We are a registered group of doctors working around the world for the betterment of health. Our primary aim is to provide comprehensive health care to everyone and everywhere.
Dr Sunil Kumar a nephrologist & kidney transplant physician currently working in India Kolkata with the Narayan group of hospitals. He completed his education from premier medical colleges in Delhi than moved to Kolkata. He has 15 years of vast experience in health care. He has published many research papers and review articles in various journals. His keen interest is in medical management of kidney diseases and kidney transplantation.
kidneys are an especially important organ of our body. Kidneys are fist-sized soft organs, which lies towards the back under the ribcage, partially covered by the lower ribs. Kidneys have especially important roles in our body, which keeps us in good health.
We are born with two kidneys each person. One in a 1000 person can be born with just one kidney. Sometimes kidneys are not in the location as described above, and they move to another part of the abdomen.
Kidneys get blood supply just like any other organ from the heart through the aorta, and after that renal artery, get 1/4 of the blood being pumped by the heart per minute. Kidneys are highly vascular organ organs, which take up a lot of blood and from this blood.
Kidneys play many roles on that blood, and after cleaning the blood, it is sent back to the body through the renal vein. Renal artery received blood is further distributed into smaller arteries and finally, it reaches the glomerular afferent arterioles. This afferent arteriole or small vessel feeds blood to the working unit of the kidney known as the nephron. Each kidney has 12 lac nephrons. Each nephron has a sieve-like structure called glomerulus which acts is a filter-like structure through which blood is passed. Apart from the glomerulus, each nephron also a tube-like structure through which the filtered load is moved further downstream. So, all the bad components are excreted from our body in the form of urine and the cleaned blood is sent back to the body through renal vein. The kidney also works in filtering out extra water or conserving water in case of increased demand in the body or decreased supply to the body. Kidneys excrete unwanted electrolytes like potassium and phosphorus, and on the same hand, it conserves electrolytes like sodium and calcium. The kidney has other functions like endocrine function, maintaining blood pressure.
Kidneys are also a source of vitamin D metabolism. The kidney also produces a hormone named erythropoietin, which helps develop RBC production or blood production. Kidneys also have a role in taking care of the appropriate Acid-base balance in the body. Our body is kept in an appropriate fixed acid-base balance in a pH range of 7.35 to 7.45. The pH imbalances might lead to life-threatening complications.
A detailed history of the patient is taken then we try to elucidate the risk factor if the person coming to our clinic is at the risk of kidney disease. After some tests, we confirm the kidney disease, and according to the type of kidney disease, treatment is given for the same.
A simple urine routine and microscopic examination will give a lot of information about the kidneys. Imaging with ultrasound or CT scan helps us understand the structural aspect of the kidney.
Sometimes we also need to know the blood supply for the kidneys, so we do a Doppler of the blood vessels. Apart from this, we also do some blood tests like serum urea serum creatinine, serum starting c Serum uric acid, Serum calcium zero phosphorus, sodium, potassium. These tests help us determine the type of kidney disease in a patient. Sometimes, a patient will still have kidney disease, which cannot be detected based on all simple blood and urine tests. These patients are advised to go for renal biopsy, which is a comparatively safe procedure in which a needle is put through back into the kidneys. We take a small piece of kidney, which is examined under the microscope after staining. Because kidneys affect other organs too, sometimes, we ask for tests like brain functions, heart functions, lung function, gastrointestinal, and liver functions to understand the extent of another organ damage secondary to kidney disease.
People with diabetes, especially uncontrolled blood sugar, hypertension, history of renal stone disease, autoimmune diseases like SLE. Admitted patients with severe sepsis, drug abusers like a painkiller. Family history of kidney disease.
In every clinic worldwide, there are four sets of patients.
The first healthy popular population who are afraid or who are aware and wants to have more knowledge about their kidney’s health will just come with some health checkup or in hand reports. We examine these patients, and we take a history about the risk factor, and we do some investigations. And very commonly, these patients have healthy kidneys. Sometimes there is some kidney disease, and which can be prevented from progression. So, we tell them some diet changes, some exercise, some yoga some options. With this help, patients stay healthy, and their lives are every day, happy life.
The second types of patients are the ones who are at risk like diabetes, hypertension, family history of kidney disease, stone disease, or previous known kidney illness or family physician referred cases.
These patients undergo a detailed history taking and examination followed by an investigation. According to their diagnosed disease and risk factors, the patients are encouraged to lead a happy, healthy lifestyle, and with some medications, they live well without dialysis or kidney transplantation.
The third category of patients is the one who has kidney disease. Prior to reaching a nephrologist, they are seen by many doctors or quacks. They are very much afraid of accepting the diagnosis and prognosis. Many times quacks treats them and do not refer them to us at right time before the disease reaches a late stage. Many of these patients are confused by a lot of knowledge online. So, when they come to us, we explain to them in detail about the disease and the best line of treatment for them.
There are two types of major subtypes of kidney disease. One is acute kidney injury another is chronic kidney disease. So acute kidney injury or rapidly progressive renal failure these are the patients which if worked up urgently will have a better outcome to the treatment given and kidneys can be saved if treatment is given at the right time.
The second subtype of this type of patient will be those who have kidney disease, but it is stable, which means some nephrons are dead which are not functioning, but the remaining nephrons are working fine. We explain to such patients the percentage of remaining kidney left and ways to live event free life. Our treatment goal is to stop the progression of damage to the remaining kidneys. Diet and exercise improve some of the kidney functions. The patients are put mainly on diet therapy, exercise, yoga, and some medicines. In the background, the management of diabetes, hypertension, and other risk factors are taken care of.
The fourth category of patients presents late in the course of their illness.
These patients are not aware of their disease or are sometimes aware, but they could not come to a nephrologist. We try to recover their kidney functions with all the world’s best of treatment. Patients are given all the help in the form of medical nutrition therapy, lifestyle management, and medications and injections.
Those patients whose kidneys are non-functioning and permanently damaged are taken care of by RRT (Renal replacement therapy) team.
Three options are available for such patient’s hemodialysis, peritoneal dialysis, or kidney transplantation.
Out of three options, these kidney transplantationg ives the best quality of life and longest survival, followed by peritoneal dialysis and hemodialysis. But all of these have their pros and cons. All of these require a different level of patient and their family involvement. So, patients choose according to their family condition. With appropriate RRT of any of patients’ choice, they usually live well.
In case a patient chooses to go for kidney transplantation, one kidney donor is usually chosen from close family members. They are worked up, and they are tested to know two important things before transplantation. First and foremost is tested that the donor should be able to live a normal healthy life even after donation. Second, the donated kidney should function without complications in the recipient. Though sometimes medical science does give surprises and rejects, most tests are usually done to make sure it does not happen. Both recipient and donor undergo a battery of tests, and after a Legal workup, they are taken for kidney transplantation. And this legal workup requires a file to be clear from the state health department, which has a say in clearing or not clearing the file for kidney transplantation.
Patients who chose peritoneal dialysisundergo a minor abdominal procedure. In which a small catheter is put in the abdomen and a small tail of the catheter is left out of the abdomen. Patients at home connect this tail of the catheter to peritoneal fluid and install fluid in the abdomen and keep for few hours. After few hours, this fluid is removed along with all the toxins. This is done by the patient at home only. A visit to their doctor is done once a month.
The third type of renal replacement therapy or option available for patients with end-stage renal diseases is hemodialysis(HD). Every HD requires a visit to the hospital where hemodialysis machines are available. Machines are fed blood through the patient's port, and that port can be a neck channel or permanent catheter, or AV fistula. After the cleaning machine returns the blood back to the patient. AVF should be created in stage four kidney disease only. Patients who chose HD as RRTAV fistula have the best quality of life compared to other type of dialysis lines.
The remaining function of the kidney, like erythropoietin production, which also fails with the failure of kidney is taken care of by injections. Injections are required to keep the blood values in a normal range. Calcium, phosphorus, sodium, potassium, and other electrodes are kept in check with other drugs and dietary modifications. With appropriate RRT patient usually lives well even with the failed kidneys. Sometimes they do develop complications that are taken care of by their nephrologists.