Kidney Disease

Kidney Disease

Kidneys are an essential part of our body. There is a pair of fist sized organs located at the bottom of the rib cage. There is one kidney on each side of the spine.

Kidneys are basically responsible for filtering waste products, excess water and impurities out of the blood. They stored toxins in the bladder and then removed them through urination. They also regulate PH, salt and potassium level in the body. Kidney produces hormones which control blood pressure and control the production of red blood cells. They also activate a form of Vitamin D which helps the body to absorb calcium.

Kidney disease occurs when kidneys get damaged and can’t perform their function. This disease may leave kidneys unable to remove wastes. It can be damaged by diabetes, high blood pressure and various other chronic conditions. Kidney disease can cause other health problems such as weak bones, nerve damage and malnutrition.

If your kidneys get damaged then waste products and fluid can make up in your body. It can cause swelling in your ankles, nausea, weakness, poor sleep and shortness of breath.

If the kidney disease gets worse with the period of time then it may stop working completely. It means that dialysis is required to perform the function of the kidneys. Dialysis is a treatment for kidney disease which filters and purifies the blood using a machine. Dialysis can’t cure the disease but it can prolong your life.

What are the types of kidney disease?

Chronic disease is one of the most common kidney diseases. It is a long-term kidney condition which doesn’t improve within the period of time. It is mainly caused by high blood pressure. High BP is risky for kidney disease because it can enhance the pressure on the glomeruli. Glomeruli are the very small blood vessels in the kidneys where blood is cleaned. With the passage of time, the increased blood pressure damages these vessels and kidney function starts to decline. Diabetes also leads to chronic kidney disease. Diabetes is a bunch of diseases which can cause high blood pressure. The increased level of sugar in the blood deteriorates the blood vessels in the kidneys over time. It means the kidneys can’t do the function properly. It may result in kidney failure when your body becomes overloaded with toxins. Other causes are chronic glomerulonephritis, chronic pyelonephritis, kidney stones, polycystic diseases, reflux nephropathy and others.

Kidney stone is another type of kidney problem. It occurs when minerals and other substances in the blood crystallize in the kidneys, forming solid stones. Kidney stones evenly come out of the body during urination. Passing kidney stones can be very painful but they rarely lead to significant problems.

  • Glomerulonephritis

Glomerulonephritis is the inflammation of the glomeruli. Glomeruli are very small structures inside the kidneys which filter the blood. It can be caused by infections, drugs and congenital abnormalities. It generally gets better on its own.

  • Polycystic kidney disease

This disease is a genetic disorder which causes the number of cysts to grow in the kidneys. These cysts can interfere with kidney function and result in kidney failure.

  • Urinary tract infections

UTI are bacterial infections of any part of the urinary systems. Infections in the bladder and urethra are the most common. They are easily treatable and infrequently result in more health problems. Though, these infections can spread to the kidneys and result in kidney failure.

What are the main symptoms of kidney disease?

Kidney disease is a condition which can easily go unnoticed till the symptoms become worse. The below symptoms are early warning signs which might be developing kidney diseases:-

  • Fatigue
  • Trouble in sleeping
  • Poor appetite
  • Dry and scratchy skin
  • Frequent urination
  • Difficulty in concentration

Symptoms which show that your kidney disease is developing into kidney failure:-

  • Nausea
  • Vomiting
  • Loss of appetite
  • Changes in urine output
  • Anemia
  • Sudden rise in potassium levels
  • High blood pressure
  • Breathlessness
  • Swelling over body

How is kidney disease diagnosed?

  • Glomerular filtration rate (GFR): the test will analyze how well your kidneys are performing and determine the stage of kidney disease.
  • Ultrasound scan: it creates clear images of your kidneys and urinary tract. The image allows your doctor to see if your kidneys are very small or large. They can also show any tumors that may be present.
  • Kidney biopsy: during a kidney biopsy, your doctor will eliminate a small piece of tissue from your kidney while you are composed. The tissue sample can help your doctor analyze the type of kidney disease you have and how much damage has occurred.
  • Urine test: your doctor may suggest you urine test for albumin. Albumin is a protein which can be passed into your urine when your kidneys are damaged.
  • Blood creatinine test: creatinine is a waste product. It is recused into the blood when creatinine is broken down. The levels of creatine in your body will enhance if your kidneys are not working properly.

How is kidney disease treated?

Treatment of kidney disease mainly emphasizes controlling the underlying cause of the disease. It means that your doctor can help you better manage your blood pressure, blood sugar and cholesterol levels. They may use one of the following methods:-

  • Drugs and medication
  • Dietary and lifestyle changes

How can kidney diseases be prevented?

Some risk factors of kidney disease such as age, race and family history are not possible to control. Although, there are some measures you can take to help prevent kidney diseases:-

  • Drink lot of water
  • Decrease intake of salt
  • Control sugar if you are diabetes patient
  • Control blood pressure
  • Stop smoking, no tobacco intake

Who is nephrologist?

Who is nephrologist?

Nephrologists are Doctors who are physicians full treat all form of kidney diseases.  Nephrologist the world comes from nephron which means a basic filter in the kidney. The nephron is a basic part of the kidney which filter blood and fond urine so many nephrons (one millions approximately) from one kidney.

Nephrons removed toxins waste excess sub senses from the blood and form urine. Doctor who special gist is creating kidney disease knowness nephrologist.

So after doing post-graduation internal medicine doctor who do superspecilization in kidney diseases are known as nephrologist of kidney specialist or kidney doctor.

Nephrologist Degree can be D.M.or D.N.B.

There is significant scarcity of the number of nephrologist an India. Nephrologists are superspecialist and most of the superspecialist. They are practice in metropolitans or major cities in India. Out of all metropolitan Delhi NCR has maximum number of nephrologists. There is many part or cities of the country where nephrologist, medical facilities related to kidney disease, dialysis centre or kidney transplant facility are available.

Introduction to Dr. Rajesh Goel

Dr.Rajesh Goel is a Senior Consultant Nephrologist and Kidney Transplant Physician practicing in Delhi, South Delhi, NCR, Panipat, Narela and Faridabad.

He practices in Kidney Care Centre which is located in Faridabad and Delhi(Saket, South Delhi), and Pushpwati Singhania Research Institute (PSRI) Hospital Kidney Care Centre is founder by Dr. Rajesh Goel with his wife Dr. Sonia Goel in 2013. In Kidney Care Centre manages all forms of outpatient department services related to kidney diseases.  PSRI Hospital is one of the best Multi Speciality Hospital in Delhi. In PSRI hospital Nephrology department deals with all forms of kidney disease. In this hospital lots of research programs and DNG Nephrologist training in nephrology is conducted. PSRI Hospital was established in 1996. In this hospital till now   successful kidney transplant have been conducted.

Who is best Nephrologist in Delhi

Dr. Rajesh Goel is very sincere and helpful to his patients. He is a doctor who listens patiently, nonjudgmentally, empathically, and who shows that he understands his patient’s problems. He skillfully manages patient problems.

He also gives proper time to his patients. He is very helpful for poor patients.

Many patients come to him from far away for a second opinion.  He not only promotes health as well as manages kidney diseases. He gives unbiased advice to his patients. He also properly communicates and prognosticates about kidney failure treatment. He respects his patients, juniors, seniors, nurses, and mentors.

He is sincere, experienced and well trained in managing all forms of kidney diseases. He has a vast experience of kidney transplant. He has manage a number of kidney failure patients, chronic kidney diseases, nephrotic syndrome(protein leaking throw urine), temporary dialysis catheter(Jugular, subclavian, femoral), kidney biopsy SLE (Lupus) Nephritis, Hemodialysis, Peritoneal dialysis(Continuous ambulatory peritoneal dialysis, automated peritoneal dialysis-APD), permacath, cystic disease,  autosomal dominant polycystic kidney(ADPKD), Vesico ureteral reflux(VUR, reflux nephropathy), renal tubular acidosis, acute kidney injury (AKI) or acute renal failure (ARF),unexplained renal failure, diabetes, related kidney disease, hypertension  related kidney disease, kidney stone, pyelonephritis, and many other kidney  diseases.

Best Kidney Hospital in Delhi

PSRI Hospital has very coordinated care, team-based care, transparent pricing and is helpful for poor patients kidney care centre.

Best Kidney Transplant Hospital in Delhi

PSRI Hospital provides one of the best kidney transplant program in north India.

They have the best transplant surgeons and nephrologist team. Dr. Rajesh Goel has conducted a number of successful kidney transplant patients.

Best Kidney Specialist in Delhi

Kidney Specialist is a Doctor who manages all types of kidney diseases. They are also known as nephrologists, kidney doctor or kidney transplant doctor.

Chronic kidney disease (CKD)

What is chronic kidney disease?

The kidneys filter waste and excess fluid from the blood. As kidneys fail, waste builds up.
Symptoms develop slowly and are not specific to the disease. Some people haven’t any symptoms in the least and are diagnosed by a lab test.
Medication helps manage symptoms. In later stages, filtering the blood with a machine (dialysis) or a transplant could also be required.

What causes chronic kidney disease (CKD)?

  • Diabetes
  • High blood pressure (hypertension)
  • Heart disease
  • Having a family member with kidney disease
  • Being African-American, Hispanic, Native American or Asian
  • Being over 60 years old

What are the symptoms of kidney failure?

There are less or no symptoms in mild to moderate kidney failure. Thus, early or even late kidney failure is usually detected on a preventive health check-up.

Swelling over body sometimes it is first noticed over feet (around ankles) or over face (around eyes).

  • Itching
  • Muscle cramps
  • Nausea and vomiting
  • Not feeling hungry
  • Swelling in your feet and ankles
  • Too much urine (pee) or not enough urine
  • Trouble catching your breath
  • Trouble sleeping

If your kidneys stop working suddenly (acute kidney failure), you may notice one or more of the following symptoms:

  • Abdominal (belly) pain
  • Back pain
  • Diarrhea
  • Fever
  • Nosebleeds
  • Rash
  • Vomiting
Life threatening presentation
  1. Convulsions
  2. Abnormal heart rate (due to high potassium)
  3.  Chest pain (pericarditis)
  4. Altered sensorium (uremic encephalopathy)
  5. Severe metabolic acidosis

How to delay chronic kidney disease progression?

Detection of kidney disease at an early stage.

Control of blood pressure (less than 135/85 mmHg, less than 130/80 mmHg in proteinuria cases)

Control of blood sugar (HbA1c less than 7%)

Avoid nephrotoxic agents (common painkillers, some antibiotics and indigenous agents) and many others

Proper treatment of infections.

Proper treatment of urine outflow obstruction.

Avoid tobacco consumption and smoking

Healthy lifestyle

Very high protein intake

Proper treatment of stones

Some kidney harmful or nephrotoxic medications

Diabetic kidney disease

Kidney disease is very common in diabetic patients. In present scenario life style related diseases like obesity, diabetes, and coronary heart disease related kidney disease are very common. Swelling over feet or face is generally a common symptom in diabetic kidney disease.

Blood sugar level should be:
  • Between 70 and 130 before eating ;
  • Less than 183 about  2 hours After eating ;
  • Between 90 and 150 at bedtime.
How to monitor kidney related complications in a diabetic patients?
  • Following to be monitored at least 3 to 6 monthly.
  • Urine for proteinuria-urine for micro albuminuria, urine for albumin(dipstick)
  • Serum creatinine level.

Whether my both kidneys are affected?

Even a single kidney is enough to perform all functions of kidney (remove all toxins, and other functions) from our body. If serum creatinine level is high then either both kidneys (if both kidneys are working) are affected or if there is a single functioning kidney and that only is affected.

Kidney disease run in family

There are few kidney diseases common in family members. Following kidney diseases are:

  1. Diabetes related kidney disease.
  2. Polycystic kidney disease (PKD) – autosomal dominant PKD or ADPKD is passed from parent to child by an autosomal dominant type of inheritance. Thus if one parent has the disease, each child has a 50-50 chance of developing the disease.
  3. Fabry disease- it involves major organs.
  4. Kidney stones
  5. High Blood Pressure
  6. Alport Syndrome- leading to CKD (hereditary nephritis), deafness and eye abnormalities.
  7. Unknown family related kidney disease.

How to manage chronic kidney disease?

  1. Control your blood sugar if you have diabetes.
  2. Keep a healthy blood pressure.
  3. Follow a low-salt, low-fat diet.
  4. Exercise at least 30 minutes on most days of the week.
  5. Keep a healthy weight.
  6. Do not smoke or use tobacco.
  7. Limit alcohol.

How to know how much my kidneys are working?

Glomerular-filtration Rate: It is a rate at which blood is filtered through glomeruli in a minute. It tells us that how much the kidneys are functioning. It can be measured or estimated. There are various formulas for measuring GFR:

  1. Cockcroft gault formula (CGF)
  2. The Modification of Diet in Renal Disease  (MDRD) equation
  3. Creatinine clearance (Urine)
  4. Others

How to estimate GFR:

  1. Inulin
  2. DTPA

Most commonly used are CGF and DTPA

Using this GFR we can differentiate chronic kidney disease (CKD) into different stages

Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 5 ND (not on dialysis) Stage 5 D (on dialysis) Stage 5 T (post-transplant) Patient can himself calculate GFR easily by computed formulas which are easily available on mobile applications and internet.

How to prevent kidney diseases?

Kidney diseases are common in:-

  1. Diabetic patients
  2. Hypertensive patients
  3. Coronary heart diseases patient
  4. Cerebrovascular disease patient
  5. Over weight and Obese patient
  6. Persons who are on long term kidney harmful medicines like painkillers (NSAIDS, lithium), some anti-biotic, some indigenous medication.
  7. Smokers and chronic tobacco users.
  8. Patients having recurrent urine infections.
  9. Patients having multiple kidney stones
  10. Persons in whom family member is suffering from kidney disease
  11. Some genetic related kidney disease.
  12. Urine outflow obstructive diseases.
  13. Hyperuricemia and gout.
  14. Connective tissue diseases like sjogrens, rheumatoid, sarcoidosis and others.
  15. Others

If there are above risk factors than routinely kidney function test (creatinine) and urine routine examination to be done.

If any modifiable risk factor is present than we need to modify them.

Medicines for chronic kidney disease (CKD)

In managing CKD there are lots of medicines are required. There is a major issue of pill burden (number of pills per day). Following medicines are used in treating CKD.

  • Hypertension-anti-hypertension medicines.
  • Anemia-oral or intravenous iron, injection erythropoietin, darbepoetin, mircera.
  • Antacids, proton pump inhibitors
  • Calcium Supplements.
  • Phosphate binders
  • Vitamin-D active or Cholecalciferol.
  • Vaccination- To prevent hepatitis B, Pneumonia, flu.
  • Multivitamins.
  • To control acidosis.
  • Medicine related to primary disease.
  • And others.

Guidelines for Dialysis with reference to COVID-19 Infection

General Guidance for Dialysis Unit

  1. A sign board to report any fever, coughing or breathing problem in dialysis unit and waiting area.
  2. All staff should strictly follow hand hygiene. Avoid touching your eyes, nose, and mouth with unwashed hands
  3. Protocol to be made and inform to concerned authorities if our old patient comes covid 19 positive.
  4. The dialysis unit staff should be trained for donning and doffing of Personal Protective Equipment (PPE) to be used for dialysis of COVID-19 positive patients.
  5. All patients on dialysis, suspected of COVID – 19 should be tested with RT – PCR test as per Government of India protocol.
  6. Protocol to be made and inform to concerned authorities if our old patient is suspected for covid 19.
  7. Educate nephrologists, nurses, technicians, other staff and all patients undergoing MHD along with their care givers about COVID 19

I. For Patients 

A. Before Arrival to Dialysis Unit
  1. All units should instruct their patients to recognize early symptoms of COVID-19 (recent onset fever, Sore throat, Cough, recent Shortness of breath/dyspnea, without major interdialytic weight gain, rhinorrhea, myalgia/bodyache, fatigue and Diarrhea)and contact dialysis staff before coming to dialysis center. The unit needs to make necessary arrangement for their arrival in the screening area. 2. Patients, who are stable on MHD may be encouraged to come to the unit alone without any attendant
B. Screening Area
  1. Should have a designated screening area, where patients can be screened for COVID-19 before allowing them to enter inside dialysis area. Where this is not possible, patients may wait away from the dialysis unit until they receive specific instructions from the unit staff.
  2. The screening area should have adequate space.
    In screening area, every patient should be asked about:
  • Symptoms suspected of COVID-19 as above.
  • History of contact with a diagnosed case of COVID 19
  • History of contact with person who has had recent travel to foreign country or from high COVID-19 prevalence area
  1. Every patient and accompanying person should put on a facemask and to make their wash hands with soap and water before entering to hospital.
C. Inside Dialysis Unit
  1. Suspected or positive COVID-19 patients should properly wear disposable three-layer surgical mask throughout dialysis duration.
  2. To use hand sanitizer before entering to dialysis unit.

II. For Dialysis Staff 

To make list of all patients with addresses and correlate with hot spots areas for covid 19 infection During Dialysis

  1. All staff to wear a three-layer surgical facemask while they are inside dialysis unit.
  2. Suspected or positive COVID-19 be dialyzed in isolation. If not be possible use of a separate shift, preferably the last of the day for dialyzing all such patients or to physically separate areas for proven positive and suspected cases.
  3. Dialysis staff should use of all personal protective equipment (PPE) for proven or strongly suspected patients of COVID-19.
  4. Separating equipments like stethoscopes, thermometers, Oxygen saturation probes and blood pressure cuffs between patients with appropriate cleaning and disinfection should be done in between shifts.
  5. Stethoscope diaphragms and tubing should be cleaned with an alcohol-based disinfectant including hand rubs in between patients. As most NIBP sphygmomanometer cuffs are now made of rexine they should also be cleaned by alcohol or preferably hypochloritebased (1% Sodium Hypochlorite) solutions
  6. Staff using PPE should be careful of the following issues:

While using PPE, they will not be able to use wash room so prepare accordingly

If dialysis is to be done bed-side in the hospital, portable RO should be properly disinfected with hypochlorite (1% Sodium Hypochlorite) solution between use of two patients

DISINFECTION AND DISPOSAL PRACTICES IN DIALYSIS UNIT 

Cloth gowns should be soaked in a 1% hypochlorite solution for 20 minutes before sluicing and then be transported for laundering after each use.

Inside dialysis unit, clean and disinfect frequently touched surfaces at least thrice daily and after every shift.

PERSONAL PROTECTIVE EQUIPMENTS (PPE) Personal protective equipment must be used while dialyzing COVID-19 positive patients. These include:

Shoe covers

Gown

Surgical cap or hood

Goggles or eye shields

Mask: Ideally all masks should be N95 respirators with filters.

kidney stones

Kidney Stones

Stones can be in kidneys, ureter, urinary bladder or urethra. It is very common in Haryana and Punjab areas because of weather conditions and genetic susceptibility. Sometimes the kidney stone formers (metabolic stone former), usually run in family.

What are kidney stones?

As we all know that kidneys perform a crucial role in our body. The kidney removes all the waste and fluid from your blood to make urine and helps to maintain its functions properly. But sometimes when you have too much wasted with not enough fluid in your blood, it develops and sticks in your kidney and make it functions unwell, these wastes are known as kidney stone.

Kidney stones are similar petite stones that develop inside the kidneys because of few wastes. They made when salts, as well as minerals that are frequently in the urine, develop up plus made it harden.

Kidney stones can be painful when passing through the urinary. If that happens, the stones can cause:

  • Pain in the side of the lower section of the belly
  • colors change of Blood in the urine
  • Nausea or vomiting
  • Pain when you urinate
  • The need to urinate in a hurry
  • Cloudy or smelly urine
  • fever and chills
  • Pain in back, burning during urination

How do I know if I have kidney stones?

Kidney stones are like a petite piece of pebble that can develop on both sides of the kidney. Kidney stones seldom generate lasting damage. Kidney stones vary not only in size but also in shape and create pain in your back.

Usually, Kidney stones normally have yellow or brown. Kidney stones can block the natural flow of urine including severe pain as well as little bleeding.

If you see the symptoms like pain in your back and bleeding then you must consult with the doctor immediately without wasting your time and prevents yourself from all these problems such as Urinary Tract infection UTI.

If you have stones in your kidney then the symptoms of this can be a severe pain in your back, pain while you move into your lower belly, plenty of urinating, pain while you peeing, cloudy, red-pink or brown urine, nausea with stomach ache, fever and chills.

Do you know the scientific name of kidney stones? 

The scientifically the kidney stone identified by is renal calculus or nephrolith. You might listen to health care professionals call this condition nephrolithiasis, urolithiasis, or urinary stones which present on the kidney.

There are probably 4 types of kidney stones, which depend on the size, location and the material they are made up of kidney stone specialist doctor near me.

How are kidney stones treated?

Each person’s treatment is different according to the kidney stones. The right treatment for you will depend on: The size, type, and location of your stone, how much pain you have, how much you are vomiting, etc. You must take some treatments like:

  1. Water: 

Drinking 8 to 12 glasses of water each day helps you to melt the stone out through urine.

  1. Lemon juice: 

You must drink squeeze lemon juice because it contains citric acid which helps you to prevent kidney stones and helps to function the kidney properly. Lemon juice has also numerous health benefits.

  1. Basil juice: 

Basil contains acetic acid which assists to break down kidney stones and decrease pain. It contains full of nutrients with the presence of antioxidants and it helps maintain kidney health.

  1.  Apple cider vinegar:

It contains acetic acid which helps to dissolve kidney stones. It also helps you to prevent pain caused by stones in the kidney.

If the stone is large or produces severe indications, you might require visiting in the hospital. If the stone is inadequate as well as causes only mild signs, you might be ready to stay home plus wait for it to pass in the urine.

You will probably necessitate taking a bunch of fluids. Plus, you might necessitate using pain medicines or drugs that perform it more accessible to pass the stone.

Stones that do not move on then it can be treated with:

  • A device that utilizes sound waves to split up stones into scantier pieces, it identified as “shock wave lithotripsy.” This mode does not require surgery, but it can be notably painful.
  • A specific variety of surgery, that composes very petite holes in the skin. while this surgery, the doctor passes diminutive machines via the holes plus inside the kidney. Then they eliminate the stone. This is denoted as “percutaneous nephrolithotomy.”
  • A piping tube that goes inside the body the equivalent method urine comes out. Doctors use devices at the close of the tube to split up or eliminate stones. It is identified as “ureteroscopy.”

What people can do to prevent from getting kidney stones again?

One manageable thing you can perform is to take excess of water. You might also necessitate changing what you have, depending on what the kidney stones were created of best kidney doctor near me for kidney stone in delhi.

WHEN IS SURGERY REQUIRED?

Surgery for stones is usually required when the size of the stones is big, it is obstructing urine flow, severe symptoms (pain, infection, blood in urine, increasing serum creatinine) and in special occupations (pilots, sailors).

Kidney Transplant Vs Dialysis

Dialysis vs kidney transplant – which is right for me?

Dialysis and kidney transplantation are the treatment for advanced stage of kidney failure. Kidney transplantation is for end stage renal disease and should have a family donor for replacement. Dialysis is the process of taking care of your failure kidney and removes the fluid and waste products. Patients have multiple restrictions when on regular dialysis sessions. After transplantation of the kidney most patients feel active and resume doing the routine work.

You can take the kidney transplantation before initiation of dialysis which is called preemptive transplantation process. Dialysis has the negative consequences on health so it can be avoided through the early transplant. If you are going for the surgery after the dialysis than you need to have the donor. The transplantation process will be start by getting the full information about the donor if you do not have the living donor then deceased person kidney can be replaced.

Advantages of kidney transplant

  • Kidney transplant help you to improve the quality of your life and reduce the risk of your dying.
  • After kidney transplant you do not need to undergo for the dialysis treatment for life till functioning of transplanted kidney.
  • You can even go for the surgery before starting any dialysis treatment by getting the living donor.
  • Long term it is cost effective as initial cost is high but subsequently monthly expenses are less.
  • Less dietary restrictions.
  • Significant improvement in functioning of other organs like heart, brain, nervous system, and others.

Disadvantages of kidney transplant

  • There will be major surgical problems like infection, bleeding, damage to surrounding organs arise during and after the transplantation.
  • If you have infection and cancer or any severe illness (not fit for surgery) then kidney transplant is not the best treatment.

Kidney transplantation has the various less chances of rejection of new kidney. You must take care of your health after the surgery. If rejection occurs then medication treatment will help you to treat the rejection.
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