Future Directions

1 Blood delivered to lumen of fibers in filter device (only one fiber shown)

Filter unit

4 Postfiltered blood delivered to extracapillary

Filter unit

4 Postfiltered blood delivered to extracapillary

6 Transported and synthesized elements added to postfiltered blood, returned to general circulation

2 Filtrate conveyed to tubule lumens

7 Concentrated metabolic wastes (urine) voided

2 Filtrate conveyed to tubule lumens

6 Transported and synthesized elements added to postfiltered blood, returned to general circulation

7 Concentrated metabolic wastes (urine) voided

5 Renal tubule cells lining fibers provide transport and metabolic function

FIGURE 19-28

Schematic for the bioartificial kidney. As experience with these techniques grows, innovations in technology will likely keep pace. Over the last 3 years, most of the major manufacturers of dialysis equipment have developed new pumps dedicated for continuous renal replacement therapy (CRRT). Membrane technology is also evolving, and antithrombogenic membranes are on the horizon [41]. Finally the application of these therapies is likely to expand to other arenas, including the treatment of sepsis, congestive heart failure [42], and multiorgan failure [43]. An exciting area of innovative research is the development of a bioartificial tubule utilizing porcine tubular epithelial cells grown in a hollow fiber to add tubular function to the filtrative function provided by dialysis [44]. These devices are likely to be utilized in combination with CRRT to truly provide complete RRT in the near future. (From Humes HD [44]; with permission.)

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