One-Fortieth of a Kidney

Every business day but one, Ben A. gets into his car in a Seattle suburb and drives clear across the city to the sporting-goods store where he is a clerk. He puts in a normal workday, then drives home to his wife and two small children. What sets Ben A., 24, apart from millions of other Americans who drive daily to and from such jobs is that he spends Wednesdays--a full 24 hours--in University Hospital, hooked up to an artificial kidney. Without that Wednesday stint on the machine, he would be dead, probably before the month is out.

Tubes in the Arms. No human being can live more than two to three weeks unless the poisons that get into the blood through normal metabolic processes are filtered out by his kidneys to be excreted in the urine. Ben A. gradually lost the use of his kidneys, probably because of a long-ago streptococcal infection similar to the type that commonly causes rheumatic heart disease. In his case the infection touched off a form of Bright's disease known as glomerular nephritis (inflammation in and around the filtering capillaries). Around Christmas 1959, the disease threatened to kill him. University of Washington Internist Belding H. Scribner could have kept Ben A. alive for a few weeks by hooking him up to the artificial kidney at short intervals. But this would have needed frequent surgery and still offered no cure. So Dr. Scribner got together with Medical Engineer Wayne Qumton to figure out a long-term answer

Because Ben A. had about one-fortieth the normal kidney function, or roughly half what is needed to maintain life, he could let the poisons pile up in his blood for a few days. Surgeon David Dillard opened an artery and a vein in Ben's left arm and implanted a plastic tube in each. He brought the ends of the tubes out over the forearm, hooked them together to form a bypass that let the blood flow through freely, to prevent clotting. When the small skin wounds healed, physicians connected the tubes to the artificial kidney. This filtered the poisons out of Ben's blood, to give him a few days' lease on life. The beauty of the technique was that with the bypass the tubes stayed in place, ready for the next hookup, without further surgery.

After his Wednesday blood cleansing (technically, a "dialysis"), Ben feels fine until about Sunday. But he passes so little urine that the poisons pile up. He drags around on Monday and Tuesday, can't wait for the day on the machine.

Limitations. Ben A. is probably the only man in the world kept alive by such means and doing a normal day's work. Dr. Scribner has three other patients on a similar routine, though they are not well enough to work. The method is being tested experimentally at a dozen other medical centers in the U.S. and Europe.

The problems are immense. The artificial kidney requires a battery of specially trained doctors, nurses and technicians around the clock to watch over it and its patient, is therefore so costly that it can be used only where research funds are footing the bills. Moreover, it is applicable to relatively few kidney disease cases. For many victims, whose disease is caused by previous high blood pressure, the method is no answer because their arterial disease is the main threat to life. But it shows that an artificial organ can substitute for the natural one for long periods. It will help researchers to find out what the deadly metabolic poisons are and thus, perhaps, point the way to cheaper, safer and less cumbersome ways of treating all forms of kidney disease.

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