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Nephrology FAQ

Kidney is a bean shaped organs about 10 to 12 cm in length situated on either side of the backbone. Each kidney comprises of approximately 1 million nephronswhich are the functional units, primarily involved in filtration of wastes besides many other functions.

CKD is an abnormality in kidney function of more than three months duration. This results in accumulation of waste products and water in the body. It is very often progressive with gradual worsening of the kidney function leading to end stage kidney disease necessitating dialysis or transplantation.

Some of the common causes are :

  • Diabetes Mellitus
  • High Blood Pressure
  • Hereditary Kidney Diseases
  • Inflammation/Infection of Kidneys

Early stages may be without any symptoms. With increase in the accumulated wastes and water, symptoms may develop such as:

  • Swelling of legs or face
  • Increased urination at night
  • Blood in the urine
  • Loss of Appetite/Vomiting
  • Breathlessness and Tiredness

If you have high blood pressure or uncontrolled diabetes or a family history of kidney disease, you may be at risk for developing CKD. Periodic screening tests in such high risk group will help in early detection of CKD. Appropriate medical advice in early stages of CKD may prevent rapid deterioration of kidney function and delay dialysis.

Early stages of CKD are very often silent without any symptoms. The only way to know is by simple blood and urine tests that indicate the accumulation of wastes in blood or leakage of proteins/albumin in the urine. Some tests may have to be done at periodic intervals to track the level of your kidney function.

High Blood Pressure is a frequent finding in CKD patients along with anaemia, bone disease, malnutrition and accelerated heart and blood vessel disease. They are more prone to various infections.

Most CKD patients require medicines to control Blood Pressure. In addition some may need diuretics to reduce the swelling of the body. People with Diabetes require controlling their blood sugar.

Some medications may have adverse effects on kidney function while some may require a dose alteration. It is best to discus with your doctor all the medicines with their doses.

Diet needs to be controlled. It should include less salt, water and low in proteins. Alcohol in small amounts may be permissible while smoking can worsen the kidney damage and steps to quit should be taken.

Some patients may continue with stable kidney function for years without requiring dialysis. Others may show relentless worsening and reach a stage necessitating 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).

Dialysis does the following.
  • 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.
There are two types of dialysis.
  • Hemodialysis
  • 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.
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 hemodialysis procedure may be substituted by another procedure which is carried out round the clock (CRRT) continuous renal replacement therapy.

One of the treatment options available for patients with end stage kidney disease is a kidney transplant. This involves surgically implanting a functional kidney that may come from a living or a deceased donor. Following transplantation, patient needs to be on lifelong medications to improve its survival.

The dialysis department of ZHHRPL is equipped with the latest dialysis machines and a full time nephrologist. The department provides all types of dialysis. Utmost care is given to quality with well trained and compassionate staff. A state-of-the-art water purification plant along with regular water tests ensures a continuous supply of ultra-pure water for dialysis.