Dr.Papaiah Nirmal Pudota

MBBS, MD, DRNB(Nephrology)

Specialization: Endoscopic & Laparoscopic Urologist,

Years of Experience: 10+ Years

Location: Hanamkonda, Warangal

It is also known as Chronic Renal Disease. This occurs over a period of month or years, with symptoms like feeling generally unwell, loss of appetite. People with high blood pressure, diabetes and a bloodline relative with CKD when screened may be found infected with this disease. CKD can be identified by a blood test for creatinine (a breakdown product of muscle metabolism). The higher the creatinine values, the lower glomerular filtration rate and as a result the capacity of the kidney reduces to filter the waste products. There are five stages in this disorder according to international standards, based on glomerular filtration rate and protein level in urine. Screening is important because treatments do exist, that delay CKD.

The important symptoms are:

  • Increased blood pressure due to overload of fluids.
  • Accumulation of urea in urine.
  • Potassium accumulates in blood resulting in hyperkalemia.
  • Erythropoietin synthesis decreases causing anemia.
  • Symptoms related to fluid overload may range from mild edema to pulmonary edema.
Acute kidney failure

The kidneys function is to filter the body fluids especially blood. If this ability of the kidney suddenly fails we call it Acute Kidney Failure. During this period the fluid levels in the body may rise to dangerous levels. It may develop over a few hours or few days. It is most common in people who are already hospitalized and are in need of intensive care. The important symptoms are:

  • Decreased urine output, though it might be normal at times.
  • Swelling in legs, ankles or feet due to retention of fluids.
  • Drowsiness, fatigue, shortness in breath and Nausea.
  • Chest pain or pressure.
  • In some cases it may result in coma or seizures.

This failure may also be found in a person, while being diagnosed for other ailments.

Diabetic kidney disease

As a result of diabetes, a person’s small blood vessels are injured. The glomeruli, filters of the kidneys are damaged. Due to this high volume proteins are released into the urine. The body will retain more amount of water and salt than normally required. It is commonly called as Diabetic Nephropathy. Raised levels of albumin in the urine are the first sign. Albumin is the main protein that leaks out of a damaged kidney. The disease is divided into:

  • Micro albuminuria, here the albumin leak is about 30 to 300 mg per day. This is sometimes called as incipient nephropathy.
  • Proteinuria, here the albumin leak is more than 300 mg per day. It is also called as macro albuminuria or overt nephropathy.
  • Symptoms are:
  • Dry, itchy skin.
  • Cramps in the muscles and puffiness around the eyes.
  • Needing to pass urine more often than normal.
  • Weight loss.
  • Glomerular disease

    This also commonly called as Glomerulonephritis. Tiny filters called glomeruli in the kidneys, remove electrolytes, toxins and waste from the blood and excrete them through urine. It might be a sudden attack of inflammation or chronic which comes on gradually. If this occurs on its own it is primary glomerulonephritis or secondary glomerulonephritis when occurred with either diabetes or lupus.

    The common symptoms are:
  • Pink or cola colored urine due to the presence of blood in the stream.
  • Anemia or kidney failure.
  • Swelling in face, feet, hands and abdomen.
  • Foamy urine due to protein content in excess.
  • Are you BP - Fit?
  • Have you checked your BP yet?
  • Do you know your risk for high BP?
  • Do any or both parents have high BP or Kidney Disease?
  • Do you have uncontrolled blood pressure?
  • Are you a hypertensive at young age?
  • Do you know that the kidney regulates your BP?
  • Be wise BP-Wise!

Know more about hypertension and its management

Visit our "Hypertension clinic" at Muthya kidney centre

Hypertension is a disease of the elderly. In some younger patients hypertension may be secondary to an underlying hormonal imbalance vascular abnormality or kidney disease. Secondary hypertension may be curable. The following suggests that hypertension may be secondary 2 to an underlying problem.

  • Young age of onset of hypertension
  • Froth in urine
  • Nocturia- need to pass urine multiple times in the night
  • Associated symptoms like severe sweating episodes palpitations, extreme fatigue or weight loss
  • Ultrasound showing small or unequal kidneys.
  • With the series of simple to complex tests secondary hypertension can be properly diagnosed and treated to ensure prevention of complications like heart disease, kidney disease and eye damage.

    We provide a comprehensive care for evaluation and treatment of hypertension.

The intensive care unit (ICU) is a common source of high-acuity nephrology consultations. Although advanced chronic kidney disease is associated with increased ICU mortality, the prognosis of acute kidney injury (AKI) requiring renal replacement therapy is far worse, with short-term mortality rates that often exceed 50%

Critical care nephrology is a subspecialty of nephrology that focuses on the care of critically ill patients with kidney disease or acute kidney injury (AKI) in the intensive care unit (ICU). It involves managing complex electrolyte and fluid balance disturbances, renal replacement therapy (RRT), and addressing the renal implications of multi-organ failure.

Role of Nephrologist in ICU:
  • AKI Management: Diagnose and manage AKI, including identifying the underlying cause and implementing appropriate interventions.
  • Renal Replacement Therapy (RRT):Initiate and manage RRT, such as hemodialysis or continuous renal replacement therapy (CRRT), to support patients with severe AKI.
  • Electrolyte and Fluid Management: Monitor and correct electrolyte imbalances and fluid overload, which can be life-threatening in critically ill patients.
  • Medication Management: Adjust medication dosing for patients with kidney disease or AKI to prevent further kidney injury and ensure therapeutic efficacy.
  • Collaboration with ICU Team: Work closely with intensivists, nurses, and other healthcare professionals to optimize patient care and outcomes.
  • Kidney Transplant Care: Manage kidney transplant patients in the ICU, including immuno suppression and monitoring for complications.
  • Prognostication and End-of-Life Care:Provide guidance on prognosis and support end-of-life care discussions with patients and families.

Nephrologists play a crucial role in the ICU, helping to manage complex patients with kidney disease and AKI, and contributing to multidisciplinary care teams to improve patient outcomes.

Integrated nephrology involves collaboration between nephrologists and other specialists to manage complex conditions affecting multiple organ systems. This approach is crucial for conditions like:

  • Cardio-Renal Syndrome (CRS):A complex interplay between heart and kidney dysfunction, where cardiac disease worsens kidney function and vice versa. Integrated care involves cardiologists, nephrologists, and intensivists working together to manage fluid overload, electrolyte imbalances, and optimize cardiac and renal function.
  • Hepato-Renal Syndrome (HRS):A type of kidney dysfunction seen in patients with advanced liver disease, often requiring collaboration between hepatologists, nephrologists, and intensivists. Integrated care focuses on managing ascites, hepatorenal syndrome, and optimizing liver and kidney function.

By working together, healthcare teams can provide high-quality, patient-centered care for complex conditions like cardio-renal syndrome and hepato-renal syndrome.

Role of Nephrologist in Kidney Transplant:

  • Pre-Transplant Evaluation:Assess patient's suitability for transplant, manage underlying kidney disease, and optimize overall health.
  • Living Donor Evaluation: Evaluate potential living donors' medical suitability and provide guidance.
  • Immunosuppression Management: Develop and adjust immunosuppressive regimens to prevent rejection.
  • Post-Transplant Care:Monitor graft function, manage complications, and adjust treatment plans.
  • Rejection Management: Diagnose and treat acute rejection episodes.
  • Long-term Follow-up: Monitor graft function, manage chronic kidney disease, and address long-term complications.
  • Nephrologists play a vital role in ensuring the success of kidney transplants, from evaluation to long-term care.

Role of Nephrologist in Interventional Nephrology:

Interventional nephrology involves minimally invasive procedures to manage kidney disease. Nephrologists trained in interventional nephrology perform:

  • Vascular Access Procedures:Creation and maintenance of arteriovenous fistulas and grafts for dialysis.
  • Tunnelled Dialysis Catheter Placement:Insertion and management of central venous catheters for dialysis.
  • Peritoneal Dialysis Catheter Placement:Insertion and management of catheters for peritoneal dialysis.
  • Dialysis Access Interventions:Angioplasty, thrombectomy, and stenting to maintain dialysis access patency.
  • Kidney Biopsy:Performing native and transplant kidney biopsies to diagnose kidney disease.
Benefits:
  • Improved Patient Care: Minimally invasive procedures reduce complications and improve outcomes.
  • Increased Autonomy:Nephrologists can perform procedures, enhancing patient care and reducing reliance on other specialists.
  • Enhanced Dialysis Access:*Timely creation and maintenance of dialysis access improve dialysis efficiency and patient quality of life.