Treatments
Nephrology
Introduction
The Division of Nephrology is available for patients at any stage of kidney disease. Our goal is to provide the highest quality care while helping patients manage their condition. Our Nephrologist is experienced in all aspects of medical care of renal disease patients. We see patients with a wide range of conditions, including diabetes and high blood pressure; inherited disorders such as polycystic kidney disease; and end-stage renal disease. Our vision is to bring the best in renal medicine to the shores of Goa and provide Comprehensive Kidney Care under one roof.
Role of Kidneys in Our Body
Kidneys are bean shaped paired organs present in the body. Their importance is apparent from the fact that they receive 20% of the blood pumped by the heart every minute.
The Kidneys are responsible for three main functions among others:
- Excretion of water and metabolic waste products as Urine.
- Maintain Homeostasis i.e. regulation of the Internal environment of the body with respect to solutes (Sodium, Potassium, Calcium etc) and blood pH.
- Secretion and activation of hormones involved in production of RBC (Erythropoietin), bone mineralization ( Vit D) , regulation of blood pressure ( Renin, Angiotensin)
When there is derangement of renal function the body is adversely affected with:
- Retention of waste and toxic products and excess water
- Increase in blood urea (generated during breakdown of proteins in body) may cause symptoms as tiredness, weakness, loss of appetite and vomiting
- Increase in blood creatinine (breakdown of muscle). If kidney function is < 10 ml/min, patient needs dialysis
- Excess salt and water retention may result in high blood pressure, swelling of legs, face and abdomen and
- Breathlessness
- Upset in internal balance of acid and base leads to build up of acid in body
- Blood calcium levels fall and phosphate levels increase because kidneys can no longer excrete phosphate
- Results in bone disease and predispose patients to fracture
- Inadequate production of hormones:
- Anemia – lack of red blood cells as a result of reduction of erythropoeitin
- Bone disease – lack of vitamin D, can result in fracture.
- Dysregulation of BP and severe hypertension
Common Causes of CKD
Diabetes:
India is the diabetes capital of the world with 41 million Indians having diabetes; every fifth diabetic in the world is an Indian. With the improving economic scenario has come sedentary lifestyle and junk foods which make our population susceptible to increased incidence of Diabetes and the metabolic syndrome. Both Heart and Kidney disease are common in these patients.
Diabetic Nephropathy accounts for greater than 40% of all patients with Dialysis requiring CKD. The optimal approach to diabetic kidney disease involves intensive multidisciplinary therapy for blood glucose control, use of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, rigorous management of blood pressure and urine protein, and treatment of cardiovascular disease risk factors. Accurate interpretation of kidney function tests is essential for optimal treatment, and in advanced diabetic kidney disease, attention to diet becomes even more critical than in earlier stages of the disease. The RG Hospital team of nephrologists, endocrinologists, and nutritionists bases its approach on extensive experience in patient care and research
Glomerular Disease:
A significant number of patients may be afflicted by Primary or Secondary Glomerular disease which results in progressive deterioration in kidney function and CKD. Prominent among these is Lupus Nephritis and Focal Segmental Glomerulosclerosis.
Interstitial Nephritis / Pyelonephritis:
This condition typically reflects urinary tract infection or obstruction, or the toxic effects of drugs, herbs, and autoimmune or lymphoproliferative disorders associated with paraproteins. It can be particularly difficult to distinguish from age-related decrease in the glomerular filtration rate (GFR) in the absence of a specific disease.
The Southern taluka of Canacona has a disproportionately large number of patients showing this type of disease. The cause (environmental, genetic or other) is not yet unraveled and further studies are required.
Hypertension:
HTN may be the etiology of CKD in up to 10-15% individuals. HTN could also results from CKD and independently contribute to worsening kidney function .Thus it is imperative that patients are screened for elevated blood pressure and receive adequate treatment for the same.
Renovascular Disease:
Atherosclerotic Renal artery stenosis in elderly and Fibromuscular dysplasia in young females may the cause for Renal artery stenosis with Secondary hypertension and CKD. Progressive worsening of GFR can be prevented by early diagnosis and control of HTN with specific intervention when appropriate.
Cystic Kidney Disease and Neoplasm:
Inherited and acquired cystic diseases of kidney are a significant cause of CKD. Some patients require Laparoscopic treatment. Renal neoplasm may result in significant loss of functioning kidneys and Nephron sparing surgery may be required to avoid dialysis.
Kidney Stones and Obstructive Uropathy:
Recurrent stones and untreated obstruction of other etiology may result in Chronic Kidney Disease. Physicians in RG Stone program identify and work to modify metabolic risk factors that predispose patients to recurrent kidney stone formation. An on-site nutritionist works closely with patients to integrate appropriate dietary changes with lifestyle and other dietary goals, and medications are prescribed as needed.
Symptoms and Stages of Kidney Disease
The symptoms of Kidney disease are not apparent till advanced stages of the disease by which time the condition is irreversible.
- Early symptoms:
- High blood pressure
- Fatigue
- Poor appetite
- Frequent urination specially during nights
- Late symptoms:
- Body itch
- Swelling of the face and legs
- Pale and sallow complexion
- Shortness of Breath
- nausea/ vomiting
- Decrease in urine volume
Kidney Disease: Improving Global Outcomes (KDIGO) with the objectives of clear understanding, better collaboration and uniform definition has provided a consensus classification of Chronic Kidney Disease (CKD) shown below:
Stage |
GFR ml/min |
Symptoms |
Treatment |
1 |
>90 |
Asymptomatic |
Lifestyle modification |
2 |
90-60 |
Asymptomatic |
Control HT/DM |
3 |
30-60 |
Early symptoms |
Renoprotection |
4 |
15-30 |
Late symptoms |
Plan for future |
5 ESRD |
<15 |
|
RRT |
Treatment Options
Stages 1 and 2 - are asymptomatic and can only be diagnosed with screening tests done early. However treatment at this stage results in reversal of the disease. All patients with Hypertension (HTN) and Diabetes (DM) need to be assessed for their risk of Kidney disease and counseled for life style modification.
Stage 3 - is associated with early symptoms and such patients need close follow up to prevent progressive worsening. Patients found to have significant renal function loss need to be on a diet prescribed on individual basis along with optimization of BP and sugar control and other risk factors.
Stage 4 - patients require stringent drug and diet prescriptions along with counseling for the imminent need for dialysis. Early creation of access for dialysis or evaluation for transplantation is associated with better results.
Stage 5 - patients also called End Stage Renal Disease (ESRD) have very little residual kidney function and require some form of renal replacement therapy (RRT) in the form of Hemodialysis, Peritoneal dialysis or renal Transplantation for the sustenance of life.
Hemodialysis (HD)
- The blood to be treated is pumped outside the body to a machine (Hemodialyzer) that acts like artificial kidney
- Tiny pores in filter membrane filter out toxins while vital components such as proteins, are left in the blood
- Excess water is also removed during the process of cleaning
- After cleaning, the machine returns the clean blood back to body.
- HD is usually carried out three times a week and average session lasts for 3-5 hours
- During the cleaning process, patients usually watch TV, read or talk to each other
Why should I choose the Division of Nephrology at RG Hospital?
RG Stone is a nationally recognized Institution with over 24 years experience in surgical management of conditions of genitourinary system including the latest in Laparoscopy and Lithotripsy. We have seventeen centers in various cities in the country. The Guinness Book of World Records recognition for treating the Largest Kidney Stone (13 cms) in the world is a testimonial to our continuing efforts to be at the cutting edge of technology.
RG Nephrology services are an addition that makes our institution a Comprehensive Renal Care center. Having decided to pioneer a chain of Complete Kidney care centers across the country we have made available to our patients highly qualified Nephrologists. The vision of this endeavor is to Kidney disease Early Evaluation and Preservation of Function (KEEP) and offers the life saving Renal Replacement therapy (RRT) to End stage renal disease patients.
The RG Hospital, Alto Porvorim, Bardez, has commissioned a Division of Nephrology with the leadership the young and dynamic Nephrologist from Goa, Dr Amol Mahaldar. We have a dedicated team of professionals to look after all aspects of kidney disease.
Our KEEP strategy of screening for asymptomatic and early renal disease is available as Population based mass screening campaigns and Clinic based advanced diagnostic and Consultation services.
What if I need Dialysis (RRT)?
RG hospital is conveniently located just 5 km from Panaji and easily accessible from all parts of Goa. This center is equipped with ultramodern machines and trained Dialysis Technologists.Fresenius, who are world leaders in Dialysis technology, have made available to us the latest 4008S Hemodialysis machine with OCM technology for accurate measurement of delivered dialysis dose. This will make it possible to deliver safe and effective Dialysis every time a patient hooks up to one of these machines. Water Treatment is very important in dialysis as an individual patient is exposed to up to 180L in just four hours. We have taken water treatment to the next level by commissioning Reverse osmosis along with Homespring. This means our patient is not being exposed to Endotoxins and thereby avoids the unpleasant reactions on dialysis. Automated reprocessing of Dialyzers means we can provide safe and precise reuse and cost reduction to our patients without compromise in dialysis efficacy. Our team is trained in Dialysis related procedures including creation of AV Fistula all under one roof. We intend to add Ambulatory Peritoneal Dialysis services shortly and Renal Transplantation in the future.y.
How do I make an appointment?
To see a kidney specialist at RG Hospital, call 09766531113.
