AKI (Acute Kidney Injury)
Acute kidney injury occurs quickly and without warning. It is a serious medical condition and requires prompt treatment. In majority of cases, the condition can be reversed, with quick treatment avoiding permanent kidney damage. Treatment involves rectifying the cause, intravenous fluid for rehydration and administering vasopressor support to help raise blood pressure. The patient may also be recommended Haemodialysis - when the patient has severe acidosis, volume overload, hyperkalemia, etc. Haemodialysis is a procedure to filter the toxins and waste products out of the blood.
CKD (Chronic kidney disease)
Chronic kidney disease is a clinical condition in which there is gradual loss of kidney function, causing a build-up of fluids, toxins and wastes in the patient’s blood stream. Chronic kidney disease is typically treated with dietary changes and oral medication to treat the symptoms. This includes medication to treat high blood pressure, lower cholesterol levels, treat anaemia, relieve swelling and protect the bones. The patient will be recommended a low protein diet to minimise the build-up of wastes in the blood stream. Advanced stage chronic kidney disease is known as end-stage kidney failure. At this stage, the kidneys no longer function, and the patient requires regular dialysis or kidney transplant surgery.
Intensive Nephrology Care
Conditions such as electrolyte disorders, fluid imbalances and acute renal failure can cause the sudden onset of symptoms and require immediate medical treatment to limit permanent functional deficiencies. Nephrologists and Critical care experts specialise in the latest cutting-edge techniques to treat these conditions. The Nephrology ICU is equipped with state-of-the-art medical equipment, including dialysis machines, to provide life-saving care to critical patients. Patients are treated with the aim of preserving maximum kidney function and restoring good health as quickly as possible.
Renal stone disease
Kidney stones, also known as renal calculi, nephrolithiasis, or urolithiasis, are hard deposits of crystallised minerals in the urinary tract. Kidney stone can affect any part of the urinary tract – the kidney, ureters, bladder or urethra. Most kidney stones cause pain once they become dislodged, as they travel through the urinary tract. Small kidney stones may pass out naturally in the urine. The doctor may provide the patient with a urinary seize to catch the kidney stone for laboratory analysis. Some kidney stones may require medication to break them up so they can pass naturally, with less pain.
Large kidney stones may be broken up using extracorporeal shock wave lithotripsy. They may also be extracted surgically. Surgical removal of kidney stones is performed by urologists with minimally invasive techniques to reduce recovery time and minimise scarring. The doctor may perform a ureteroscopy procedure or a percutaneous nephrolithotomy.
Polycystic Kidney Disease
Polycystic kidney disease is a genetic disorder that results in the formation of multiple fluid-filled sacs on the kidney. The kidneys become enlarged and may lose function over time. Polycystic kidney disease can also cause cysts to develop on the liver. Treatment in the early stages of the disease can help slow the progression and delay end-stage kidney failure. If the cysts are large and close to rupturing or at risk of infection, the doctor may elect to have it removed. Kidney cysts can be removed laparoscopically.
Hemodialysis is a therapeutic procedure to remove wastes and toxins from the blood, in patients whose kidneys have lost function completely. The dialysis machine has a mechanical filter that does the job of the compromised kidney. Blood is pumped out of the patient’s body and into the dialysis machine through special tubes. The blood passes through the filters and the waste and toxins are removed. The purified blood is pumped back into a vein in the patient’s arm. Dialysis sessions typically last 3-4 hours and are recommended 3-4 times a week for patients with completely compromised kidneys.
Peritoneal dialysis performs the same function as haemodialysis, but in a different way. During peritoneal dialysis, a catheter carrying a cleansing fluid is inserted into the abdomen. The lining of the abdomen, called the peritoneum, acts as a filter, and removes waste from the blood stream. After a fixed amount of time, the cleansing fluid and wastes are drained out of the abdomen. Peritoneal dialysis is simpler to perform and can be done at home, once the patient is given the proper education and training by a health-care professional. Peritoneal dialysis is usually a daily procedure.
Continuous Renal Replacement Therapy (CRRT) Continuous renal replacement therapy is provided to critically ill patients with acute kidney failure, especially those with an unstable heart rate and blood pressure. During continuous renal replacement therapy, the patient’s blood is passed through an external filter that mechanically purifies the blood, before it is returned to the body. Continuous renal replacement therapy works on the same principle as dialysis, but the pace is much slower. CRRT is done over a 24-hour period, as compared to dialysis which takes about 4 hours. The slow rate allows patients with unstable blood pressure to stabilize and respond better to the treatment.
A kidney transplant is a surgical procedure to graft a healthy kidney from a living or deceased donor, to a patient with compromised kidney function. When the kidneys lose function, they stop filtering toxins and wastes out of the blood stream. This is dangerous and other organs in the body may be poisoned. Dialysis is also an option for patients who have lost kidney function, but transplant is considered a more permanent solution with lower long-term costs and better quality of life. It is important to choose a matching donor kidney to minimise the chances of rejection by the patient’s immune system. The surgical transplantation is performed under general anaesthesia. It is a surgical procedure, and hence does have certain risks – The patient may develop postoperative complications such as blood clots, infection or stroke.
A kidney biopsy is a minimally-invasive procedure performed to remove a small portion of the kidney tissue for laboratory testing. A kidney biopsy may be done to assess the extent of damage caused by kidney diseases. A kidney biopsy may be recommended by the doctor if there is blood in the urine, excessive protein in the urine and other signs of deteriorating kidney function. Kidney biopsies are usually performed as an outpatient procedure, meaning an overnight hospital stay will not be required. The patient is usually given an intravenous drip, with optional sedatives. The doctor uses an ultrasound to visualise the exact location of the biopsy. The location is marked and a local anaesthetic is applied. A micro-incision is made at the site of the biopsy and the needle is guided through the incision into the kidney. Once the tissue sample is collected, it is sent to pathology for analysis.
A kidney transplant is a surgical procedure to graft a healthy donor kidney into a patient with compromised kidney function. The donor organ may be retrieved from a deceased (brain-dead) donor or from a live donor. If the patient chooses to go with a live donor, the donor must be in good health, have two viable kidneys (one for donation and one for the donor’s continued use), be a good match for the patient and be able to withstand the stress of a surgery without any foreseeable complications. The transplant surgery is performed in two parts – retrieval and transplant. During the retrieval, the surgeon carefully harvests one kidney from the donor. The blood vessels to the kidney are then expertly grafted and blood flow is restored.
PERMCATH (permanent dialysis catheter insertion)
A PermCath is a long-flexible tube inserted permanently into a vein in the neck or the groin, to facilitate easy dialysis treatment. The tube is left in place permanently, as the patient likely requires dialysis treatment 3-4 times a week. The tube tunnels beneath the skin and is exposed at the site of attachment to the dialysis machine. PermCaths are inserted when the patient requires multiple dialysis sessions over a period of more than 2 weeks. The PermCath has lower chances of becoming infected with long-term repeated usage, when compared to a temporary dialysis catheter.
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