Extracorporal blood purification: more than diffusion and convection. Does this help?:

Recent Updates on Blood Purification: Use of Smart Polymer Materials

Blood purification is indispensable in addressing various conditions such as liver dysfunction, autoimmune diseases, and renal failure whereby toxins have to be cleared from the bloodstream effectively. Conventional methods that involve hemoperfusion, hemodialysis, and hemofiltration possess several weaknesses, including loss of plasma components and inefficient clearance of high molecular weight solutes. This review explores current developments in blood purification techniques particularly stimuli-responsive polymers for use in extracorporeal therapy among other applications. Many aspects of engineering stimuli-responsive polymers are described in terms of their role in the removal of small soluble molecules and toxins in blood purification techniques. The development of stimuli-responsive systems has introduced a new paradigm in blood purification by enabling selective, on-demand control of polymer parameters in response to external stimuli such as temperature, pH, electrolytes, and light. Such advanced materials have been demonstrated potential for toxin clearance, minimizing thrombosis, and improving blood compatibility and antifouling, which are far much better than traditional approaches. Furthermore, the review presents a perspective on stimuli-responsive polymers that could be used in developing novel extracorporeal systems for future medical purposes.

Proteomic Investigations into Hemodialysis Therapy

The retention of a number of solutes that may cause adverse biochemical/biological effects, called uremic toxins, characterizes uremic syndrome. Uremia therapy is based on renal replacement therapy, hemodialysis being the most commonly used modality. The membrane contained in the hemodialyzer represents the ultimate determinant of the success and quality of hemodialysis therapy. Membrane's performance can be evaluated in terms of removal efficiency for unwanted solutes and excess fluid, and minimization of negative interactions between the membrane material and blood components that define the membrane's bio(in)compatibility. Given the high concentration of plasma proteins and the complexity of structural functional relationships of this class of molecules, the performance of a membrane is highly influenced by its interaction with the plasma protein repertoire. Proteomic investigations have been increasingly applied to describe the protein uremic milieu, to compare the blood purification efficiency of different dialyzer membranes or different extracorporeal techniques, and to evaluate the adsorption of plasma proteins onto hemodialysis membranes. In this article, we aim to highlight investigations in the hemodialysis setting making use of recent developments in proteomic technologies. Examples are presented of why proteomics may be helpful to nephrology and may possibly affect future directions in renal research.

7 Leverfalen

De lever vervult tal van essentiële functies in het menselijk lichaam, waaronder ontgifting van het bloed en aanmaak van diverse eiwitten en hormonen. Tevens speelt de lever een rol in het afweersysteem. Leverfalen kan omschreven worden als een situatie van onvoldoende werking van de lever bij deze processen. Dit beeld ontstaat wanneer door het verlies van functionele cellen het totale effectieve levervolume beneden een kritische grens komt. In dit hoofdstuk wordt ingegaan op diverse vormen van leverfalen en twee specifieke bij leverfalen voorkomende problemen, namelijk hepatische encefalopathie en verhoogde bloedingsneiging.