MILESTONES IN NEPHROLOGY
`
`The Artificial
`
`Kidney:
`
`a dialyser
`
`with
`
`a great
`
`area.
`
`By
`
`w. j. KOLFF,
`for
`Specialist
`Hospital
`of Kampen
`
`internal
`(The
`
`diseases
`Netherlands);
`
`at
`
`the Municipal
`
`H. TH.
`
`J. BERK,
`Managing
`Works.
`with
`
`of
`Director
`collaboration
`
`the
`
`the
`
`Kampen
`of
`
`Enamel
`
`M.
`
`NURSE
`Messrs.
`
`ter WELLE;
`E. C. van DUK
`
`Miss A. J. W.
`der
`van
`and J. van Noordwijk
`
`LEY;
`
`(Submitted
`
`for
`
`publication
`
`October
`
`6,
`
`1943).
`
`with
`
`comments
`
`by
`
`J. KOLFF
`WILLEM
`Reprinted
`from Acta. Med.
`
`A. GOTCH
`FRANK
`and
`Scand.
`CXV!!:121-b34,
`
`1944
`
`Purpose
`
`of
`
`the
`
`artificial
`
`kidney.
`
`we
`
`as
`
`as
`
`is
`
`the
`and
`in
`
`try
`
`from
`resulting
`from uremia
`suffering
`of patients
`treatment
`In the
`remove
`be, where
`we cannot
`our
`first
`attempt
`will
`renal
`insufficiency
`the
`formation
`of endprod-
`insufficiency,
`to restrict
`the
`cause
`of
`this
`by
`giving
`a diet
`contain-
`by
`ucts
`that
`have
`to be
`excreted
`the
`kidney
`ing
`little
`albumen.
`Next
`we make
`all
`extrarenal
`factors
`influencing
`the
`secretion
`of
`urine
`favourable
`as
`possible.
`We
`regulate
`the
`absorption
`of water,
`control
`the
`composition
`of
`blood
`give
`supply
`sodiumchloride
`this
`lost
`by
`vomiting.
`We
`alkali
`and
`the
`case
`of
`acidosis,
`so on.
`Furthermore
`we
`to aid
`the
`circu-
`lation
`as much
`as possible
`by
`removing
`troublesome
`exudates,
`etc.
`If in spite
`of all
`these
`efforts
`the secretion
`of urine
`should
`remain
`insufficient,
`so that
`the
`endproducts
`of metabolism
`accumulate
`more
`rises
`of
`and more
`in the organism,
`the urea
`percentage
`the blood
`and
`the
`uremia
`gets more
`and more
`serious,
`we have
`come
`to the
`end
`of
`our
`resources.
`Urea
`and
`and with
`the
`responsible
`However,
`a failure.
`All
`as
`
`AUTHOR
`
`COMMENTARY
`
`Wilem
`
`J. Kolif
`
`University
`Salt
`Lake
`
`of Utah,
`City,
`Utah
`
`L.
`
`M (cid:1)
`
`patient
`to improve
`is
`in medicine
`motive
`leading
`or prolong
`a life
`is possible
`to save
`care
`if
`and
`it,
`it
`life, never
`pro-
`for a happy
`if itjust
`only
`done
`be
`it should
`means
`I would
`like to do this by mechanical
`longs misery(cid:1)
`if one
`This
`is hardly
`considered
`scientific;
`if possible.
`of a National
`Institutes
`of Health
`Study
`member
`Section
`is a gadget,”
`then
`grant
`is
`lost. Yet
`these
`the
`says
`“This
`may
`open
`have
`opened
`entirely
`means
`and
`mechanical
`I am not
`of research.
`to one
`concept
`new fields
`restricted
`when
`it comes
`to alleviating
`disease. After
`hemodialysis,
`we developed
`practical
`and
`dial-
`inexpensive
`peritoneal
`and propagated
`the forced
`ysis,
`high
`caloric-low
`protein
`diet
`(see
`“New Ways
`of ‘freating
`Sat
`Uraemia”).
`Naka-
`I
`revived
`cadaver
`kidney
`transplantation,
`moto
`and
`had
`the
`which
`been
`practically
`abandoned,
`by dialyzing
`donor
`recipient
`until
`the
`acute
`tubular
`necrosis
`of
`the
`recovered
`in its new owner;
`it
`took
`from five
`to
`kidney
`(see my article
`in Terasaki’s
`book).
`days
`120
`When we saw that blue blood
`in the rotating
`drum artifi-
`red, we made membrane
`oxygenators
`for
`cia!
`kidney
`became
`in 50% of all open
`(It
`is now used
`heart
`heart
`open
`surgery.
`cases
`today.) When
`people
`irreparable
`surgery
`with
`heart
`not be helped with
`heart-lung
`machine-sup-
`could
`failure
`we began
`to make
`artificial
`hearts. The resis-
`ported
`surgery,
`against
`artificial
`hearts
`was
`and
`is enormous.
`There
`is
`tance
`Yet,
`recently,
`of
`disbelief.
`general
`consecutive
`implant
`16
`all on the verge
`of death,
`only
`in Thcson,
`Arizona,
`patients
`15 survived.
`later went
`home
`one died;
`Thirteen
`patients
`with a transplant;
`still have their
`artificial
`hearts.
`two
`
`sweat,
`with
`body
`the
`leave
`substances
`other
`toxic
`removing
`of
`ways
`and
`several
`feces,
`have
`the kidneys
`for
`the uremia
`without
`using
`all
`attempts
`at
`finding
`a satisfactory
`method
`
`vomit
`products
`been
`tried.
`have
`proved
`
`the
`the
`
`normal
`
`dialysed,
`be
`can
`kidneys
`the
`by
`excreted
`substances
`in uremia,
`one
`in the
`blood
`accumulate
`substances
`all
`these
`and
`by dialysis.
`For
`from the
`blood
`substances
`try
`to remove
`these
`might
`a
`certain
`liquid
`dialysed
`against
`must
`be
`purpose
`the
`blood
`this
`body,
`then
`the
`and
`or membranes
`outside
`through
`a system
`of
`tubes
`blood must
`be kept
`the
`patient’s
`body.
`The
`brought
`back
`again
`into
`liquid
`by means
`of a substance
`preventing
`clotting.
`If all
`substances
`accumulating
`in uremia
`could
`be
`successfully
`removed,
`a person
`able
`would
`be
`to live without
`kidneys,
`in some
`cases
`so long
`till his
`own
`kidneys
`would
`resume
`their
`activity.
`on animals
`In 1912
`and
`1913
`vividialysis
`was
`performed
`pressed
`through
`Rowntree
`and Turner
`(1,
`2). The
`blood
`was
`tem of collodion
`tubes
`and
`subsequently
`brought
`back
`into
`mal,
`clotting
`being
`prevented
`by hirudine.
`(3) used
`5) and Haas
`(1928)
`Necheles
`(1924)
`(4,
`has
`latter
`applied
`vividialysis
`to
`human
`beings
`the
`of
`was,
`capacity
`however,
`much
`too
`small;
`in the
`course
`of bloodwashing,
`he could
`remove
`only
`2 grams
`of urea.
`In
`1938 W. Thalhimer
`took
`the
`problem
`again,
`heparine
`and
`cellophane
`tubes.
`our
`regret
`we
`whether
`he
`has
`achieved
`a practical
`solution.
`
`by Abel,
`a sys-
`the
`ani-
`
`apparatus;
`other
`as well.
`The
`a whole
`day
`
`armed
`not
`
`do
`
`with
`know
`
`up
`To
`
`Nipro Ex. 1004
`
`000001
`
`(cid:1)
`

`
`1960
`
`Journal
`
`ofthe
`
`American
`
`Society
`
`of Ncphrologv
`
`the arti-
`allows
`The Food
`and Drug
`only
`Administration
`to be used
`ficial
`heart
`Yet,
`in
`to transplantation.
`as a bridge
`the year 2008,
`the winner
`of the marathon may well be dis-
`qualified
`because
`he will
`have
`an artificial
`heart.
`
`Fig.
`blood
`
`1 (cid:1) A cellophane
`within
`the
`
`has
`
`tube
`cellophane
`rotating
`
`been
`always
`the
`blood
`
`wound
`sinks
`
`(cid:1)OVC5
`
`spirally
`to
`the
`from
`
`round
`lowest
`left
`
`an aluminum
`point.
`When
`right.
`
`to
`
`cylinder.
`the
`
`The
`
`drum
`
`is
`
`The
`
`apparatus.
`
`to
`
`the
`
`by
`cello-
`
`to
`
`clotting
`prevent
`can
`i.e.
`membranes,
`of
`a dialysing-appa-
`large
`enough
`using
`a cellophane
`least
`25 to 30 metres.
`and
`all
`previous
`the
`tube
`system
`to pass
`through
`area:
`volume
`gets
`
`shall
`
`last
`in the
`built
`in use
`at present.
`consists
`of
`a large
`segment
`in a tank
`
`few years
`
`and
`
`horizontal
`of
`rinsing
`
`GUEST
`
`COMMENTARY
`
`we
`investigators
`previous
`Contrary
`dialysing
`excellent
`we
`have
`and
`heparine,
`construction
`next
`step was
`The
`tube.
`phane
`ratus with
`and
`a membrane
`blood
`volume
`a small
`kidney.
`We
`calculated
`that
`by
`human
`rival
`the
`we
`should
`need
`a length
`of
`at
`tube
`25 mm wide,
`difference
`between
`our
`apparatus
`A principal
`from
`the
`fact
`that
`we
`have
`not
`filled
`results
`ones
`that we
`cause
`a small
`quantity
`of
`blood
`hut
`entirely.
`is for
`the
`rest
`empty,
`so that
`the
`ratio
`a tube which
`favourable.
`much
`more
`apparatus
`over
`the various
`We pass
`kidney
`only
`the
`artificial
`describe
`fig.
`4)
`The
`apparatus
`(fig.
`3 and
`cylinder,
`revolving
`with
`its
`undermost
`liquid.
`have
`tube
`cellophane
`of
`30 metres
`cellophane
`blood
`is
`in the
`cylinder.
`The
`it
`sinks
`and
`in which
`rest
`evacuated
`of
`in the
`direction
`cylinder
`rotating
`to
`right.
`continually
`moves
`from
`left
`tube
`by
`a rubber
`leaves
`the
`cellophane
`(fig.
`4), and
`low axle
`to the right
`it enters
`In the
`hollow
`axles
`low axle
`on
`the
`left.
`ed
`by
`a rotating
`coupling
`(fig.
`5).
`Methods
`of dialysis:
`I . Conti,iuously.
`through
`the
`
`to
`the
`
`spirally
`wound
`been
`has
`which
`tube,
`point.
`lowest
`the
`in figure
`arrow
`the
`lowest
`seeking
`carried
`through
`tube,
`by flowing
`through
`the
`rubber
`tube
`is
`
`the
`round
`the
`been
`for
`the
`With
`1 the
`blood
`point.
`hol-
`the
`hol-
`the
`interrupt-
`
`It
`
`pass
`
`The
`kidneys
`
`blood may
`and
`after
`
`let out
`be
`dialysis
`be
`
`of one bloodvessel,
`brought
`back
`
`into
`
`vessel.
`another
`2. Fractio,,ated.
`2. A side
`tube
`has
`branch
`to the
`patient
`
`process
`The
`attached
`the
`
`other
`
`been
`and
`
`is shown
`to the
`circuit
`to a burette.
`
`schematically
`branching
`By
`raising
`
`in figure
`in two:
`one
`or
`lower-
`
`ing
`
`the
`
`burette
`
`blood
`
`may
`
`be
`
`let
`
`into
`
`or out
`
`of
`
`the
`
`patient
`
`and
`
`into
`
`or
`
`a
`
`2.
`the
`
`Fig.
`from
`impure
`
`1. Connection
`patients
`blood
`Burette
`Off.
`Connection
`
`is
`low:
`with
`
`with
`
`body
`flowing
`purificd
`dialyser
`
`dialyser
`the
`the
`
`into
`from
`blood
`shut
`burette
`
`off.
`
`shut
`burette.
`burette
`is
`flowing
`Burette
`into
`the
`
`Burette
`off.
`II. Tube
`into
`the
`from
`high:
`patients
`
`down:
`patient
`to
`dialyser.
`the
`dialyser
`purified
`blood
`body.
`
`impure
`shut
`Ill.
`
`is
`blood
`off.
`Burette
`Tube
`to
`patient
`into
`the
`burette.
`is
`flowing
`from
`
`flowing
`high:
`shut
`IV.
`the
`
`Fig. 1. The first
`
`series of artificial
`
`kidneys
`
`ready
`
`September
`
`1944.
`
`Frank
`
`A. Gotch
`
`San Francisco,
`
`California
`
`T here were
`
`to
`available
`guidelines
`no quantitative
`set out
`to design
`an arti-
`and Berk when
`they
`Kolif
`solute
`of
`understanding
`in
`1940.
`Kinetic
`kidney
`ficial
`developed
`in the 1950s
`and
`slowly
`in dialyzers
`transport
`was essentially
`complete
`with Allan Michael’s
`article
`in
`of
`1968 (1), which
`provided
`a mathematical
`description
`the
`relative
`contributions
`of
`the membrane,
`blood,
`and
`dialysate
`film transport
`resistances
`for
`all of
`the major
`flow regimens.
`The
`rotating
`drum dialyzer
`that Kolif
`and Berk
`designed
`and reported
`in 1944 was developed
`guided
`by
`brilliant
`intuitive
`and
`error,
`through
`trial
`understanding
`of
`the
`problem.
`dialyz-
`the primary
`that
`title of their
`article
`The
`suggests
`but
`they
`surface
`area,
`er design
`requirement
`was
`a
`large
`Haas
`built
`a 2.1-m2
`dia-
`more
`accomplished
`much
`than
`this.
`human
`dialysis,
`but
`lyzer
`that was
`for
`used
`the
`first
`it
`removed
`only 2.0 g of urea over
`of dialysis
`(2). The
`4 hours
`Kolif/Berk
`not
`only
`contained
`a large mem-
`kidney
`design
`brane
`area
`(2.3 m2), but
`also
`successfully
`minimized
`the
`blood
`and
`dialysate
`film transport
`resistances
`sufficient
`to
`achieve
`urea
`clearances
`of
`flow of
`175 ml/min
`at a blood
`200 ml/min.
`The
`achievement
`of
`this
`impressive
`perfor-
`of design
`parameters
`mance
`through
`intuitive
`optimization
`
`Nipro Ex. 1004
`
`000002
`
`

`
`Fig.
`phane
`
`3.
`
`Front
`tube
`
`view
`which
`
`The
`
`dialyser.
`the
`of
`plainly
`visible,
`are
`The cylinder
`has
`
`blood,
`covers
`been
`
`contained
`the
`aluminum
`provided
`with
`
`30 windings
`in the
`cylinder
`with
`ridges.
`
`of
`a thin
`
`cello-
`film.
`
`In
`dialyser.
`is necessary.
`passing
`may
`be
`and
`
`following
`
`this method
`
`only
`
`one
`
`single
`
`there
`patient
`to the
`whether
`directly
`seen
`by means
`of which
`
`is a cellophane
`there
`exists
`one may
`check
`
`window,
`positive
`if blood
`
`or
`is
`
`tube
`which
`pressure
`
`the
`of
`out
`venapunction
`In the
`through
`negative
`flowing.
`Rinsing
`a heating
`phane
`glucose
`
`liquid.
`element
`impermeable
`was
`necessary.
`
`We use 70 to 100 litres
`
`to 37#{176}-39#{176}C,and
`clean
`to bacteria.
`To avoid
`At present
`we
`use
`
`is
`
`NaCI
`glucose
`tapwater
`
`sterilising.
`and
`be
`
`rinsing
`of
`not
`though
`hemolysis
`following
`
`the
`
`warmed
`liquid
`as
`sterile,
`addition
`the
`composition:
`
`by
`cello-
`of
`
`0.7%
`1.5%
`97.8%
`
`blood,
`and
`with
`a-
`
`with
`in contact
`coming
`All parts
`and
`Cleaning
`cleaned
`thoroughly
`are
`cellophane
`the
`couplings
`tubes,
`i.e.
`together
`and
`kept
`filled
`put
`subsequently
`They
`may
`sterilised.
`superol
`is washed
`out with
`the
`Before
`use
`of
`superol.
`a solution
`air
`is expelled
`from the
`tube.
`and
`all
`saline
`solution
`pyrogenic
`apply
`the
`following
`doses:
`At present
`we
`Heparinising.
`At
`the beginning:
`400 mg of heparine
`in the
`>kidneys>>
`400 mg
`patient
`(intravenously)
`100 mg.
`half
`hour
`every
`When
`experimental
`dialysis.
`of
`urea
`1.68%
`proves
`to be
`1.24
`grams
`have
`therefore
`been
`
`dialysis:
`During
`ofan
`Results
`solution
`4.17%
`2.49%
`utes;
`
`or
`
`(cid:1)..
`
`-,
`
`.
`
`>>
`
`>>
`
`(cid:1)>
`
`>‘
`
`dialysing
`still
`present
`excreted
`
`cm3 of a
`500
`5 mm-
`after
`by dialysis
`in
`
`Milestones
`
`in Nephrologv
`
`P)61
`
`the
`They minimized
`accomplishment.
`a landmark
`truly
`was
`film diffusion
`blood
`winding
`the mem-
`distance
`by
`spirally
`drum with
`suffi-
`revolving
`brane
`a horizontal
`tubing
`around
`of blood
`to
`pass
`tension
`to “cause
`a small
`volume
`dent
`so that
`the
`ratio
`for
`the
`rest
`empty,
`a tube
`which
`is
`through
`thick
`blood
`gets more
`favorable.”
`Undoubtedly,
`area:volume
`their
`efficien-
`kidneys
`seriously
`compromised
`ifims
`in Haas’
`some
`con-
`design
`also
`likely
`promoted
`cy. The
`rotating
`drum
`in addi-
`in the
`bloodstream
`with
`backflow,
`vective
`mixing
`tion
`to net
`forward
`blood
`flow,
`and
`quite
`good
`facilitated
`mixing
`of dialysate
`to minimize
`dialysate
`film resistance.
`The Kolif/Berk
`article
`is also
`a landmark
`in that
`it marks
`between
`research
`physician
`and
`engi-
`the
`first
`collaborative
`neer. A fruitful
`interaction
`between
`these
`two
`disciplines
`undoubtedly
`contributed
`greatly
`to their
`successful
`develop-
`ment
`of
`clinically
`artificial
`kidney
`and
`has
`the
`first
`useful
`to mark
`progress
`in the field
`of artificial
`organs
`up
`continued
`to the present
`time.
`a fascinating
`contained
`article
`The Kolif/Berk
`descnp-
`dialysis.
`to
`of
`uremia
`responsiveness
`of
`the
`clinical
`tion
`coma
`and
`uremic
`of
`complete
`documented
`They
`reversal
`evidence
`for
`the
`regression
`of
`retinopathy
`to provide
`first
`low
`molecular
`critical
`pathogenetic
`of
`dialyzable
`role
`The
`authors
`weight
`solutes
`in acute
`uremic
`neurotoxicity.
`as
`of using
`urea
`defined
`with
`remarkable
`the
`concept
`clarity
`the
`quantifying
`a generic
`low molecular
`weight
`solute
`for
`quan-
`dose
`of dialysis.
`has been modified
`and
`This
`concept
`over
`the
`intervening
`years,
`but
`replaced
`tified
`53
`(although
`ultimately
`it will
`be when
`there
`under-
`standing
`of
`the biochemistry
`of uremia).
`treat-
`long-term
`Unfortunately,
`Kolif’s
`dream
`of chronic
`disease
`16 years
`another
`ment
`of end-stage
`renal
`had
`to wait
`team,
`until
`1960,
`when
`another
`gifted
`physician/engineer
`that
`cannulas
`Scribner
`and
`Quinton,
`designed
`in-dwelling
`and
`proved
`for
`repeated
`to the
`circulation
`successful
`access
`of maintenance
`hemodialysis
`(3). Kolif
`era
`ushered
`in
`the
`has continued
`to contribute
`to the successful
`implementation
`of
`dialysis
`therapy
`and
`development
`artificial
`organs
`of
`his
`throughout
`the
`past
`years
`since
`original
`landmark
`53
`a
`publication.
`He was
`prime
`mover
`in
`founding
`the
`for Artificial
`Internal
`Organs
`and has con-
`American
`Society
`for
`tributed
`greatly
`to the
`design
`requirements
`blood
`oxy-
`the
`genation
`and
`artificial
`heart.
`It
`is understandable
`that
`he
`bristles
`little
`about
`charge
`of
`“gadgetering,”
`when
`a
`the
`nearly
`25 years
`after
`the Kolif/Berk
`16 years
`after
`article
`and
`the
`advent
`of
`chronic
`dialysis
`therapy,
`dialysis
`successful
`was
`described
`as the
`“epitome
`of half way
`technology”
`and
`least
`“the
`day may
`not be far distant
`when
`the dialyzer,
`at
`for
`chronic
`dialysis,
`will
`take
`its place with
`the
`iron
`lung”
`(4).
`Twenty-one
`years
`have
`now
`passed
`since
`these
`wise
`pro-
`and the dialyzer
`continues
`to provide
`the only
`nouncements,
`for
`end-stage
`renal
`disease.
`effective
`
`a
`
`not
`is better
`
`therapy
`
`4. Half
`Fig.
`cylinder
`by
`
`view.
`lateral
`the
`hollow
`
`cellophane
`The
`inside
`axle.
`sterilised
`
`which
`together
`
`tube
`the
`with
`
`into
`
`passes
`coupling
`the
`tubes.
`
`a rubber
`fixed
`
`is
`
`tube
`after
`
`leaving
`having
`
`the
`been
`
`Operating
`and
`
`1. Michaels
`AS:
`for
`hemodialyzers
`TransAm
`SocArtifintern
`2. Drukker
`W: Haemodialysis:
`ment
`of Renal
`Function
`
`performance
`and
`parameters
`other
`membrane-separation
`12: 387-392,
`Organs
`A historical
`review.
`by Dialysis:
`A Textbook
`
`criteria
`devices.
`
`1968
`In: Replace-
`of Dialysis,
`
`Nipro Ex. 1004
`
`000003
`
`

`
`I 962
`
`Journal
`
`of
`
`the Amcrican
`
`Society
`
`o Nephrologv
`
`Fig.
`being
`
`5. A rotating
`pressed
`Ofl
`
`coupling.
`the
`inner
`has been
`
`to
`nut
`
`The
`tube
`fixed
`
`blood-light
`by means
`on the
`
`is
`joint
`of
`a screw
`screw
`socket
`
`formed
`socket.
`as well.
`
`by
`
`a cotton
`Later
`on
`
`packing
`a counter
`
`these
`utes
`
`ems,
`human
`
`5 minutes.
`first
`0.57% proves
`The
`dialysing
`and
`our
`glomeral
`
`After
`to he
`still
`area
`of our
`second
`one
`to
`being
`20,00
`
`the
`
`dialysis
`
`for
`
`another
`
`5 mm-
`
`kidney
`sq.
`
`amounts
`cms,
`the
`
`to
`total
`
`17,000
`area
`
`square
`of
`the
`
`continuing
`present.
`first
`23,000
`sq. cms.
`
`S..
`
`Patient.
`
`consulted
`grew
`
`(Dr. Keiner)
`ophthalmologist
`the
`age,
`of
`29 years
`single.
`Miss
`was
`extensive
`worse.
`There
`steadily
`sight
`her
`because
`1942
`in December
`foci
`in the retina. Dr. Dhont,
`and white
`edema
`of both papilles with hemorrhages
`a chronic
`nephri-
`found
`symptoms
`specialist
`kr
`internal
`diseases
`in Zwolle,
`of
`245/150.
`isosthenuria.
`hematuria,
`2-3%
`of
`tis with
`uremia:
`Tension
`Urine:
`albumen.
`Urea
`percentage
`of
`the blood
`I 10 mg%.
`Under
`general
`treatment
`the urea percentage
`but
`the
`1st
`of March
`had
`to
`he
`taken
`she
`on
`almost
`daily
`and
`her
`state
`grew
`worse,
`so
`that
`artificial
`kidney
`a chance,
`well
`knowing
`there
`a temporary
`improvement
`to gain.
`On arrival
`at
`the Kampen
`hospital
`as follows:
`By bleeding
`down
`rapidly.
`breath
`smelt
`
`sank
`the blood
`of
`hospital
`again.
`to
`Dr. Dhont
`decided
`was
`nothing
`to
`lose.
`
`to 75 mg%.
`She
`vomited
`the
`to
`give
`hut
`perhaps
`
`on the 16th of March
`
`1943,
`
`her state was
`
`from the
`had
`her Hb.
`nose
`Pulse
`l()(). Tension
`220/140.
`strongly
`urine.
`The
`heart
`was
`of
`
`sunk
`Urea
`enlarged
`
`to 35%
`percentage
`towards
`
`still
`and was
`164 mg%.
`the
`left,
`the
`
`going
`The
`ictus
`
`l(cid:1)’(cid:1)I,
`
`Li
`
`tt
`
`1%
`
`(cid:1)i
`
`(cid:1),
`
`S
`
`of
`
`the
`
`of
`
`audible.
`of
`the
`days.
`All
`to a normal
`time we
`let
`pulmonary
`gave
`no more
`
`line,
`the axillary
`reached
`almost
`were
`murmur
`a systolic
`and
`a gallop
`and oppression
`of palpitation
`and complained
`The
`patient
`sat up in bed
`the
`following
`audible
`on
`were
`moist
`rhonchi
`chest.
`All
`over
`the
`lungs
`these
`symptoms
`have
`improved
`after we brought
`the Hb percentage
`level
`by transfusions
`of syrup
`of erythrocytes.
`during which
`each
`an
`equal
`volume
`the
`patient(cid:1)s
`blood
`escape
`for
`fear
`of
`causing
`edema.
`During
`subsequent
`course
`the
`treatment
`the
`heart
`trouble.
`As we
`started
`we
`ceeded
`that
`
`patient
`first
`portions
`the
`at
`
`would
`of blood.
`same
`level
`
`dialysis
`to the
`react
`In the
`end we
`sue-
`for
`26
`days,
`after
`
`of
`
`our
`how
`at all
`know
`not
`did
`small
`dialysing
`repeatedly
`with
`urea
`percentage
`the
`keeping
`in
`available.
`were
`veins
`no more
`serviceable
`improvement.
`a clinical
`of
`in
`the way
`stood
`have
`Various
`complications
`necessitated
`repeated
`which
`the
`nose.
`from
`bleedings
`of
`all
`the
`alarming
`First
`after
`reiterated
`cau-
`subdued
`but which
`were
`14.5
`litres),
`transfusions
`(totaling
`became
`evident.
`Next,
`10th
`day
`a paricarditis
`On
`the
`terisations
`(Dr. Hinnen).
`otitis media
`of both
`an angina,
`a painful
`parotitis
`and after
`that
`a very
`serious
`Eustachii
`into
`the
`ears.
`The
`copious
`purulent
`secretion
`ran
`through
`the
`tube
`and
`excited
`the vomiting
`again which
`had just
`decreased
`a little.
`After
`throat
`treatment
`with
`sulfanilamides
`this
`too improved.
`When
`a preparation
`of arteries
`(Dr. Kehrer)
`ruined)
`very
`persistent
`hemorrhages
`arose
`from
`tissue
`owing
`to the
`heparine.
`After
`the
`12th
`dialysis
`urea
`percentage
`of
`the
`the
`followed.
`following
`the
`At
`necrop.s%’
`Prof. Dr. J. I. Th. Vos was
`The
`kidneys
`were
`very
`cally.
`The
`glomeruli
`showed
`tively.
`hyalinisation.
`The
`arterioles
`The
`heart was
`very
`strongly
`There
`was
`a purulent
`pericarditis
`
`was
`the
`
`necessary
`subcutaneous
`
`(all
`
`being
`veins
`connective
`
`had
`blood
`
`become
`rapidly
`
`a failure,
`rose
`to
`
`being
`artery
`the
`640 mgc% , whereupon
`
`damaged,
`death
`
`appeared:
`kind
`enough
`small,
`their
`all
`stages
`and
`capillaries
`enlarged
`with
`without
`
`to examine
`weight
`was
`of
`degenerative
`showed
`a mighty
`the
`signs
`
`of
`
`80
`
`the organs microscopi-
`and
`67 grams
`respec-
`changes
`up
`to perfect
`serious
`sclerotic
`changes.
`of
`wall
`the
`left
`ventricle.
`specific
`inflammation.
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`sL
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`S.,,
`
`Fig.
`
`6. Graph
`
`of
`
`patient
`
`S..
`
`treated
`
`with
`
`the
`
`artificial
`
`of urea
`percentage
`The
`reproduced
`dialyses
`are
`bottom
`the quantities
`
`blood
`the
`of
`by columns.
`of urine
`passed
`
`indicated
`been
`has
`column
`The white
`24 hours
`are
`per
`
`kidney.
`
`In
`
`systolic
`the
`figure
`the
`top
`the
`blackened.
`them being
`between
`each
`is shown
`to sink
`line.
`It
`by a drawn
`of blood
`dialysed:
`the quantity
`indicates
`found
`represented
`by white
`blocks.
`The
`
`of
`
`and
`
`diastolic
`
`blood-pressures
`
`have
`
`been
`
`indicated,
`
`the
`
`difference
`
`after
`time
`shaded
`the
`quantities
`
`dialysis,
`a large
`one
`the quantity
`of urea
`excreted
`
`etc. The
`100 cm3
`to 278 mg per
`from 339
`e.g.
`at
`the
`of urea
`removed
`by
`the dialysis.
`Right
`with
`this
`urine
`are
`indicated
`by shaded
`blocks.
`
`Nipro Ex. 1004
`
`000004
`
`(cid:1)
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`
`lungs
`The
`Prof.
`infarcts.
`on
`to look
`they
`Possibly
`(clots),
`emboli
`to the
`returning
`patient
`In this
`life, but we have
`
`cuneiform
`small
`showed
`not
`find
`Vos
`however
`did
`them as old
`hemorrhages.
`may
`be
`accounted
`for
`so
`that
`in the
`patient’s
`vein.
`we
`could
`been
`able
`
`foci,
`necrosis
`Clinically
`hemorrhages
`blood
`will
`
`hemorrhagic
`of old
`reminding
`centre,
`so he
`is
`inclined
`in the
`they
`gave
`no
`symptoms.
`(heparine)
`around
`small
`through
`a filter
`before
`
`pass
`
`by
`the
`
`future
`
`effect more
`not
`to collect
`valuable
`
`a slight
`
`prolongation
`
`of her
`
`than
`data.
`
`Clinical
`
`symptoms
`
`of
`
`the
`
`uremia
`
`during
`
`treatment.
`
`not make
`by
`uremic
`she was
`vomiting
`
`deadly
`that
`For
`patients.
`often
`strikingly
`was
`temporarily
`
`indolent
`the
`first
`well
`and
`less
`
`impression
`dull
`and
`after
`days
`four
`her mind was
`violent
`after
`the
`
`the
`per-
`5th
`
`of
`or
`
`the
`was
`the
`after
`as
`
`of
`that
`
`would
`One
`off
`with
`
`suffice
`gets
`the
`after
`the
`the
`tem-
`of urea
`in
`per
`24
`concen-
`
`concerning
`results
`finds
`1 one
`In table
`where
`dialysis,
`fractionnated
`more. With
`the
`percentage
`the
`kidney,
`times
`through
`the
`bath
`water.
`to
`the
`concentration
`in
`It
`the
`through
`kidney.
`once
`blood
`flows
`only
`so
`completely.
`Besides,
`out
`not
`being
`washed
`after
`prolonged
`dialyses,
`rises
`urea
`in
`bath
`the
`bath.
`in the
`change
`the water
`sees
`one
`From this
`table
`removed
`urea
`are
`being
`account
`be
`taken
`into
`before
`only
`once
`was
`changed,
`the
`
`the
`
`Milestones
`
`in Nephrologv
`
`the
`of
`In
`
`summarized
`urea
`circulates
`blood
`in the
`blood
`urea
`continuous
`dialysis
`is
`therefore
`most
`the
`concentration
`future
`we
`
`in
`
`I’)63
`
`once
`a few
`sinks
`the
`often
`of
`shall
`
`creatinine,
`acid,
`uric
`that
`by
`dialysis.
`blood
`the
`from
`flowing
`blood
`was
`that
`the
`In
`the
`being
`infused
`again.
`substances
`large
`amounts
`these
`of
`the
`dialysis
`(51 mg
`per
`
`of
`
`rest
`
`nitrogen
`The
`fact
`through
`the
`rinsing
`bath,
`had
`accu-
`cm3
`for
`
`l0()
`
`end
`
`not
`towards
`
`and
`must
`kidney
`which
`mulated
`urea).
`percentage
`The
`accurately.
`read
`table
`From
`from the blood
`Percentage
`percentage
`presume
`flowing
`entirely.
`intoxication
`
`be
`
`of xanthoproteine
`
`in heparinised
`
`blood
`
`could
`
`not
`
`gather
`
`that
`
`indoxyl
`
`too
`
`is being
`
`removed
`
`the
`to determine
`but
`One
`cannot
`blood
`so that
`its potassium
`an
`uremia
`of death.
`
`3 we may
`by dialysis.
`impossible
`it
`found
`we
`ofpotassium:
`blood
`plasm.
`in heparinised
`of potassium
`potassium
`dialyses
`very
`rapidly,
`the
`ionised
`the
`kidney
`only
`once
`will
`probably
`lose
`important
`as
`patients
`suffering
`from
`is
`in
`potassium
`often
`seems
`to be
`the
`direct
`cause
`
`that
`through
`This
`
`by
`
`Dialysing
`
`into
`
`the
`
`blood
`
`of
`
`substances
`
`added
`
`to
`
`the
`
`bath
`
`water
`
`in and
`go
`molecules
`membrane
`dialysing
`the
`Through
`or glucose
`out
`of NaCl
`the
`loss
`to compensate
`desired
`e.g.
`bath.
`to the
`rinsing
`added
`are
`substances
`these
`blood
`From table
`entered
`that Cl’
`has
`always
`is evident
`5 it
`patient’s
`from
`the
`kidney,
`especially
`when
`the
`body
`view
`of
`salt was
`too
`low.
`In taking
`a retrospective
`enough
`must
`admit
`that we
`did
`not
`always
`supply
`attributed
`gave
`it
`repeatedly.
`The
`loss
`of Cl’ must
`be
`had
`In the
`dialyses
`N#{176}s,IV and V no
`glucose
`The
`bloodglucose
`sank
`to very
`low values.
`and X (and
`other
`ones)
`glucose
`was
`being
`
`bath.
`VII
`bath.
`
`If
`out.
`from
`
`is
`it
`the
`
`of
`we
`we
`
`patient’s
`the
`percentage
`treatment
`the
`although
`salt,
`to the
`vomiting.
`been
`added
`to the
`In the
`dialyses
`N”.
`resorbed
`from the
`
`that,
`sees
`one
`the
`of
`percentage
`which
`substances
`bath
`added
`to the
`of
`the blood will
`bath,
`a surplus
`
`a well-chosen
`given
`may
`remain
`blood
`are
`as yet
`removed
`water.
`be regulated
`being
`washed
`
`accord-
`out,
`
`the
`
`a
`
`the
`
`did
`S.
`Miss
`made
`usually
`dialysis
`greater
`clear.
`The
`fectly
`dialysis.
`to 9th
`of March:
`16th
`the
`on
`found
`Rochat
`ophthalmologist
`The
`Eyes.
`hemorrhages,
`many
`dilated,
`veins
`widely
`prominent
`papillae;
`strongly
`from the papillary
`region.
`foci
`radiating
`and
`a small
`number
`of white
`the
`edema
`of
`the
`papillae
`The
`sight was
`very
`bad. During
`treatment
`later.
`The
`hemorrhages
`were
`disappeared
`nearly
`entirely
`and
`returned
`The white
`foci
`improved
`totally
`resorbed,
`no fresh
`ones
`appeared.
`and
`sight
`improved
`so much
`temporarily,
`again
`later
`on.
`The
`increasing
`could
`that
`she
`read
`the paper without
`any difficulty;
`this
`improvement
`until
`remained
`the
`last
`days
`of her
`life.
`the bloodpressure
`of
`a sinking
`During
`the dialysis
`Bloodpressure.
`effects
`of
`Secondary
`could
`through
`shock
`often
`be
`observed.
`the
`shock
`Even
`when
`probably
`heparine
`used
`accounted
`for
`this.
`and
`blood,
`extra
`saline
`by
`entirely
`overcome
`after
`dialysis
`giving
`few days
`for
`the
`first
`bloodpressure
`remained
`at
`a lower
`level
`are
`shown
`the
`dialyses
`dialysis.
`the
`graph
`(see
`figure
`6)
`On
`blood
`dialysed,
`of
`quantity
`columns:
`the white
`column
`indicates
`the
`In the
`top
`by dialysis.
`the
`shaded
`one
`the
`quantity
`of urea
`removed
`one
`sees
`the
`graph
`the
`bloodpressure
`has
`been
`reproduced;
`here
`bloodpressure
`each
`time
`after
`a larger
`a lasting
`decrease
`the
`dialysis
`days
`the
`blood
`occurs,
`e.g.
`from
`180/1
`10 to 145/100.
`After
`four
`six
`1.
`the
`removal
`pressure
`returns
`to its
`former
`level.
`Possible
`causes
`are:
`of a tension-increasing
`substance
`from the blood
`by dialysis?
`2.
`insuf-
`ficiency
`of
`the
`left
`ventricle,
`or
`chronic
`shock.
`This
`was
`not
`in accor-
`dance
`with
`the
`clinical
`picture.
`The
`hope
`that
`the patient’s
`Urine.
`to maintain
`a
`certain
`balance
`has
`impression
`that
`the
`urine
`production
`larger
`dialysis
`(see
`figure
`6). This
`porarily
`lowered
`blood
`pressure
`and
`the
`blood
`after
`dialysis.
`Besides
`the
`hours
`decreased
`gradually
`during
`her
`tration
`of
`urea
`in the
`urine
`sank
`till
`urea
`in the
`blood.
`This must
`be
`seen
`sive
`renal
`degeneration.
`been
`Never
`has
`there
`dialyses.
`The
`sediment
`erythrocytes.
`
`production
`urine
`fulfilled.
`been
`not
`slackened
`suddenly
`connected
`may
`be
`the
`lowered
`percentage
`of
`amount
`urine
`passed
`stay
`in hospital,
`and
`the
`it equalled
`the
`concentration
`as
`a consequence
`of
`the
`progres-
`
`of
`
`of hemoglobine
`a trace
`only
`seldom
`contained
`
`in the
`some
`
`urine
`leucocytes
`
`after
`
`the
`and
`
`above
`printed
`table
`From the
`a normal
`sodium
`rinsing
`bath,
`If necessary,
`other
`unchanged.
`K,
`etc. may
`be
`e.g.
`Ca, Mg,
`The
`dialysable
`constituents
`to
`those
`of
`fluid
`in
`ing
`deficit
`replenished.
`resorbed
`Oxygen
`is
`sees
`blue
`blood
`
`one
`
`the
`
`very
`get
`
`rapidly:
`red.
`
`already
`
`after
`
`a few windings
`
`Peru’iitages
`
`of
`
`z(cid:1)rea
`
`in the blood
`
`I.
`
`Table
`and in the rinsing
`
`hat/i
`
`in (cid:1)ng
`
`jwr
`
`/00
`
`e,n1.
`
`Research
`
`on substances
`
`removed
`
`by
`
`the
`
`artificial
`
`kidney.
`
`Dialysis
`
`N(cid:1).
`
`I
`
`II
`
`IV
`
`V
`
`VI
`
`VII
`
`IX
`
`X
`
`are
`
`fully
`We
`the
`for
`responsible
`a measure
`chose
`it as
`dialyse
`more
`cules
`will
`in
`the
`larger
`Urea:
`out
`respectively.
`dialysed
`per
`24
`hours
`with
`patient
`Figure
`6 shows
`how
`rapidly
`in the
`beginning
`to rise
`again
`very
`rapidly
`
`is
`
`of
`the
`
`utmost
`the
`at
`urea
`that
`aware
`of uremia,
`but
`symptoms
`clinical
`of
`the
`dialyses.
`the
`results
`for
`bigger
`ones
`less
`rapidly
`and
`urea
`of
`and
`40,
`35
`grams
`dialyses
`24,
`excreted
`quantity
`of urea
`The
`largest
`amounted
`to 12 grams.
`the
`urine
`having
`the
`percentage
`urea
`after
`for
`at
`could
`be
`kept
`same
`level
`after
`the
`treatment
`was
`discontinued.
`
`partly
`only
`nevertheless
`Smaller
`so.
`
`co-
`we
`mole-
`
`were
`by
`the
`
`risen
`26 days,
`
`of patient
`Blood
`dialysis
`Blood
`from kidney
`dialysis
`of urea
`Percentage
`bath
`rinsing
`Blood
`of patient
`dialysis
`
`before
`
`after
`
`in
`
`after
`
`172
`
`217
`
`303
`
`319
`
`255
`
`339
`
`324
`
`324
`
`5
`
`10
`
`2(1
`
`45
`
`10
`
`to
`
`92
`
`3()
`
`7(
`
`55
`
`56
`
`51
`
`275
`
`233
`
`333
`
`Fractionated
`
`dialysis
`
`(‘ontinuous
`
`dial.
`
`Nipro Ex. 1004
`
`000005
`
`

`
`I 964
`
`Journal
`
`of
`
`the American
`
`Society
`
`of Nephrology
`
`!)ata
`
`(()fl((.,.,,jflg
`
`diverse
`in
`
`rel(’Istion
`(cid:1)ng per
`
`100
`
`Sulfa(cid:1)(cid:1)u’t/:vlt/ziazol
`products,
`X.
`c,n3
`in dialysis
`N(cid:1)
`
`aFl(l Calcium
`
`Percentage
`
`ofglucose
`
`in
`
`(cid:1)ng
`
`per
`
`100
`
`ens3
`
`of
`
`blood
`
`and
`
`bat/s
`
`water.
`
`Table
`
`2.
`
`Table
`
`6
`
`Uric.
`acid
`
`9.3
`10
`
`.
`Creatinine
`
`.
`
`Rest
`
`N
`
`Urea
`
`Sulfamet.
`.
`hylthiazol
`
`5.44
`
`l$8
`
`324
`
`15.3
`
`Ca
`
`9.4
`9.4
`
`5.2
`
`4.5
`
`253
`
`Dialysis
`
`N(cid:1).
`
`Blood
`
`of patient
`
`before
`
`dialysis
`
`Blood
`
`from kidney
`
`after
`
`dialysis
`
`Bath water
`
`dialysis
`
`IV
`
`95
`
`95
`
`2
`
`t)
`
`V
`
`98
`
`107
`
`20
`
`1)
`
`0
`
`VII
`
`X
`
`1 14
`
`114
`
`450
`
`454
`
`tSOO
`
`301
`
`1(14
`
`106
`
`550
`
`568
`
`15(5)
`
`189
`
`BlOOd
`
`of patient
`
`heftre
`
`dialysis
`
`Blood
`dialysis
`
`of patient
`
`during
`
`of patient
`
`after
`
`Blood
`dialysis
`
`from kidney
`Blood
`dialysis
`
`during
`
`Blood
`
`from
`
`kidney
`
`after
`
`dialysis
`
`Rinsing
`
`bath
`
`after
`
`treatment
`
`7.4
`
`4.7
`
`4.1
`
`4.8
`
`4.7
`
`2.2
`
`2.3
`
`51
`50
`
`49
`
`233
`
`45
`
`58
`
`51
`
`6.7
`
`6.5
`
`5.3
`
`I,,doxslreactio,i
`
`aftc.r
`
`JOII(’S
`
`(most
`
`intense
`
`colour
`
`takers
`
`as
`
`100).
`
`Table
`
`3
`
`Date
`Dialysis
`
`N(cid:1).
`
`19/Ill
`II
`
`21/Ill
`
`-
`
`22/Ill
`III
`
`23/Ill
`
`-
`
`14/I
`X
`
`4/V
`
`Blood
`
`of patient
`
`after
`
`80
`85
`
`Bath water without
`glucose
`
`Table
`
`7
`
`301
`
`201)
`
`Bath water with
`glucose
`
`Tue
`
`SOdilUfl
`
`percentage
`
`of
`
`the
`
`blood
`
`serum
`
`in mg
`
`per
`
`100
`
`cm3.
`
`,
`loiIll
`
`329
`
`331)
`
`Date
`Dialysis
`
`N(cid:1).
`
`Blood
`
`of patient
`
`before
`
`dialysis
`
`Blood
`after
`
`of patient
`dialysis
`
`Blood
`
`from kidney
`
`. . . .
`
`31/Ill
`VII
`
`305
`
`292
`
`26/Ill
`V
`
`3 12
`
`309
`
`328
`312
`
`309
`308
`
`the
`what
`question
`the
`osmotic
`membrane
`as well.
`force
`is acting
`of
`the
`blood-plasm.
`of water
`may
`probably
`
`easy
`is not
`is doing.
`are
`active.
`the
`blood:
`glucose
`
`concerning
`to form an opinion
`the
`dialysing
`On
`both
`sides
`of
`a mechanic
`From
`blood
`the
`the
`colloid-osmotic
`action
`to the
`bath
`the
`
`retraction
`
`Blood
`
`of
`
`patient
`
`from
`
`Blood
`Bathwater
`
`kidney
`before
`
`treatment
`Bathwater
`
`after
`
`treatment
`
`. .
`
`55
`
`50
`
`1(5)
`
`19
`
`33
`
`0
`
`+
`
`+
`
`Water
`
`It
`water
`forces
`Towards
`By
`adding
`be augmented.
`Cultures
`kidney
`after
`
`l’ercc’(cid:1)stagc’
`
`ofpotas’siui(cid:1)s
`
`in
`(wit/soul
`
`mg
`
`per
`a tracc’
`
`100
`of
`
`1/sc’ patie(cid:1)st
`of
`e,n3
`/sel,solvsis).
`
`S blood
`
`serum
`
`Table
`
`4
`
`Date
`
`l6(cid:1)III
`
`23’III
`
`12/IV
`
`4/V
`
`Potassium
`
`and
`
`18.5
`
`15.8
`
`19.6
`
`and
`
`17.5
`
`18.1
`
`85
`
`92
`
`and
`
`Blood
`
`from
`
`heart
`
`after
`
`8 hours
`
`death
`
`Table
`
`5.
`
`J’crce(cid:1)ttagc
`
`of NaC1
`(calculated
`
`in
`
`1/ic’
`
`blood
`
`plas(cid:1)n
`
`in
`
`(cid:1)ng
`
`per
`
`/00
`
`c,rz3
`
`from
`
`1/sc’
`
`(Cl
`
`‘)).
`
`the
`of
`dialysis
`
`both
`blood
`remained
`
`from
`sterile.
`
`the
`
`patient
`
`as well
`
`as
`
`from
`
`the
`
`Summary.
`
`with
`cms.,
`
`a small
`in which
`
`blood
`the
`
`could
`
`be
`products
`for:
`
`dialysed
`were
`rest N,
`
`is a dialysing-apparatus
`kidney
`artificial
`The
`sq.
`area
`of
`about
`20,000
`and
`a dialysing
`volume
`a patient
`is cleared
`of
`retention
`products.
`of
`blood
`one
`patient
`24,
`40,
`and
`35
`grams
`of urea
`With
`in 1 .5, 4, and
`6 hours
`respectively.
`Other
`retention
`out
`could
`removed
`by dialysis
`as well.
`This
`be demonstrated
`urea,
`acid,
`creatinine
`and
`indoxyl.
`uric
`suffering
`believe
`to be
`able
`to keep
`patients
`We
`punction
`so
`alive
`long
`as bloodvessels
`for
`anuria
`In the
`case
`of acute
`uremia
`possibility
`the
`regenerate
`in
`the meantime.
`Sulfamethylthiazol
`to
`stances
`with
`small
`molecules
`(poisons!)
`may
`sis
`as well.
`
`be
`
`from uremia
`are
`available.
`kidneys
`exists
`for
`the
`and
`other
`sub-
`removed
`by
`dialy-
`
`and
`
`Post
`
`Scriptum
`
`at
`
`the
`
`time
`
`of
`
`correction,
`
`January
`
`the
`
`J5hh1,
`
`1944.
`
`table
`
`5 the high
`value
`In
`caused
`by
`infusion
`probably
`for
`determination
`was
`taken.
`after
`dialysis
`no. X gave
`the
`
`of
`of
`
`748
`saline
`Further
`following
`
`(check
`a short
`analysis
`results:
`
`750)
`time
`
`of
`
`mg%
`before
`the
`
`is
`
`of NaCI
`the
`sample
`rinsing
`fluid
`
`533
`530
`
`535
`
`530
`
`575
`
`585
`
`612?
`
`560
`
`562
`
`570
`
`633
`
`623
`
`474
`
`494
`
`641)
`
`5(K)
`
`506
`
`591)
`
`605
`
`639
`
`638
`
`6(X)
`
`600
`
`748
`
`750
`
`644
`
`636
`
`7(5)
`
`7(5)
`
`7(X)
`
`7(X)
`
`Bath
`
`water
`
`650
`
`65(1
`
`651)
`
`570
`
`223
`III
`
`243
`IV
`
`26/3
`V
`
`28/3
`IV
`
`31/3
`VII
`
`6/4
`VIII
`
`(cid:1)4
`IX
`
`12/4
`
`19/4
`XI
`
`4f(cid:1) (cid:1)
`
`173
`I
`
`590
`558
`
`1)atc
`I)ials’sis
`
`N(cid:1).
`
`Bloc )d of
`
`patient
`
`. .
`
`Blo
`af
`
`)d of
`patient
`ter dialysis
`
`. . .
`
`Blat
`
`d from kidney
`
`533
`534
`
`556
`
`564
`
`658
`652
`
`642
`
`649
`
`633
`
`632
`
`Nipro Ex. 1004
`
`000006
`
`

`
`42 mg of magnesium,
`
`25 mg of
`
`Milestones
`
`in Nephrology
`
`1965
`
`contained
`of bath water
`70 litres
`of potassium.
`and
`210 mg
`phosphorus
`with
`have
`been
`treated
`patients
`Two more
`point
`of view hopeless
`both were
`from a clinical
`from
`cachexia
`and
`uremia
`a man
`suffering
`1.
`grams
`of urea
`were
`removed
`tuberculosis.
`32
`next
`day
`he passed
`more
`urine
`than
`before
`a man
`with
`an
`acute
`glomerulo-nephritis
`kidneys
`been
`decapsulated
`
`artificial
`cases;
`bilateral
`to
`due
`dialysis;
`one
`by
`the dialysis.
`oliguria,
`and
`success.
`He
`
`kidney,
`
`of
`
`one
`passed
`
`the
`
`renal
`on the
`
`2.
`
`whose
`
`had
`
`without
`
`collapse
`into
`did
`not
`he
`contents
`urea
`290 mg%.
`to prevent
`In order
`start
`heparinisation
`100
`and
`100 mg
`
`and
`awake.
`of
`
`a few hours
`coma
`grams
`of urea
`100
`the patient’s
`blood
`
`before
`were
`showing
`
`dialysis,
`the
`removed
`a decline
`
`which
`from
`in 6 hours,
`the
`from 460
`to
`
`to
`200,
`
`thrombosis
`2 or
`3 hours
`of heparine
`
`it proved
`in the needles
`dialysis,
`before
`the
`at hourly
`intervals.
`
`advisable
`by
`giving
`
`Literature.
`
`1.
`
`2.
`3.
`
`4.
`
`5.
`
`On
`of
`
`of
`
`removal
`the
`living
`animals
`therapy.
`Vol.
`
`ofthe
`
`Idem,
`blood.
`Abderhalden’s
`Abt.
`V.
`part
`p.
`1356,
`116,
`
`8,
`1928.
`p. 158,
`
`p. 611.
`Handbuch
`