Abstract
Uræmia is common, little is known of its actual nature and treatment has therefore been unsatisfactory. The kidney is not only an organ of excretion but guards the chemical and physical constitution of the extracellular fluids.
In uræmia, urea and other products of metabolism including the toxic phenols accumulate. That the physical and chemical composition of the extracellular fluids, excluding protein, can be influenced by contact across a semi-permeable membrane is the basic concept of the treatment of uræmia by dialysis, whether by means of the artificial kidney or by peritoneal lavage.
The principles of treatment of uræmia are: (1) To remove the cause. (2) Reduce the load on the kidney. (3) Assist or take over the function of the failing kidney in the hope that it may recover. (4) To relieve symptoms without thereby prejudicing recovery.
Dialysis can be effected by peritoneal lavage or by conducting the circulating blood through a tube of semi-permeable membrane. The composition of the dialysing fluid is of the utmost importance the aim being to keep the physical and chemical balance of the extracellular fluid within the normal range and to encourage the diffusion of toxic metabolic products. The excessive use of parenteral fluids and diuretics in uræmia may be harmful. A number of cases of peritoneal dialysis are described.