Overview

The department of Nephrology began operations with artificial kidney Dialysis department (AKD). Nephrology provides diagnosis, treatment and management of acute and chronic at any stage from acute to chronic. It was followed by clinical nephrology, facilities for chronic peritoneal dialysis and kidney transplantation. We have special attention towards dialysis access, looked after by our nephrologists. The department has a team of highly qualified and experienced nephrologists to look after adult patients.

Vascular access procedures are done at bed side in ICU and AKD for temporary access and in OT or Cath-lab for long term vascular access.

Key Diseases

• Acute Kidney Disorders
• Chronic Kidney Diseases
• Kidney failure
• Kidney Stone
• Urinary tract infections
• Cardio renal issues
• Amyloidosis
• Diabetic kidney disorder
• Electrolyte disorders
• Glomerulonephritis
• Hypertension (chronic hypertension)
• Other kidney diseases like rheumatology and kidney disorders.

Key Procedures

Dialysis

Dialysis is a treatment that does some of the things that are done by healthy kidneys. It is needed when the kidneys have been damaged and are not able to carry out their normal functions. With the result there is retention of waste products in the body along with salt, water and other chemicals. This may happen during temporary failure of the kidney (a renal function) and when there is permanent damage (chronic renal failure).

Common treatment for psychological disorders includes:

• Removes waste products, salt and extra water so that their levels may not increase in the body.
• Keep a safe level of certain chemicals in the blood such as sodium, potassium and bicarbonate.
• Control blood pressure.
• The department offers both types of dialysis Haemodialysis & Peritoneal dialysis:

Hemodialysis – an artificial kidney (dialyser) is used to remove waste and extra chemicals and fluids from the body. In this dialysis blood flows out of the body to the artificial hemodialysis through an access (entrance) made in the blood vessels by the doctor. The blood is returned to the body after cleaning through the same access. The vascular access is created by the doctor by inserting a tube (catheter) into a vein in the neck or below the collar bone or in the groin. These catheters are used in emergency situation or if a permanent vascular access like an AV Fistula has not been created. (Arteriovenous fistula (AVF) is a surgically created connection between an artery and vein. The veins on the upper extremities usually, develop in about 6-8 weeks and can be used for placement of needles to remove or return blood to the body). In dialysis impurities are removed from the blood through the membrane into a solution (dialysate) and pass out to the drain. At the same time substances required are kept in the blood at optimal levels. A hemodialysis procedure lasts from 3-4 hours and is carried out 2-3 times in a week. The prescription for your dialysis is determined by the Physician. He will consider how well your own kidneys are working, how much fluid weight you have gained between treatment, how much waste you have in your body etc.

Peritoneal dialysis - in peritoneal dialysis the blood is cleaned within the body. A tube (peritoneal catheter) is placed in the abdomen (belly) to make an access (entrance). The belly is filled with a dialysate fluid and purities and extra fluid are drained out of the blood from the blood vessels that are present in the lining of the peritoneal cavity. Benefits of dialysis Dialysis removes the accumulated waste products, fluids and water from the body that have been accumulated because of failed kidneys. They also normalize the levels of certain important chemicals such as sodium, potassium and bicarbonate. However dialysis does not carry out all the functions of the kidney (do a laundry job) and hence certain other medications such as Erythropoiten and Vitamin D may not be prescribed.

Risks

• Hemodialysis – risks associated with placement of temporal vascular access (catheters).
• Bleeding
• Injury to neighboring structures such as artery, plura (cover of lungs) (causing accumulation
of air in the cavity outside the lungs).
• Infection
• Accidental removal of catheter
• Technical failure eg. Blockage of catheter

Permanent catheter

• Technical failure eg. Poor quality artery of vein
• Infection
• Bleeding

Complications from hemodialysis

• Fall of blood pressure
• Cramps
• Fever
• Irregular heart beat
• Other rarer complications include destruction of red blood cells (hemolysis) or lowering of oxygen in blood.

Peritoneal catheter

• Technical failure (displacement of catheter or block of catheter).
• Infections

Procedure risks

• Tpoor drainage
• Tleak of fluid into chest or outside the peritoneal cavity
• Tinfections

Alternative procedures:

The alternative to dialysis is a renal transplant which may or may not be advised to a patient depending upon various medical and other factors. At times the usual haemodialysis procedure may be substituted by another procedure which is carried out round the clock (CRRT) continuous renal replacement therapy.

What if dialysis is not done?

If dialysis is not done have been because kidneys have failed, impurities (waste) and fluid accumulate in the body. Patient’s body is poisoned and various organ system will start failing eg. Patient will have a difficulty in breathing because of accumulation of fluid in the lungs, or because acid has been retained in the body or the patient may lose consciousness or have convulsions (fits) or the heart may fail or behave irregularly. The ultimate outcome will be death.