UNIT 8: URINARY SYSTEM

SECTION A: KIDNEY DISEASE

1 You are going to read a story of Peter, a kidney patient. He uses the following expressions in his account of
life with kidney diseases. Find out the meaning of those you do not know and then think why or in what
context he uses them.

They wouldn't answer. CAPD bone weary fatigue flu

Prozac a high achiever hopes fade be sick
horrible gloopy stuff put an end to all that a flock of junior doctors
a phone call forced fluid intake dissociated state
peeing for England assumed it was now happy ever after
wary of planned trips outside Europe

2 Now read the story and see if your predictions match Peter's actual experience.6

14 YEARS AS A KIDNEY PATIENT – A SNAPSHOT OF MY MEMORIES

We thought I had flu. I was sick, shaking, couldn’t in the corridor.

stop hiccupping. After seeing three GPs I was Good advice
eventually sent to hospital. Then the ambulance to from nurses –
the specialist unit, a dialysis machine in the middle never let a doctor
of the night, in the middle of winter. My wife asked take blood. Staff
if I was going to die. They wouldn’t answer. In the becoming friends.
event it seems I was quite close. My memories of Feeling safe.
that time in hospital are strangely disassociated.
Over the months increasing tiredness then CAPD.
Woken up every
Those were the desert years. Bone weary fatigue. A
few hours when the dialysis machine was wheeled
daily routine, hoover, walk the dogs, collapse into a
in, trees silhouetted through the window. That
chair. The down side – frustration, anger, feeling
horrible gloopy stuff they insisted I had to eat and
suicidal, to the GP – God bless Prozac. Coming to
Sue spooning it into my reluctant mouth. I was
terms with it all. The up side, making best use of
discharged from hospital for Christmas. Home after
what energy I had, reading, getting into philosophy
six weeks. Gradually back to work, but without the
again, caravan holidays, walking the dogs on the
energy to do the job.
beach, discovering local folk concerts, local theatres.
Some context. My wife Sue and I had been together Hilarious family meals.
for 7 years and were about to adopt, after a year’s
But years pass, you get slower, hopes of a transplant
preparation, two much battered children. I had
fade. Winter again. A phone call; “are you up for a
never had a stay in hospital before this episode of
transplant?” Three hours later – on the table.
acute kidney injury (AKI). I was a high achiever,
Afterwards they said I looked different, smelt
working in the social care sector looking forward, at
different. I certainly felt different. Ready for home.
56, to one more big job, one more project where I
Looking forward to a normal life. That was it,
could make a difference. AKI and the fatigue put an
assumed it was now happy ever after!
end to all that.
Winter again, four years later. Christmas Day,
We moved home to Derby. At first, I seemed to be
rushed into hospital. Violently sick, shaking, and
in and out of hospital like a yo-yo. A lot of pain at
this time hallucinating. They told me I was seriously
times. A flock of junior doctors, huddling uncertain
ill, 50% kidney function gone – although that came
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 UNIT 8: URINARY SYSTEM

back. The disassociated state, an observer as much Still, plenty to do; we’re planning a month’s slow
as a patient. Forced fluid intake, felt I was peeing for drive round Scotland in September. Must remember
England. Back home, I took two months to get fit the tablets.
again. Bit more wary now of planned trips outside
Europe.

3 Based on what you have read (and what you may know about kidney patients) discuss the following questions
with your partner.

1 What do you think are the most difficult aspects of living with kidney disease?
2 What is Peter's attitude to his experience? Has it been changing throughout? If yes – how?
3 What attitude did he take toward different ranks of healthcare staff?
4 Is he more optimistic or pessimistic as regards his future life with kidney disease?

4 Go online and find out about one of the following issues – the symptoms and causes of chronic kidney
disease. Then explain to the class.

- symptoms of chronic kidney disease

- connection between high blood pressure (HBP, hypertension)
and chronic kidney disease
- connection between diabetes and chronic kidney disease
- complications of chronic kidney diseases

SECTION B: KIDNEY DISEASE TREATMENT OPTIONS

1 Read the profiles of three kidney patients, candidates for dialysis.

TREVOR
Trevor is a young college student, 22, with a very active lifestyle. Apart from his
studies, he is a keen sportsman and traveller, engaged in several extracurricular
activities organized by his college. He is a very outgoing person, popular among his
mates. He has no siblings and his parents got divorced when he was three years
old. Although his mother does her best to support him at college, he needs to have a
part-time job too. Lately, Trevor's lifestyle has started to take its toll on him. So
much so, that he has developed a severe gastritis which required a short hospital
treatment. Three days later he was back with AKI, caused probably by inadequate
combination of medications prescribed for his stomach. After emergency treatment, he was left with severely
limited kidney function and in need of dialysis. Despite these misfortunes he keeps a warrior mindset and wants
to be in control of his situation. He has decided not to let his condition limit his life options.

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 UNIT 8: URINARY SYSTEM

CHRISTINE
Cristine is a middle-aged woman, 48, working a part-time job as a receptionist in
a local hotel in her town. She is a very communicative and sociable person. She has
reduced her workload lately due to her history of duodenal ulcers and because she
was diagnosed with type 2 diabetes three years ago. Her children are grown up and
live abroad, her husband often travels for work. They live in a small, two-room flat.
She hasn't been feeling well lately, experiencing intermittent muscle cramps,
fatigue and swollen feet. Her blood pressure has increased, too. After a few medical
check-ups, she was diagnosed with chronic kidney disease and her doctor suggested she may need to go on
dialysis. She has always been afraid of needles and faints at the mere sight of blood. She lives quite far from the
clinic, though this is reasonably accessible by public transport.

MATTHEW

Matthew is a late middle-aged man, 64, nearing his retirement. He works as a finance
administrator for a big company, which is a quite stressful position though he rather
enjoys it.
He has a history of high blood pressure and angina. Apart from that, he has been
suffering from chronic kidney diseases which has progressed to an advanced stage. He
needs to change his dialysis treatment and has been put on a kidney transplant list. He
is married to a stay-at-home wife and has three adult children (all with their own
families now) living nearby. He is anxious to avoid early retirement as this could
significantly affect his pension rates.

2 Now read the information below and decide what kind of dialysis you would consider more suitable for each
of the patients. Give reasons for your choice and suggest what lifestyle changes the patients may need to
make.1, 5

What is dialysis?
- Dialysis uses a filtering machine or a special fluid in your belly to filter waste out of your body. This is
usually something your kidneys do.
- Dialysis only filters out waste – it can’t replace other functions of your kidneys, such as making
hormones. Dialysis only does 10–15% of the work that a healthy kidney would do.
- For some people, dialysis is the only option for treating kidney disease. For others, dialysis keeps them
alive until a kidney is found for a transplant.

What are the dialysis options?

- Peritoneal dialysis (PD)
- Haemodialysis

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 UNIT 8: URINARY SYSTEM

Peritoneal dialysis (PD)

Special fluid and part of your belly work together to filter waste out of your blood. You might need this
treatment every day. With some training, you can do PD at home, at work, when traveling, or while you
sleep.
- A special fluid is put into your belly through a tube.
- The fluid and the lining of your belly work together to clean your body.
- While the fluid is in your belly, you can walk around and do your daily activities.

PD is done every few hours, the used fluid must be drained, and new, clean fluid put in. This is not painful
but must be done carefully so you don’t get an infection. You have to sit still while the fluid drains and new
fluid goes in, which takes about 30 minutes.

Haemodialysis
A machine filters waste products out of your blood. You might need this treatment 3-4 times a week or every
day. It can be done at home or at a dialysis centre. It takes 3–5 hours each time, and you will be connected to
the machine for that time.

- Usually, 2 needles are put in your arm or into a catheter (tube) in your chest.
- Your blood comes out of your body through one of the needles.
- Your blood runs through a tube into a machine that filters out extra waste and fluid.
- The clean blood goes through another tube and back into your body through the other needle.

How to choose a type of dialysis

Peritoneal dialysis (PD) may be a choice for you if you:
- don’t have certain stomach diseases, such as Crohn’s disease, heart disease or cancer
- don’t have scars on your stomach that get in the way of treatment
- still have some limited kidney function
- want to do your own treatment at home
- can do treatment every day
- have space to store supplies at your home
- want to be independent and in control of your treatment

Haemodialysis in a dialysis centre may be a choice for you if you:

- live close enough to a centre to get there 3 times each week
- want to have 4 dialysis-free days a week
- would rather have trained professionals handle your
treatment than do it yourself
- are ok with restricted fluid intake and diet
- are ok with needle sticks

Haemodialysis at home may be a choice for you if (you):

- want to do your own treatment at home
- can do treatment most days of the week
- your family member is willing to be trained to help you
- have space to store a machine and supplies at your home
- are ok with restricted fluid intake and diet
- are ok with needle sticks

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Potential problems with each type of dialysis

The longer you stay on dialysis, the more likely you are to get heart disease or an infection. This can be
deadly.
Possible side effects of PD:
- fatigue Possible side effects of haemodialysis:
- infection in your belly, peritonitis - muscle cramps
- hernias caused by pressure from the dialysis - high or low blood pressure
solution - joint pain and stiffness
- bloating, nausea - fatigue
- weight gain - depression, anxiety
- higher blood sugars if you’re diabetic - blood infection, sepsis
- high temperature

Teacher Chat
Students may go online if they wish to get an even broader perspective on the issue, though the information provided here is
sufficient for the task. You may conduct this as a pair/group activity and assign one patient per group etc., depending on time
constraints. There are no recommended answers here, the result is based solely on students' opinions and discussion.

Sources
https://transplantliving.org/kidney/what-is-dialysis/ and following sites
https://www.nhs.uk/conditions/dialysis/pros-cons/

3 Discuss the following questions concerning kidney transplant with your partner.

1 Do you know anybody with a transplanted kidney?

How are they doing?
2 How many kidney transplants are performed in the Czech/Slovak
Republic yearly?
3 Why is kidney transplant a good choice for many patients with
chronic kidney disease? What are the most noticeable benefits?

4 Read the short text below and discuss the questions concerning illegal organ trade in pairs.10

The world is desperate for organs. If you need a new kidney in the USA, you only have a one in three chance of
obtaining it legally. People are prepared to pay a lot of money to save their own or loved one's life. So an
international black market for human organs and surgery exists.

1 What do you know about illegal organ trade?

2 Of all global transplants how much do you think illegal trade accounts for?
3 Why is a kidney the most frequently traded organ on the black market?

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 UNIT 8: URINARY SYSTEM

5 The following words are used when speaking about transplantations and illegal organ trade. What do they
mean? Explain or find out.

donor vendor broker recipient poverty next-of-kin trafficking

6 Watch a video concerning illegal organ (kidney) trade and complete the gaps in the text with the words from
the video script. There are always two words per gap.8

1 One of the reasons behind the booming illegal kidney trade is the

increase _____________________ in the West.

2 There are four basic models of live _____________________.

3 The direct model is the _____________________.

4 Similarly to human and sex trafficking organ donation can be done

_____________________.
5 In some parts of the world creditors accept a kidney as _____________________.

6 People who sell their own kidney to get out of extreme poverty are not selling their kidney

_____________________.

7 People in _____________________ tend to be targeted for organ donation.

8 Selling an organ in the black market presents serious _____________________.

9 Uneducated donors may be even be made to believe their kidney will _____________________.

10 Infection, chronic pain and the damaged _____________________ often result from organ transplants

performed illegally.

11 By legalizing organ trade, Iran _____________________ their black market but still there is

a _____________________ to deal with.

12 By legalizing organ trade, you may actually encourage people to cause _____________________ to

themselves. This means the most poorest and the most desperate will still be _____________________.

Some critics of legalizing organ trade would even say that the government is _____________________

from the poor.

13 The flow of organs has always been in _____________________ only.

14 The only way to deal with the organ problem is _____________________ which means to massively

increase the _____________________ of organs.

15 To solve the issue with a huge shortage of kidneys everybody could become a _____________________.

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 UNIT 8: URINARY SYSTEM

SECTION C: ANATOMY AND FUNCTION OF KIDNEYS

1 What do you know about kidneys? Discuss the questions in pairs.

1 What is the function of kidneys?

…………………………………………………………………………………………………………….

2 How many times does the blood pass through the kidneys each day?

…………………………………………………………………………………………………………….

3 How many litres of blood do the kidneys filter every 24 hours?

…………………………………………………………………………………………………………….

4 What does nephron, the basic functional (filtering) unit of kidney, consist of?

…………………………………………………………………………………………………………….

5 What is urea?

…………………………………………………………………………………………………………….

6 What happens to waste products in blood, such as urea?

…………………………………………………………………………………………………………….

7 What happens when you consume less water than you should?

…………………………………………………………………………………………………………….

8 What is the connection between kidneys and renin and erythropoietin?

…………………………………………………………………………………………………………….

2 Now watch a short video about the function of kidney and check and/or note down the answers to the
questions you discussed.7

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 UNIT 8: URINARY SYSTEM

SECTION D: VOCABULARY CONSOLIDATION

1 There is one wrong word in each sentence. Identify it and replace it with a more suitable one. Try to recall the
expressions you came across in this lesson. It is possible you will come up with more than one expression.

1 Ian is a haemodialysis patient. He complains of being thirsty most of the day as his fluid intake is
resolved to one litre per day. _____________________
2 Margaret was successfully operated and received a new kidney. Unfortunately, she increased a severe
infection while still in hospital. _____________________
3 If toxic substances put up in your blood, it can lead to sepsis. _____________________
4 Due to the medical team's negligence, Rory was freed from hospital in critical condition.
_____________________
5 Julia's mother never cared about her hypertension which in the end literally called her kidneys off.
_____________________
6 Please don't forget that when you waste the fluid from your belly in peritoneal dialysis, you need to sit
still. _____________________
7 Excessive consumption of salt can extend the kidneys' ability to filtrate the blood properly.
_____________________
8 Unfortunately, the damage done to kidneys by chronic kidney disease is uncertain.
_____________________

USEFUL EXPRESSIONS

to account for tvořit (část z celku) duodenal ulcer dvanáctníkový vřed

anxiety úzkost emergency treatment nouzové ošetření
availability dostupnost end konec
battered child týrané dítě to put an end to sth ukončit něco
to be on transplant register být v registru exploitative vykořisťovatelský
transplantací extracurricular activities mimoškolní činnosti
to be targeted for organ donation být vytipován pro fatigue únava
dárcovství orgánů to feel suicidal mít sebevražedné myšlenky
bloating nadmutí břicha flu chřipka
breakdown of proteins rozklad bílkovin fluid tekutina
broker makléř, prostředník bodily fluid tělní tekutina; restricted fluid
creditor věřitel intake omezený příjem tekutin
dialysis dialýza to drain fluid odsát, vypustit tekutinu; to filter
haemodyalisis hemodialýza; peritoneal dialysis out fluid odfiltrovat tekutinu
peritoneální dialýza gastritis gastrititida, zánět žaludku
debt repayment splacení dluhu glomerulus glomerul, klubíčko
disassociated state zde: stav extrémní odtažitosti od to hallucinate mít halucinace
života harm újma
to discharge sb from hospital propustit někoho to cause bodily harm způsobit tělesnou
z nemocnice újmu
demand zde: poptávka (ekonomický termín) healthcare staff pracovníci ve zdravotnictví
to meet demand uspokojit poptávku hernia hernie, kýla, výhřez
downside nevýhoda, stinná stránka to hiccup škytat
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high achiever volně: úspěšný člověk deceased organ donor zesnulý donor – dárce
hope fades naděje uvadá orgánů
hormone hormon to harvest organs odebírat orgány
to secrete a hormone vylučovat hormon organ trade obchod s orgány
to huddle shluknout se, schoulit se illegal organ trade ilegální, nezákonný obchod
hypertension (HBP) hypertenze, vysoký krevní tlak s orgány
to ingest přijímat potravu to legalize organ trade legalizovat obchod
intermittent muscle cramp přerušovaná svalová s orgány
křeč part-time job práce na částečný úvazek
joint pain bolest kloubů to pee čůrat
kidney ledvina peritonitis peritonitida, zánět pobřišnice
irreversible kidney damage (ne)vratné poverty chudoba
poškození ledviny recipient příjemce
transplanted kidney transplantovaná retirement důchod
ledvina to avoid early retirement vyhnout se
acute kidney injury (AKI) akutní poškození předčasnému odchodu do důchodu
ledvin; kidney disease onemocnění ledvin; room for improvement prostor pro zlepšení
kidney transplant transplantace ledvin, to rush sb to hospital rychle někoho převézt do
ledvinový transplantát nemocnice
to obtain a kidney legally legálně získat ledvinu, sexual assault sexuálně motivovaný útok
to perform a kidney transplant surgery provést sibling sourozenec
transplantaci ledvin sieve cedník, síto
low water level nízká hladina, úroveň vody to sift through prosít, procedit
to lure sb nalákat, přivábit stiffness ztuhlost
medical risk zdravotní riziko supply nabídka (ekonomický termín)
to present a serious medical risk to take its toll on brát si svoji daň na
představovat vážné zdravotní riziko trafficking nelegální obchodování, kšeftování
middleman prostředník, zprostředkovatel urea močovina
middle-aged woman žena středního věku ureter močovod, ureter
nausea nevolnost, nucení na zvracení, nauzea urine moč
needle jehla vendor prodejce
nephron nefron, strukturální a funkční část ledviny vulnerable zranitelný
next-of-kin nejbližší žijící příbuzný war zone válečná zóna
observer pozorovatel waste products zde: odpadní látky
organ organ weight gain přírůstek hmotnosti, přibývání na váze
bean-shaped organ orgán ve tvaru fazole workload pracovní zátěž

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REFERENCES

1 https://transplantliving.org/kidney/what-is-dialysis/ and following sites

2 https://www.heart.org/en/health-topics/high-blood-pressure/health-threats-from-high-blood-pressure/how-high-
blood-pressure-can-lead-to-kidney-damage-or-failure
3 https://www.kidney.org/atoz/content/diabetes
4 https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521
5 https://www.nhs.uk/conditions/dialysis/pros-cons/
6 https://www.thinkkidneys.nhs.uk/aki/case-studies/14-years-as-a-kidney-patient-a-snapshot-of-my-memories-
by-peter-naish/
7 https://www.youtube.com/watch?v=FN3MFhYPWWo&t=2s
8 https://www.youtube.com/watch?v=V6GwyvbG7AM
9 https://en.wikipedia.org/wiki/Organ_trade

Pictures

Google images

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