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Nephrology

Nephrology

Nephrology is a medical discipline that covers the diagnosis, treatment and management of kidney diseases. Commonly treated disorders include kidney stones and kidney failure. Nephrology also involves comprehensive care for kidney diseases associated with other illnesses and conditions, such as hypertension and diabetes.

Kidney Transplant

The Centres of Nephrology and Urology have a sizeable and comprehensive kidney transplant program, having performed both autologous and cadaveric transplants. It has the first organ transplant registry in India. The Centres also perform minimally invasive surgery for renal donors thereby minimising post-operative recovery time and hospitalisation.

The stringent infection control practices, immunosuppressive protocols and proactive vigil for complications and their prompt management make the service a huge success. The Transplant unit also integrates, analyzes and addresses the health needs of the transplant patient and his or her family. The Apollo Hospitals group has performed more than 21000 kidney transplants till date.

Types of kidney transplants performed

  • Cadaveric renal transplantation
  • Cadaver-donor kidney transplantation
  • Living donor kidney transplants (from both related and unrelated donors)
  • Laparoscopic donor Nephrectomy

More to know ….

What is a kidney transplant?

A kidney transplant is a surgical procedure to place a kidney from a live or deceased donor into a person whose kidneys no longer function properly.

The kidneys remove excess fluid and waste from blood. When kidneys lose their filtering ability, dangerous levels of fluid and waste accumulate resulting in kidney failure or end-stage kidney disease. A kidney transplant is often the best treatment for kidney failure.

Only one donated kidney is needed to replace two failed kidneys, making living-donor kidney transplantation an option. If a compatible living donor isn't available for a kidney transplant, the patient's name may be placed on a kidney transplant waiting list to receive a kidney from a deceased donor.

A kidney transplant is used to treat kidney failure (end-stage kidney disease), a condition in which kidneys can function at only a fraction of normal capacity. People with end-stage kidney disease need either to have waste removed from their bloodstream (dialysis) or a kidney transplant to stay alive.

Causes of kidney failure

  • Diabetes
  • Chronic, uncontrolled high blood pressure
  • Chronic glomerulonephritis - an inflammation and eventual scarring of the tiny filters within your kidneys (glomeruli)
  • Polycystic kidney disease

Sometimes kidney disease can be managed with diet, medication and treatment for the underlying cause. If despite these steps kidneys still can't filter your blood adequately,r a kidney transplant is the treatment of choice.

Finding a donor

A kidney donor can be living or deceased, related or unrelated. The nephrologist will consider several factors, such as blood and tissue types, when evaluating whether a living donor will be a good match. Family members are often the most likely to be compatible kidney donors. But many people undergo successful transplants with kidneys donated from people who are not related to them.

During a kidney transplant

  • Kidney transplants are performed with general anesthesia
  • The surgeon makes an incision and places the new kidney in the lower abdomen. Unless the patient's own kidneys are causing complications such as high blood pressure, kidney stones, pain or infection, they are left in place.
  • The blood vessels of the new kidney are attached to blood vessels in the lower part of the abdomen, just above one of the legs.
  • The new kidney's ureter - the tube that links the kidney to the bladder - is connected to the bladder.

After a kidney transplant

  • Doctors and nurses monitor the patient's condition in the hospital's transplant recovery area to watch for signs of complications. The new kidney will make urine like the patient's own kidneys did when they were healthy. Often this starts immediately. In other cases it takes several days.
  • Close monitoring is necessary for a few weeks.
  • Transplant recipients need a number of medications after kidney transplant. Drugs called immunosuppressant's help keep the patient's own immune system from attacking the new kidney. Additional drugs help reduce the risk of other complications, such as infection, after transplant.

Dialysis

Dialysis is a treatment where the functions of the kidney are replicated by the dialysis process in situations where the kidneys have failed to function normally.

When is dialysis needed?

Dialysis is needed when you develop end stage kidney failure – usually when 85 to 90 percent of your kidney function is lost and there is a GFR of < 15. Click here to learn more about the stages of Chronic Kidney Disease and GFR.

What does dialysis do?

Dialysis is required to keep the body in balance by:

  • waste, salt and extra water removal to prevent them from building up in the body
  • ensuring maintenance of a safe level of chemicals in your blood, like potassium, sodium and bicarbonate
  • blood pressure control

Is kidney failure permanent?

In some cases, acute kidney failure can get better after treatment. In such cases of acute kidney failure, dialysis is done only for a short time until the kidneys get better.

In chronic or end stage kidney failure, your kidneys do not get better and you will need dialysis for the rest of your life unless transplant is an option.

Are there different types of dialysis?

Hemodialysis and peritoneal dialysis are the two types of dialysis

Will dialysis help cure the kidney disease?

No. Dialysis does the work of healthy kidneys, but it does not cure the kidney disease.

Is dialysis uncomfortable?

The dialysis treatment is painless. However, some patients may have fall in BP, nausea, vomiting, headache or cramps. With frequent treatments, those problems usually go away.

Do dialysis patients feel normal?

Many patients live normal lives except for the time needed for treatments. Dialysis usually makes you feel better because it helps many of the problems caused by kidney failure.

Do dialysis patients have to control their diets?

Yes. You may be on a special diet. The diet may vary according to the type of dialysis.

Can dialysis patients continue to work?

Many dialysis patients can go back to work after they have gotten used to dialysis.

Hemodialysis

In hemodialysis, waste and extra chemicals and fluid from your blood are removed by a hemodialyser machine. To get your blood into the machine, an access is made into your blood vessels. This is done by minor surgery to your arm or leg. Sometimes, joining an artery to a vein under your skin to make a bigger blood vessel called a fistula is also done.

How long do hemodialysis treatments last?

This depends on:

  • how good kidney function is
  • fluid weight gained between treatments
  • build and weight of patient
  • the type of dialyzer used

Usually, each hemodialysis treatment lasts about four hours and is done three times per week.

Peritoneal dialysis

In this type of dialysis, your blood is cleaned within your body. A plastic tube called a catheter is placed into your abdomen to make an access. During the treatment, the peritoneal cavity in the abdominal area is slowly filled with dialysate through the catheter. The blood stays in the arteries and veins that line your peritoneal cavity. Extra fluid and waste products are drawn out of your blood and into the dialysate. Plasma exchange may be done along with dialysis, to filter clotting factors and unwanted proteins. Charcoal hemofiltration in which a charcoal layer is used to remove wastes from blood, a process similar to dialysis, may sometimes be used.

What are the different kinds of peritoneal dialysis and how do they work?

Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD) are the two common types.

Continuous Ambulatory Peritoneal Dialysis (CAPD) is the only type of peritoneal dialysis that is done without machines. The patient can do it themselves usually four or five times a day at home or work. A bag of dialysate needs to be put into your peritoneal cavity through the catheter. The dialysate stays there for about four or five hours before it is drained back into the bag and thrown away. This is called an exchange.

Automated Peritoneal Dialysis (APD) is done using a special machine called a cycler. This is similar to CAPD except that a number of cycles (exchanges) occur. Each cycle usually lasts 1-1/2 hours and exchanges are done throughout the night while you sleep.

Urology

Urology is the branch of medicine that focuses on diagnosing, treating and managing disorders of the urinary and male and femalegenital tracts. Commonly treated problems include bladder and kidney stones, diseases of the prostate gland, male infertility, erectile dysfunction and urinary incontinence.

The Centers of Urology at Apollo Hospitals provide diagnostic and surgical services for all genitourinary disorders. Areas of expertise include Renal Transplantation, Uro-oncology (urological cancers), Reconstructive Urology, Endo-urology for stone diseases (including Flexible Ureteroscopy, Percutaneous Nephrolithotomy and Laparoscopic Nephrectomy), Neuro-Urology with urodynamic facility, Andrology for treatment of male infertility and erectile dysfunction (including prosthetic surgery), Female Urology and Paediatric Urology.

The team of Urologists at Apollo Hospitals, continuously seek to develop ways to improve surgical results while reducing recovery time and side effects. They practise advanced surgical techniques including those for bladder preservation and diseases of the prostate, treatment of benign inflammatory and infectious disorders, diagnosis and treatment of kidney stones, all types of voiding dysfunction (including incontinence, obstruction and reconstruction of the upper and lower urinary tract), male infertility, and impotence. Surgical diseases of the adrenal gland are also treated.

Urinary Incontinence management for women

Urinary problems can affect women of all age groups. The problems are such that they can affect their day-to-day chores; restrict their personal, family and social activities and ultimately, the quality of their life. Compounding reasons can even lead to the condition of depression and sometimes unpleasantness in married life. It is important that women shed their inhibitions, step out and seek medical help at the earliest, rather than assume that these minor conditions will disappear soon or may not lead to serious conditions later on. The most common urinary problems encountered are: recurrent urinary infection, urine leak, frequency, urgency, and urge-leak.

The most common urinary problems encountered are: recurrent urinary infection, urine leak, frequency, urgency, and urge-leak. Common symptoms for urinary infection include - burning pain during or after passing urine, lower tummy pain, back-ache, fever or chills, blood in the urine, frequency, urge or leak. Vaginal infections precipitate or coexist with urinary infections. Urine leak could be due to urge-leak or secondary to stress-leak. Other problems include - difficulty in starting to pass urine(require pressure in lower tummy to start to urinate) or have poor flow or the sense of incomplete emptying. Diabetes, Stroke, Multiple Sclerosis, Parkinson’s Disease, Lumbar disc prolapse, Spinal Injuries etc. can affect the bladder - In most conditions, timely intervention has proved effective with proper evaluation and appropriate treatment. It is imperative that women with any of the above symptoms/ indications relating to urinary problems visit an Urologist at the earliest - treat the condition in the early stage itself, thereby preventing compounding serious or chronic conditions like urosepsis and kidney failure.

Key Procedures

Urologic Oncology

The Centers offer specialized treatment of urologic malignancy with emphasis on the management of patients with cancers of the kidney (radical nephrectomy), bladder (radical cystectomy), prostate (radical prostatectomy), testis and penis. Patients benefit from innovative surgical techniques for treatment of pelvic and retroperitoneal malignancy as well as reconstructive efforts including "neo bladder". A multidisciplinary approach is used with all cancer patients, with regular interactions with faculty from both Medical Oncology and Radiation Therapy.

Reconstructive Surgery

We have expertise in all areas of urinary tract, pelvic and genital reconstruction, including treatment of abnormalities resulting from injury, disease or surgical therapy. Faculty surgeons have extensive experience in both upper and lower urinary tract reconstruction including treating complex urethral strictures using buccal mucosa.

Laparoscopy (Surgery through a "Keyhole")

Apollo Hospitals has a rapidly developing program in Laparoscopic Urologic surgery ranging from ablative and reconstructive renal surgery. Traditional surgery usually requires long, deep incisions and a lengthy recovery period. Minimally invasive surgery uses a thin, telescope-like instrument called an endoscope, which is inserted through a small incision. Laparoscopic nephrectomy (Removal of kidney through key hole) is replacing open nephrectomy throughout the world and is routinely performed here as well.

Endourology

Patients have access to a full spectrum of urologic endoscopic equipment and techniques including both flexible and rigid instrumentation. Techniques include trans-urethral surgery of the urethra, prostate, bladder, ureter and kidney, and percutaneous renal surgery. Kidney stones are removed through keyhole (percutaneous nephrolithotomy) and ureteric stones are removed through "microsurgery" (telescopic surgery). The latest methods of minimally invasive stone surgery are also available, with instrumentation for Ultrasonic Lithotripsy and Pneumatic lithotripsy.

Andrology

The Urologists at Apollo Hospitals specialize in the diagnosis of impotence, reconstructive microvascular surgery, and pharmacological treatment for sexual dysfunction. A variety of treatment options, such as oral agents, Caverject (an injectable therapy), and a prosthetic inflatable penile implant, are used and tailored to fit both the patient's underlying patho-physiology and lifestyle. Assessment and treatment for male infertility is also provided, and microsurgical procedures (reverse vasectomy), vasectomy and epididymal aspiration are performed. The hospital offers the most advanced treatment available for Benign Prostatic Hyperplasia, commonly called BPH or enlarged prostate.

Neuro-urology

Neuropathic bladders secondary to trauma (Spinal cord trauma) and neurologic diseases like stroke and Parkinson's disease are evaluated and managed. Assessment may include complex neuro-urodynamic evaluation to better characterize the urinary continence dysfunction. Treatment options include medical, surgical and/or prosthetic alternatives.

Uro-Gynecology

The subspecialty of Urogynecology is concerned with the diagnosis and treatment of those urinary tract disorders most prevalent in women. These include urinary incontinence and pelvic floor prolapse, voiding dysfunction, recurrent urinary tract infection, urethral syndrome and interstitial cystitis.

Pediatric Urology

The Pediatric Urology Service treats congenital abnormalities of the genitourinary system in children. Reconstructive surgery for hypospadias, cryptorchidism, and other genital abnormalities is usually performed on an ambulatory surgery or short-stay basis.

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