Nephrology

A nephrologist is a doctor who look at kidney disease.

• The kidneys are two bean-shaped organs situated in the back muscles (on either side of the spine) of the upper abdominal cavity in our body.
• The main function of the kidney is to filter the blood circulating through your body by removing waste and excess salts and regulate the water fluid levels.
• They are also responsible for regulating pH, salt, and potassium levels in the body.
• Produce hormones that regulate blood pressure and control the production of red blood cells.
• Activate a form of vitamin D that helps the body absorb calcium.

Chronic Kidney Disease.

• The most common form of kidney disease is chronic kidney disease caused by high blood pressure and diabetes.
• Kidney failure is the last (most severe) stage of chronic kidney disease. This called end-stage renal disease or ESRD for short.
• Other causes include, autoimmune diseases, such as lupus and IgA nephropathy, Genetic diseases, polycystic kidney disease, Nephrotic syndrome and Urinary tract problems

Acute Renal Failure:
• This type of kidney failure is called acute kidney injury or acute renal failure and is of sudden onset. .
• Common causes of acute renal failure include Heart attack, Illegal drug use and drug abuse, not enough blood flowing to the kidneys, Urinary tract problems. However this type of kidney failure is not always permanent.

Chronic kidney disease, also known as chronic renal failure, is a slow progressive loss of kidney function over a period of several years. Eventually the patient has permanent kidney failure. It is staged as per based on the patient's level of glomerular filtration rate (GFR) which is a measure of filtering capacity of the kidneys.

• Nausea
• vomiting
• Loss of appetite
• Changes in urine output
• Fluid retention
• Anaemia (a decrease in red blood cells)
• decreased sex drive
• Sudden rise in potassium levels (hyperkalaemia)
• Inflammation of the pericardium (fluid-filled sac that covers the heart

A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract.

Kidney stones form when there is a decrease in urine volume and/or an excess of stone-forming substances in the urine. Dehydration is a major risk factor for kidney stone formation.

Symptoms of a kidney stone include flank pain and blood in the urine can be present.

Diagnosis of kidney stones is best accomplished using an ultrasound, intravenous pyelography (IVP), or a CT scan.

• Most kidney stones eventually pass through the urinary tract on their own within 48 hours, with ample fluid intake.
• Ketorolac (Toradol), an injectable anti-inflammatory drug, and narcotics may be used for pain control when over-the-counter pain control medications are not effective.
• Lithotripsy is a procedure which can be done to remove stones. Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive treatment of kidney stones and biliary calculi.

The most common stone types (calcium oxalate and calcium phosphate, accounting for 80% of all stones) cannot be dissolved with medications. However, in patients with uric acid stones, medication (potassium citrate) can be successfully given to dissolve the stones, helping them to pass and preventing from re-development.

Kidney stones cause pain if they are blocking the ureter and trying to pass down towards the bladder. Stones that are not obstructing are generally not painful.

Each treatment has its own inherent risks. Some risks that can be associated with all surgical procedures are the possibility of bleeding and infection. It is extremely rare for patients undergoing shock wave lithotripsy (SWL) or Ureteroscopy (URS) to have significant problems with blood loss or infection. The probability is higher with more invasive treatments such as percutaneous nephrolithotomy (PNL) or open surgery. Antibiotics are generally given at the time of surgery to help prevent infection.

Some discomfort is inevitable after surgical intervention for stones. The degree of discomfort is directly related to the invasiveness of the procedure. If needed, your urologist will prescribe medication to help control the pain during the recovery period.

Kidney infections are caused when bacteria infects your kidneys. The bacteria are usually a type called E. coli, which live in the intestine. The bacteria get in through the opening of the urethra and move upwards through the urinary tract, first infecting your bladder and then your kidneys.Most urinary tract infections involve only the bladder and urethra (the lower urinary system). Pyelonephritis results when a UTI progresses to involve the upper urinary system (the kidneys and ureters).

Fever, nausea, abdominal pain, vomiting, and confusion.

A Kidney abscesses can occur where pus accumulates inside kidney tissues. Symptoms include blood in urine, weight loss, and abdominal pain.

• Urine output measurements. The amount of urine excreted in a day may help to determine the cause of kidney failure.
• Urine tests: Analysing a sample of urine, a procedure called urinalysis, may reveal abnormalities that suggest kidney failure.
• Blood tests: A sample of blood may reveal rapidly rising levels of urea and creatinine — two substances used to measure kidney function.
• Imaging tests. Imaging tests such as ultrasound and computerized tomography may be used to help see your kidneys.
• Kidney biopsy: Removing a sample of kidney tissue for testing, a kidney biopsy to remove a small sample of kidney tissue for lab testing.

• A kidney transplant is a surgical procedure which allows a person whose own kidneys have failed to receive a new kidney (recipient) from another person. (Donor)
• A successful kidney transplant can improve many of the complications of kidney failure and is the best solution to patients whose kidneys have stopped working or are close to failing.
• The functioning kidney is removed either from a living donor or someone who has recently passed away.
• A transplanted kidney performs all the functions of a kidney a person has from birth

• Patient who is diagnosed with end stage kidney diseases is candidates for kidney transplantation. In other words the kidneys are not functioning optimally.
• The two basic options for treating end-stage kidney failure are dialysis and kidney transplantation.

A) Living donor transplant: Become a Donor Today & Save a Life!

A living donor may be someone in your immediate or extended family, or it may be your spouse or a close friend. In some cases, a living donor may even be a stranger who wishes to donate a kidney to someone in need of a transplant.

Advantages of Live Donor Transplant are as follows:

• Receiving a kidney from a living donor has shown to last longer than a kidney from a deceased donor.
• The operation can be planned to suit your schedule, since it is not necessary to wait for a kidney to become available from a deceased donor.

B) Deceased donor (cadaver donor) is someone who has consented to donating his or her organs upon death. In situations where the wishes of the deceased donor are not known, family members may consent to organ donation.

A person is advised kidney transplant in the following conditions”
Kidney Failure - Temporary (AKI Acute Kidney Failure)
- Permanent (CKD Chronic Kidney Disease

Dialysis is the procedure wherein blood electrolytes are balanced and wastes and fluids are filtered out of the blood.

Peritoneal

Haemodialysis

• You need dialysis when you develop end stage kidney failure - the time you lose approx. 85 - 90 % of your kidney function.4
• Dialysis, regardless of the type can restore some functions of your kidneys but not all.

The purpose of the dialysis machine acts as a special filter like an artificial kidney and gets the blood cleaned. An access is taken through the blood vessels so that the blood is enters the dialyser.

The dialyser has two parts separated by a thin membrane the blood cells, proteins and large molecules remain in the blood but the waste products are washed away, this is how blood is cleaned.

It is usually done three times a week for about three to four hours . it can be done at  home frequently 4 to 7 times per week. In kidney failure it has to be done in a shorter time.

What is peritoneal dialysis?

A soft plastic tube is placed in the abdomen and a sterile cleansing fluid is placed through this catheter. After dialysis is complete, the fluid leaves your body through the catheter. There are two types:

• Continuous Ambulatory Peritoneal Dialysis
• Automated Peritoneal Dialysis

This is 24 hours; patient is not sleeping and can move around when dialysis is going on during peritoneal dialysis.

• A renal or kidney biopsy is a diagnostic procedure used to separate and evaluate kidney tissue.
• It helps doctor to identify and assess kidney disease, its severity, and consequently, decide its treatment.
• A renal biopsy also helps to monitor the effectiveness of kidney treatments and complications, if any following a kidney transplant.

• Percutaneous or a renal needle biopsy
• Percutaneous or a renal needle biopsy

Percutaneous nephrolithotomy (PNL) is the procedure of choice for the treatment of large or complex” renal calculi” commonly known as “renal stones”. This technique is well established, with high rates of success and accepted morbidity. Percutaneous nephrolithotomy technique is in constant evolution. Supine position has been proved as an acceptable option.

PCNL offers effective option for removal of large and complex stones in patients with minimal invasion. Percutaneous nephrolithotomy are safe with very low morbidity.

Yes; the follow up treatment is targeted to prevent recurrence of the kidney stones

The usual hospital stay following successful l PCNL is around 3-4 days. However, the treating doctors shall determine the health status of the patient and shall advice accordingly.

The usual hospital stay following successful l PCNL is around 3-4 days. However, the treating doctors shall determine the health status of the patient and shall advice accordingly.

Patients are recommended PCNL when the urine low is blocked, pain due to presence of kidney stones, large size kidney stone unable to pass through urine, urine leakage, recurrent urinary tract infection due to kidney stones etc

The length of time the stent remains in place is variable. Your doctor will probably request it to be removed within a 1-4 week period. This can be removed in the doctor's office. It is common to feel a slight amount of flank fullness and urgency to void as a result of the stent. These symptoms often improve over time as the body adjusts to the indwelling stent. It is critical that patients return to have their stent removed as instructed by their physician as a prolonged indwelling ureteral stent can result in encrustation by stone debris, infection, and obstruction of the kidney.

Lithotripsy is a procedure that uses shock waves to break up stones in the kidney, bladder, or ureter (tube that carries urine from kidneys to the bladder. After the procedure, the tiny pieces of stones pass out of your body in your urine. The lithotripsy attempts to break up the stone with minimal collateral damage by using an externally applied, focused, high-intensity acoustic pulse.

A fluoroscopic x-ray imaging system or an ultrasound imaging system is used to locate the stone and aim the treatment. The patients undergoing this procedure can, in some cases, see for themselves the progress of their treatment with the help of the ultrasound or x-ray monitor.

ESWL is the least invasive and the commonest treatment for kidney stones however it provides very low stone free period for the patient. The passage of stone fragments may take a few days or a week and may cause mild pain. ESWL is not without risks. Overall complication rates of ESWL range from 5–20%.