For Kidney Crises

To most laymen, mention of anything seriously wrong with the circulation of the blood suggests trouble in the heart or the arteries leading to the brain; rarely do they consider the kidneys. But more than half of all U.S. deaths are classed technically as due to "cardiovascular-renal" diseases, and last week the American Heart Association marked its annual fund drive with new emphasis on the renal (kidney) part of the triad. Most notable exhibits: "artificial kidneys," which are now saving lives at a growing number of U.S. medical centers.

The human kidney is a filter capable of such fine chemical discrimination that no machine yet visualized can come near matching it. But with uncommon ingenuity and commonplace materials, researchers have produced an effective stand-in which does its most obvious and important jobs. Head and shoulders above other kidney makers is tall, tart Willem Johan Kolff, 48, of the Cleveland Clinic. Physician Kolff made his gadgeteering breakthrough in his native Netherlands during the Nazi occupation.

Prefabs at $59. First model made in the U.S. was almost as big as a commercial laundry machine and cost up to $7,000. Dr. Kolff has now got it down to a stainless-steel tub 24 in. across, 17 in. high. Three-fourths of the artificial kidneys in U.S. use are of this type, made by the Travenol division of Baxter Laboratories. Cost: $1,300. Most important economy feature: instead of big moving parts that took hours to sterilize and set up, the core of the kidney now consists of a disposable unit of cellophane and plastic wire, not much bigger than a quart can, which comes pre-sterilized at $59.

The artificial kidney is for crisis situations when hours mean the difference between life and death. The human body cannot survive unless at least one kidney is doing its job of filtering the body's waste products from the blood so that they can be voided in the urine. A variety of things can cause an abrupt kidney shutdown: shock with heavy blood loss (after surgery or an accident), some severe infections, mismatched transfusions, and many poisons. Of these, carbon tetrachloride attacks the kidneys directly; most are general poisons (often, overdoses of common drugs such as barbiturates and even aspirin) which the overloaded natural kidneys cannot void fast enough.

Wintergreen for Laxative. In New York City last week a longshoreman, 62, went to his medicine cabinet in the dark seeking castor oil, pulled out the wrong bottle and drank 2 oz. of oil of wintergreen. He was soon in convulsions and a raging fever, and threatened with death from brain damage. Rushed to Bellevue Hospital, he was stretched out beside the artificial kidney, which was primed with two pints of blood containing heparin to prevent clotting. Attending doctors from Cornell University put a cannula into the radial artery in the patient's wrist, connected this by polyethylene tubes with the core of the artificial kidney. Key part of this core: cellophane tubing of ordinary sausage-casing size. From the core, other tubes led back to veins in the patient's elbow.

As the poison-laden blood flowed through the core, a pump bathed the tubing in a chemical bath matching the salinity and acidity of normal blood. The minute porosity of the tubing allowed chemicals abnormally concentrated in the blood to escape into the rinsing fluid's lower concentration. But the holes are too fine to pass blood cells or big protein molecules. Dialysis ("through solution") took six hours, with a squad of four physicians and specially trained technicians in constant attendance. It saved the longshoreman's life.

Lose a Quart. Smallest patient treated at New York Hospital was a 26-lb., two-year-old boy who had mistaken aspirin for candy. The vessels in his arm were not big enough for the cannulas, so the doctors worked tubes from his thighs up into the great veins entering the heart, kept them spaced far enough apart to avoid recirculating the same blood. After dialysis and a night's sleep, the boy woke up well.

In kidney failure following shock, the artificial kidney can remove an ounce of urea in six hours, along with potent but still unidentified poisons. Patients suffering from edema (waterlogged with brine) can lose a quart an hour with a simple pressure adjustment.

There are many things the human kidney does automatically that the artificial kidney cannot yet do, but in crisis situations, the Kolff device and its variants do things that nature alone cannot do.

This file is automatically generated by a robot program, so reader's discretion is required.