complications, including:

• Blood clots and bleeding
• Leaking from or blockage of the tube (ureter) that links the kidney to the bladder
• Infection
• Failure or rejection of the donated kidney
• Death, heart attack and stroke

Compared with dialysis, kidney transplant is associated with:

• Better quality of life
• Lower risk of death
• Fewer dietary restrictions
• Lower treatment cost

NEPHRON

The Nephron is the microscopic structural and functional unit of the kidney. It is composed of a renal corpuscle and a renal tubule. The renal corpuscle consists of a tuft of capillaries called a glomerulus and an encompassing Bowman’s capsule. The renal tubule extends from the capsule. The capsule and tubule are connected and are composed of epithelial cells with a lumen. A healthy adult has 1 to 1.5 million nephrons in each kidney. Kidneys contain two types of nephrons, each located in different parts of the renal cortex: cortical nephrons and juxtamedullary nephrons. A nephron is used separate to water, ions and small molecules from the blood, filter out wastes and toxins and return needed molecules to the blood. Blood is filtered as it passes through three layers: the endothelial cells of the capillary wall, its basement membrane, and between the foot processes of the podocytes of the lining of the capsule.

Renal Corpuscle generates the glomerular filtrate composed of water, ions, and small molecules.

Proximal convoluted tubule reabsorbs sodium, chloride, potassium, water, glucose, amino acids, bicarbonate, calcium, and phosphate. It secretes ammonium and creatinine.

Loop of Henle (thin descending limb) reabsorbs water.

Loop of Henle (thin ascending limb) reabsorbs sodium and chloride.

Loop of Henle (thick ascending limb) reabsorbs sodium and chloride.

Distal convoluted tubule reabsorbs sodium and chloride

Collecting duct reabsorbs sodium, chloride, and water and secretes ammonium, hydrogen ions, and potassium.

Main functions of Kidney

1. Removes nitrogenous waste & toxins from the body

2. Controls acid-base balance

3. Controls water balance

4 Maintains electrolyte balance

5. Maintains Blood Pressure

6. Produces the hormone called ERYTHROPOIETIN

7. Activates Vitamin-D

INFECTION & DISEASES

• Acute Renal failure (kidney failure): A sudden worsening in how well your kidneys work. Dehydration, a blockage in the urinary tract, or kidney damage can cause acute renal failure, which may be reversible.

• Chronic renal failure: A permanent partial loss of how well your kidneys work. Diabetes and high blood pressure are the most common causes.

• Pyelonephritis: (infection of kidney pelvis): Bacteria may infect the kidney, usually causing back pain and fever. A spread of bacteria from an untreated bladder infection is the most common cause of pyelonephritis.

• Glomerulonephritis: An overactive Immune system may attack the kidney, causing inflammation and some damage. Blood and protein in the urine are common problems that occur with glomerulonephritis. It can also result in kidney failure.

• Kidney Stones (nephrolithiasis): Minerals in urine form crystals (stones), which may grow large enough to block urine flow. It’s considered one of the most painful conditions. Most kidney stones pass on their own, but some are too large and need to be treated.

• Nephrotic Syndrome: Damage to the kidneys causes them to spill large amounts of protein into the urine. Leg swelling (edema) may be a symptom.

• Polycystic kidney disease: A genetic condition resulting in large cysts in both kidneys that hinder their work.

• End-stage renal disease (ESRD): Complete loss of kidney strength, usually due to progressive chronic kidney disease. People with ESRD require regular dialysis for survival.

• Papillary necrosis: Severe damage to the kidneys can cause chunks of kidney tissue to break off internally and clog the kidneys. If untreated, the resulting damage can lead to total kidney failure.

• Diabetic Nephropathy: High blood sugar from diabetes progressively damages the kidneys, eventually causing chronic kidney disease. Protein in the urine (nephrotic syndrome) may also result.

• Hypertensive nephropathy: Kidney damage caused by high blood pressure. Chronic renal failure may eventually result.

• Kidney cancer: Renal cell carcinoma is the most common cancer affecting the kidney. Smoking is the most common cause of kidney cancer.

• Interstitial nephritis: Inflammation of the connective tissue inside the kidney, often causing acute renal failure. Allergic reactions and drug side effects are the usual causes.

• Nephrogenic diabetes insipidus: The kidneys lose the ability to concentrate the urine, usually due to a drug reaction. Although it’s rarely dangerous, diabetes insipidus causes constant thirst and frequent urination.

• Renal cyst: A hollowed-out space in the kidney. Isolated kidney cysts often happen as people age, and they almost never cause a problem. Complex cysts and masses can be cancerous.