Nephrology

 

r.KMH well equipped with latest infrastructure to treat renal disease. In addition to regular maintenance hemodialysis for chronic kidney disease, continuous Renal replacementand renal transplanation are regularly performed. Nephrology department is managed by team of Nephrologists, Urologist, transplant surgeons having vast experience in India and abroad and team of highly trained dialysis technologists and staff nurses.

WARNING SIGNS OF KIDNEY DISEASE
In early stages of the illness, patients are asymptomatic. Swelling of legs, facial puffiness,reduction in urine output, nausea, vomiting, alteration of sleep pattern itching, anaemia are other symptoms. It is mandatorythat routine testing for kidney diseases are done on a regular basis.

WHO NEEDS TO BE SCREENED?

  • All diabetic patients should be screened for renal diseases every 3 months
  • Hypertensives
  • Obese individuals
  • Childhood history of urological surgery
  • Family history of renal disease

All the above categorized be screened for renal diseases. Those with history of renal stone disease should undergo urine analysis, renal parameter evaluation ,renal Doppler periodically as advised by the Nephrologist.

DIALYSIS
It is dishearting to say patients that they have to undergo dialysis weekly twice life long to sustain life. But large group of patients are coming in late stages of renal failure, when they have no options except to dialysis. the only way to reducethe burden is early deduction of renal diseases and their prevention.
Dr.Kamakshi memorial Hospital is well equipped to tackle any renal disease at any time of the day. Round the clock dilysis facilities are available .CRRT is regularly done for post-operative, sepsis patients with volume overload.
SLED machine is a new add to our unit for taking care of critically ill patients. Permcath placement /A.V. grafts are placed very efficiently by our cardiovascular team.
AV fistulas are planned in advance and catheter sepsis in our unit is almost nil. All ICU medical officers are very efficient in placing temporary vascular access in emergency situation. Hemodialysis is done at ICU ITSELF WITH ZERO DELAY.
Dr.KMH does routine renal biopsy by USG guidance. The hospital is equipped with ample number of dialysis in which machine dedicated for positive case. Puere R.O system and U.V. light sterilization for water treatment makes the department functions effectively.

WHAT IS A KIDNEY TRANSPLANT?
Kidney transplanation means replacement of the failed kidneys with a working kidney from another person, called a donor. kidney transplanation is not a complete cure, although many people who receive a kidney transplant are able to live much as they did before their kidneys failed. People who receive a transplant must take medication and be monitored by a physician who specializes in kidney disease (nephrologist) for the rest of their lives.

KIDNEY TRANSPLANTATION
Family members or individuals who are unrelated but make a good match may be able to donate one of their kidney.
A person receiving a transplant usually receives only one kidney, but, in rare situations, he/she may receive two kidneys from a decresed donor. In most cases, the diseased kidneys are left in place during the transplant procedure. The transplanted kidney is implanted in the lower abdomen on the front side of the body.

WHY IS A KIDNEY TRANSPLANT RECOMMENDED?
A Kidney is recommended for persons who have serious kidney dysfunction and will not be to live without dialysis or a transplant. Kidney transplant patient’s quality of life is better than dialysis patient. On long term basis Renal transplant is cost-effective.

INTERNATIONAL SOCIETY OF NEPHROLOGY – RECIPE FOR PREVENTION OF KIDNEY FAILURE

  • Prevent Obesity
  • Keep physically fit
  • Stop smoking
  • Control blood pressure adequately
  • Control diabetes
  • Treat proteinuria & early kidney failure
  • Treat elevated cholestrol & lipids
  • Treat anemia

Have regular follow-up & treatment as necessary.

INSTRUCTIONS TO BE FOLLOWED BEFORE KIDNEY TRANSPLANTATION
Overseas patients when they come for renal transplant are advised to have a complete health check-up of the donor and serology test so thst there won’t be any delay in underoing surgery.

Chronic kidney disease
Chronic kidney disease (CKD) is when one suffers from gradual and usually permanent loss of kidney function over time, usually months to years. CKD is also referred to as end-stage renal disease, where there is total or near-total loss of kidney function and patients need dialysis or transplantation.

The major causes of CKD are diabetes and high blood pressure, in addition to other causes such as multiple cysts in the kidneys (polycystic kidney disease), Glomerulonephritis (inflammation and damage of the filtration system), hardening of the arteries (atherosclerosis), chronic kidney infections and certain medications. Although there is no definite data on the incidence of kidney failure in India, it is estimated that about 1 lakh new patients are diagnosed with this condition every year.

In contrast to CKD, acute renal (or kidney) failure (ARF) happens rapidly and may be due to dehydration, disruption of blood flow through the kidneys as in heart or liver failure or after major surgery or infection. Sometimes it is due to obstruction of the flow of urine or due to diseases of the kidneys themselves such as glomerulonephritis. Usually the kidneys in ARF recover most of their function with adequate support and treatment of the cause of the illness. In a small percentage of cases recovery may not be complete and this results in renal insufficiency or even chronic renal failure.

The Nephrologists at Dr Kamakshi Memorial Hospital provide expert medical treatment for renal failure which is aimed at slowing the progression of the disease, treating the underlying cause and to treat complications as and when they arise. However sometimes the damage is irreversible and one has to replace lost kidney function either by dialysis or transplantation.

In end-stage renal disease, kidney function can be replaced only by dialysis or by kidney transplantation. See the Transplant section for more information about transplants. There are two types of dialysis offer our patients: hemodialysis and peritoneal dialysis.

Hemodialysis involves circulation of blood through a filter on a dialysis machine. Blood is cleansed of waste products and excess water. The acid levels and the concentration of various minerals such as sodium and potassium in the blood are normalized. The blood is then returned to the body. If one needs long-term haemodialysis this requires access to a blood vessel so that the machine has a way to remove and return blood to the body. This may be in the form of a dialysis catheter or an arteriovenous fistula or graft.

We may insert either temporary or permanent catheters. These catheters are either placed in the neck or the groin into a large blood vessel. These catheters are prone to infection and may also cause blood vessels to clot or narrow, even in expert hands.

An arteriovenous graft is placed in patients who have small veins or in whom a fistula has failed to develop. The graft is made of artificial material and the dialysis needles are inserted into the graft directly.

The preferred access for hemodialysis is an arteriovenous fistula wherein an artery is directly joined to a vein. The vein takes four to six weeks to enlarge and mature before it can be used for dialysis. Once matured, two needles are placed into the vein for dialysis. One needle is used to draw blood and run through the dialysis machine. The second needle is to return the cleansed blood.

These venous access devices usually can be placed under local anesthesia on an outpatient basis and the doctors in Dr Kamakshi Memorial Hospital are experienced in performing these procedures with little discomfort or complication.

Hemodialysis typically takes three to five hours and is needed two to three times a week. Patients will need to travel to our dialysis center for hemodialysis where our well trained dialysis technicians and nurses will help with the procedure, under the supervision of our nephrologists. Currently our unit performs over 400 such procedures a month. Home hemodialysis is possible in some situations however this is not yet popular in India.

Peritoneal dialysis utilizes the lining membrane (peritoneum) of the abdomen as a filter to clean blood and remove excess fluid. A catheter is implanted into the abdomen by a minor surgical procedure. About 2 to 3 liters of dialysis fluid are infused into the abdominal cavity through this catheter. This fluid contains substances that pull wastes and excess water out of neighbouring tissues.

The fluid is allowed to dwell for two to several hours before being drained, taking the unwanted wastes and water with it. The fluid typically needs to be exchanged four to five times a day. Peritoneal dialysis may be performed manually or by using a machine to perform the dialysis at night.

Peritoneal dialysis offers much more freedom compared to hemodialysis since patients do not need to come to our dialysis center for their treatment. They can carry out many of their usual activities while undergoing this treatment. We generally prefer this type of therapy for our paediatric patients.

Most patients are candidates for both hemodialysis and peritoneal dialysis. There are little differences in outcomes between the two procedures. We may recommend one kind of dialysis over the other based on each individual’s medical and surgical history. It is best to choose one’s modality of dialysis after understanding both procedures and matching them to their life style, daily activities, schedule, distance from the dialysis unit, support system, and personal preference.

End-stage renal disease cannot be treated with conventional medical treatments such as drugs. Only two treatments allow patients to continue living when their kidneys stop functioning: dialysis and kidney transplantation. People who require dialysis give up some degree of their freedom because of their dialysis schedule, fragile health, or both. Also dialysis can be tiring, cause fluctuations in blood pressure and patients are prone to certain infections even when great care is taken.

Kidney transplantation offers the best outcomes and the best quality of life for such patients with End Stage Renal Disease. Kidney transplantation means replacement of the failed kidneys with a working kidney from another person, called a donor. This is not a complete cure, although many people who receive a kidney transplant are able to live much as they did before their kidneys failed.

The renal transplantation unit at KMH has excellent results in this procedure, led by experienced surgeons and physicians trained both here and abroad. The team is well supported by other specialties and support staff within the hospital, allowing for excellent pre and post operative care required to maintain the highest standards possible for a good outcome following transplantation.

In our practice, transplanted kidneys may come from living related donors or people who have died of other causes (cadaveric donors). A person who needs a kidney transplant (the recipient) can accept a kidney that comes only from a donor who matches certain of his or her characteristics. The more similar the donor is in these characteristics, the greater the chance of long-term success of the transplant. Potential live kidney donors also must be in good health and undergo a thorough medical evaluation, donor safety being of paramount importance. If a patient is considered eligible for a kidney transplant, every effort will be made to find a donor among his or her family members who are most likely to match. Transplants from a living related donor generally have the best results. We do not accept or encourage the use of unrelated living donors for transplantation.

If no suitable donor can be found, the patient’s name will be added to a common waiting list, maintained by the government, for a cadaver donor kidney. Every new kidney that becomes available is tested and checked against this list to find the most perfect match. Recent developments in Tamil Nadu have made brain death declaration mandatory in the state run government hospitals and private hospitals are encouraged to do the same. This and other Government Orders have resulted in a surge of cadaveric organ donation activity. However there is a shortage of organs for transplantation, requiring patients to wait months to years before getting a transplant. For more information please visit the official government website http://www.india-transplant.com/.

Meet our staff When patients have near a relative willing for donation but are not suitable for themselves due to, for example a blood group or a cross match incompatibility, kidneys can be exchanged between another donor and recipient pair in a similar situation and two compatible live donor transplants are possible. Patients willing for such a “donor swap” must present themselves before the State Government Authorization Committee to seek approval for the transplant. Paired kidney exchanges are not illegal and are in fact encouraged so as to deter illegitimate trade of organs in this country.

Generally speaking, it is difficult to arrange exchange transplants. A sizeable number donors and recipients need to be enrolled in the database for a better chance of identifying an exchange pair. Logistically, the center needs multiple operating rooms and teams of surgeons as all the participants must be readied for surgery at the same time. If willing patients may enroll themselves in the hospital’s Paired Kidney Donor Exchange Programme and if you wish further information, please contact us.

The potential recipient must undergo a very detailed medical evaluation prior to kidney transplantation. This evaluation may take a few weeks and require several visits to the transplant center for tests and examinations. The purpose of this thorough evaluation is to test whether one would benefit from a transplant and can withstand the rigors of the surgery and antirejection medications and the adjustment to a new organ.

The medical team, which includes nephrologists, transplant surgeons, a transplant coordinator, a social worker, and others, will conduct a series of interviews with the donor (for live donor transplant), recipient and family members. They will be asked many questions about their medical and surgical history, medications taken and about habits and lifestyle. They would also want to make sure patients are mentally prepared for the procedure and afterwards. A complete physical examination will be performed. The recipient’s blood and tissue will be typed so that he or she can be matched to the donor kidney. This significantly lessens the chance of rejection. Other lab tests and imaging studies complete the evaluation of the donor and the recipient.

Kidney transplant surgery is a major procedure and generally requires ten days in the hospital. The surgeon places the new kidney just above the groin area and attaches the artery that supplies blood to the kidney and the vein that carries blood away from the kidney. The kidney is also attached to the ureter, which carries urine from the kidney to the bladder. The recipient’s own kidneys are usually left in place unless they are causing problems, such as infection.

A conventional live donor operation is carried out by a loin incision to expose the relevant kidney and then identifying the arteries that supply and veins that drain it. A pre operative CT angiogram gives the surgeons a clear idea of the anatomy of the donor. Once the kidney is removed, it is flushed with a cold preservative solution and kept cool until it is connected back in the recipient.

More recently this procedure is carried out laparoscopically. Dr Kamakshi Memorial Hospital is one of the few centers that specialize in this procedure which reduces post operative discomfort for the donor and enables early discharge and return to work, a factor that has encouraged live donation in many instances.

Every operation has risks, and it is the period after the surgery that is most critical. All transplant recipients require lifelong immunosuppressant medications to prevent their bodies from rejecting the new kidney. The drugs work by suppressing the immune system, which is programmed to reject anything “foreign,” such as a new organ. Like any medication, these drugs can have unpleasant side effects. People who receive a transplant must take their medication regularly and be monitored by a physician. Our medical team will watch very carefully to make sure that the recipient’s new kidney is functioning properly and that the body is not rejecting the kidney or developing other complications.

Dr Kamakshi Memorial Hospital is geared towards visitors from many countries and our staff is well trained in spoken English and other regional languages. Our well trained coordinators will assist you with the day to day arrangements for investigations and other issues you may face in an alien environment. The International Help Desk arranges pick up to and from the airport and comfortable serviced apartments for the patients and family near to or within the city. The hospital diet kitchen serves only vegetarian food but arrangements can be made for clean meat and poultry from the serviced apartments.

All foreign nationals and patients from outside Tamil Nadu State must present themselves to the Authorization Committee for approval for live donor transplants even if the donors are first degree relatives. This process requires documentation such as a No Objection Certificate in original from the Embassy of the country or state of domicile and other evidence of proof of relationship. Kindly note that it may take a couple of weeks at least before the Authorization Committee meeting and approval is obtained. Foreign nationals may qualify for a cadaver organ only if there are no suitable local recipients for a donor offer. For more information on this issue please visit the official government website http://www.india-transplant.com/.

For more details please contact us well in advance in order to avoid unnecessary delay upon your arrival.


Designation : MD(Int Med).,D.M(Nephro)., Nephrologist
Area of Expertise : Nephrology

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Nephrologist
Kidney Transplantation