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Technological Advances in Renal Replacement Therapy

An ideal form of renal replacement therapy would mimic the kidneys completely. It would remove solutes with a molecular weight spectrum similar to that of the kidneys; would remove water and solutes on the basis of individual patient needs; and would be bio-compatible, wearable, and ideally implantable.

 Nissenson and colleagues have proposed the human nephron filter (HNF) as a novel mode of RRT for patients with ESRD. The HNF consists of two membranes that operate in series within one cartridge. The first membrane is called the G membrane and is analogous to the glomerular membrane in the nephron. It mimics the functions of the glomerulus by using convective transport to generate plasma ultra filtrate that contains solutes that approach the molecular weight of albumin. The second membrane is called the T membrane and mimics the functions of the tubule.

T membrane consists of human cortical tabular epithelial cells (HCTC) seeded onto samples of single-crystal silicon, polycrystalline silicon, silicon dioxide, silicon nitride, SU-8 photoresist, SNM’s and polyester tissue culture inserts, and grown to confluence. The cells formed confluent monolayers with tight junctions and central cilia. It is molecularly engineered and selectively reclaims convectively the designated solutes to maintain homeostasis. No dialysate used in the system.

Human nehron filter (HNF) will be implantable devices and shall function throughout 24 hours. These exciting new technologies if realized would replace existing ways of dialysis and transplantation benefitting patients suffering from chronic kidney disease.

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