Category Archives: Nephrologist

nephrologist in Delhi

Chronic Kidney Disease in The Elderly

Renal physiological aging is characterized by a reduction in the renal glomerular filtration rate. In other words, the kidney does its filtration work in a slower way, in the same way that the locomotion of an elderly person is also slower, but maintaining the preserved function, that is, reaching the same place.

“The elderly are the biggest consumers of medication.”

This situation must be distinguished from the effective presence of kidney disease in the elderly, a situation in which the functioning of the kidneys is not adequate and is not related to the physiological decline of age. In situations of illness, and as in any other young or adult patient, kidney malfunction can be so severe that some interventions are needed. One is the medication review.

The elderly are the biggest consumers of medication, as they also accumulate more pathologies, and some medications can impair kidney function. Pain medications from the group of non-steroidal anti-inflammatory drugs, often taken by the elderly due to their degenerative osteoarticular pathology, can be very harmful and their indications and alternatives reviewed.

The other substantial intervention by the nephrologist is to prepare the patient for renal replacement treatment if and when the kidneys “stop”.

In India, kidney transplant is rarely performed in patients over 65/70 years old, since the risk of intervention and immunosuppression is greater than its benefit. But aging in the elderly is highly heterogeneous: age is of little significance for the decisions to be made, since other more important factors can overlap, such as: associated diseases, functionality, autonomy and independence. Thus, an elderly person may be a candidate for transplantation, despite not being the norm.

“ There are kidney patients who, due to the advanced comorbidities they have, do not benefit, in terms of time or quality of life, from any renal function replacement therapy. “

As for dialysis modalities (hemodialysis or peritoneal dialysis), there is no difference between them, similarly to what happens in young patients. The only point to note is that peritoneal dialysis is a modality that depends on the patient to be performed, unlike hemodialysis that is performed by a nurse in a hemodialysis center. Therefore, if the patient is not able to perform the technique, he may need a caregiver to do it for him, or, if he does not have it, this modality should not be an option.

Finally, there are kidney patients who, due to the advanced comorbidities they present, do not benefit, in terms of time or quality of life, from any renal function replacement therapy. These patients should be offered palliative care. Therefore, patients should be followed up by nephrologist in Delhi in order to control the symptoms of kidney disease, promoting quality of life, but without being subjected to more invasive techniques.

The choice of these options should always be made in conjunction with the assistant kidney specialist in Delhi, who should clarify the particularities of each elderly person, in order to better adapt the treatment to the person in question.

renal failure

Symptoms And Causes of Renal Failure

Acute renal failure

We say that we are facing acute renal failure when its onset is relatively early, less than three months. It can be reversible if it is treated in an appropriate and timely manner.

The chronic renal failure, the acute exacerbation is the installation of acute renal failure in a patient with chronic renal failure.

Chronic renal failure

We say that we are facing chronic kidney failure ( CRF ) when it is possible to determine that kidney failure has existed for more than three months.

The name of this entity was changed to chronic kidney disease as there are situations of kidney disease/injury without failure. Examples of such situations are albuminuria/proteinuria, changes in urinary sediment, renal ultrasound changes, anatomopathological kidney lesions in renal biopsy or even a kidney transplant.

Stages of chronic renal failure

Chronic kidney disease has several stages or phases, causes, and degrees of albuminuria. The stages of chronic renal failure are as follows:

Stage 1 – Glomerular filtrate> = 90 -normal or elevated renal function;

Step 2 –  glomerular filtrate 60-89 – decreased renal function with mild;

Stage 3a –  Glomerular filtrate from 45 to 59 – renal function with mild to moderate decrease;

Stage 3b –  Glomerular filtrate from 30 to 44 – renal function with moderate to severe decrease;

Stage 4 –  Glomerular filtrate from 15 to 29 – renal function with severe decrease;

Stage 5 –  Glomerular filtrate <15 -Renal failure (add D if the patient is on dialysis).

Glomerular filtrate values ​​in (mL / min / 1.73 m2).

Pathophysiology of renal failure

The pathophysiology of renal failure, acute or chronic, can have different levels. If the pathology that damages the kidneys is found “before” the kidneys, it is called the renal failure of a pre-renal cause, as for example in cases associated with heart failure or the removal of volume in the vessels.

In turn, if the pathology is intrinsic to the kidneys, as is the case of acute glomerulonephritis or pyelonephritis, renal failure is considered to be of renal cause.

Finally, if the cause of renal failure is related to obstruction of urinary drainage, such as prostate hypertrophy, it is called post-renal.

Find out below what the symptoms of kidney failure are.

Symptoms in renal failure

The signs and symptoms of kidney failure are usually late, so they appear in the more advanced stages of chronic kidney disease. They can result from decreased glomerular filtration, such as edema (swelling), decreased urinary elimination or high blood pressure.

In stage 4, or more commonly in stage 5, more evident signs or symptoms may appear, such as generalized weakness (asthenia), lack of appetite (anorexia), nausea, vomiting, and changes in the central nervous system (slowness of reasoning, drowsiness) and rarely seizures).

These initial symptoms of chronic renal failure are explained to patients who are already being followed up with nephrologist in Delhi. In most cases, however, kidney disease is detected in routine tests without previous suspicion of its existence.

In India, cases of chronic renal failure that are diagnosed only at stage 5, using the emergency service to start hemodialysis on an emerging basis, have decreased. This improvement is mainly due to the improvement of primary health care with timely referral to kidney specialist in Delhi.

Causes of kidney failure

The causes of renal failure are multiple and vary according to the age group. As an illustrative example, the etiology of chronic kidney diseases that led to the beginning of regular dialysis in Delhi: diabetes mellitus 33.9%, arterial hypertension 13.1%, glomerulonephritis chronic 11.2%, polycystosis 4.9%, hypoplasia / renal dysplasia 0.7%, other causes 18.5% and unknown causes 17.7%.

Children only reach “normal” kidney function at two years of age, so below that age, the classification of chronic kidney failure at the stages mentioned above cannot be applied.

The vast majority of cases of kidney failure in early stages are, in general, related to congenital kidney diseases. However, the causes of kidney failure in pediatrics, requiring dialysis or kidney transplantation, also include glomerular diseases.

Diagnosis of renal failure

The diagnosis of renal failure can be made by family doctors, taking into account some aspects, namely:

  • The complete absence of diuresis (anuria) is not a characteristic of chronic renal failure, but of acute renal failure or acute chronic kidney failure;
  • Elevated creatinine and serum urea are characteristic of renal failure;
  • To better characterize the stage of chronic renal failure, creatinine clearance is used using 24-hour urine collection (determination of urinary volume and creatinine) and blood (determination of serum creatinine): creatinine clearance = urinary creatinine (mg / dl) / serum creatinine (mg / dl) X urine volume of 24 hours (ml) / 1440 (minutes). It is expressed in ml / minute (normal values: men> 90 ml / minute; women> 80 ml / minute). Formulas can also be used to calculate creatinine clearance, avoiding the 24-hour urine collection that is often not performed correctly or is not feasible;
  • The signs and symptoms of chronic kidney disease should lead to an assessment of renal function (serum creatinine and urea, as well as creatinine clearance using mathematical formulas or with 24-hour urine collection as already described);
  • Elevated serum potassium values ​​are not essential for diagnosis;
  • Other common analytical changes in chronic kidney disease in advanced stages (3 to 5) are anemia, metabolic acidosis, low serum calcium, and elevated parathormone;
  • Summary analysis of urine may reveal albuminuria and urinary sediment may show changes such as hematuria and erythrocyte cylinders;
  • Renal ultrasound is the exam indicated for initial imaging evaluation in suspected chronic kidney disease. It may reveal a decrease in kidney size, although in diabetes mellitus this change may not exist even in advanced stages of CRF. Another echographic abnormality typical of chronic kidney disease is the decrease in differentiation between the cortex and the renal medulla. If multiple bilateral renal cysts appear, we may be in the presence of a polycystic disease.

The early referral of patients with chronic renal failure to the best nephrologist in Delhi has had an impact on improving their follow-up, with implications for delaying their progression as well as for the adequate treatment of the various complications of chronic renal failure.

How to prevent kidney failure?

Renal failure can be prevented, essentially through the following measures:

  • Lifestyle changes to prevent frequent causes of chronic renal failure, such as type 2 diabetes or cardiovascular disease including high blood pressure;
  • Obesity (overweight) can also be associated with chronic kidney failure. Lifestyle should be changed in order to avoid obesity;
  • Avoid exposure to nephrotoxic drugs, especially non-steroidal anti-inflammatory drugs.
habits that affect kidney

Surprising Habits That Can Affect Your Kidneys

A number of habits can damage the health of the kidneys. Thus, in addition to alcohol consumption or insufficient fluid intake, increased protein intake, lack of exercise, vitamin and mineral deficiency can affect the kidneys.

The kidneys have the role of filtering blood, producing hormones, absorbing minerals, neutralizing acids and removing toxins and excess water from the body. Surprisingly, many of the daily behaviors actually affect the proper functioning of the kidneys.

Exaggerated use of analgesics

Medications used for pain, such as non – steroidal anti-inflammatory drugs, can damage the kidneys, especially in people who already have kidney disease. Therefore, it is recommended by nephrologist in Delhi never to exceed the maximum recommended dose.

Increased salt consumption

Salt can increase blood pressure and, in turn, can affect the kidneys. Processed foods are important sources of sodium and phosphorus.

Insufficient fluid intake

Proper hydration helps the kidneys cleanse the body of toxins. Abundant water consumption is also one of the best ways to avoid kidney stones formation. A healthy diet is considered the one in which the water supply rises to two liters per day.

Lack of sleep

Rest at night is very important for general well-being and even for the kidneys.

The functioning of the kidneys is regulated by the sleep-wake cycle, which helps to coordinate their action during the 24 hours. Lack of sleep causes disorders of the functioning of the kidneys.

High meat consumption

Animal protein generates large amounts of acid in the blood, which can be harmful to the kidneys, causing proteinuria.

Foods high in sugar

Sugar contributes to obesity, which increases the risk of high blood pressure and diabetes, two of the main causes of kidney disease.

Beyond desserts, sugar is often added to foods and beverages that are not considered sweet. Breakfast cereals and bread contain significant amounts of carbohydrates.

Smoking

People who smoke are more likely to have protein in their urine, which is a sign of kidney damage.

Diseases that affect the kidneys, such as diabetes and high blood pressure, are also exacerbated by smoking, and smokers have a higher risk of requiring kidney transplants and dialysis.

Excessive alcohol consumption

Kidneys help the body filter out harmful substances, including alcohol. The kidneys of a person who consumes a lot of alcohol are subjected to very high pressure, which can cause damage to the kidney system.

Increased alcohol consumption – over four servings a day – doubles the risk of kidney disease. Alcohol is a dehydrator and interferes with the regulation of blood flow to the kidneys, explains nephrologist in Delhi.

Coffee consumption

Coffee raises blood pressure, which can trigger kidney disease. Also, consumed in large quantities, it increases the level of calcium in the urine.

diabetes-kidney-disease

Diabetic Kidney Disease

More and more people are suffering from diabetes globally. The prevalence of increasing diabetes means that the prevalence of diabetic kidney disease, one of the dangerous complications that increase mortality worldwide, also increases, explains nephrologist in Delhi.

diabetic-kidney-disease

What is diabetic kidney disease?

If high blood sugar persists, it will damage small blood vessels in the kidney. This can cause the protein to escape into the urine, resulting in symptoms such as hypertension, edema, and kidney damage. Finally, these injuries lead to serious kidney disease, end-stage kidney disease. Kidney disease caused by diabetes is called diabetic kidney disease.

Why is it important to know about diabetic kidney disease?

  • The worldwide prevalence of diabetes is increasing rapidly.
  • Diabetic kidney disease is the most common cause of chronic kidney disease, and 40-45% of newly diagnosed patients with end-stage kidney disease are diabetic.
  • Treatment of end-stage renal disease is more costly for patients in developing countries.
  • Early diagnosis and treatment can prevent diabetic kidney disease. Even with chronic kidney disease, proper treatment can delay the treatment of renal replacement therapy such as dialysis or kidney transplant in Delhi for a considerable period of time.
  • Management of diabetic kidney disease is more important because of the high mortality from cardiovascular disease.

Therefore, early diagnosis of diabetic kidney disease is very important in the treatment of patients, says the best nephrologist in Delhi.

How many diabetic patients lead to diabetic kidney disease?

There are two categories of diabetes, depending on which category it is likely to progress to diabetic kidney disease.

1) Type 1 diabetes-insulin-dependent diabetes mellitus

Type 1 diabetes occurs mainly in children, and insulin is essential for the treatment. Approximately 30-35% of patients are known to lead to diabetic kidney disease.

2) Type 2 diabetes – non-insulin dependent diabetes mellitus

Type 2 diabetes mellitus is predominantly in adults and is often treated without insulin in most patients. It is known that about 10-40% lead to diabetic kidney disease. Type 2 diabetes is the most common cause of chronic kidney disease in more than one of three chronic kidney disease patients, says kidney specialist in Delhi.

What type of diabetes leads to diabetic kidney disease?

Although it is difficult to predict which diabetes will lead to diabetic kidney disease, several key factors are known.

  • Type 1 diabetes mellitus that occurred before the age of 20
  • Unregulated blood sugar (high glycated hemoglobin)
  • Uncontrolled blood pressure
  • In the case of visual impairment such as diabetic retinopathy or nerve damage such as diabetic neuropathy
  • Proteinuria, obesity, smoking, hyperlipidemia

When does diabetes mellitus (diabetes) develop in diabetics?

Diabetic kidney disease (sickness) takes years to develop, so it rarely develops within the first 10 years. In type 1 diabetes, soybean red mildew symptoms occur between 15 and 20 years after the onset, and if it has not progressed to kidney disease for 25 years after the onset, the likelihood of developing kidney disease is lowered, says doctor for kidney in Delhi.

When should a diabetic patient suspect a diabetic kidney disease?

Diabetic kidney disease (sickness) can be suspected if you have any of the following symptoms.

  • When foamy urine or urinary albumin/protein is present (observable early on)
  • Worsening of high blood pressure or previous hypertension
  • Edema of the ankle, foot or face; Decrease in urine volume or weight gain (due to the accumulation of water)
  • The decrease in insulin or diabetic drug requirements
  • Frequent hypoglycemia, or diabetes that has not been controlled in the past,
  • Drug-free diabetes: Many people think that diabetes has been cured because of good blood-sugar control, but in fact, it can mean kidney disease. In kidney disease, the duration of action of the diabetes drug is long.
  • Symptoms of chronic kidney disease at the end-stage (helplessness, fatigue, anorexia, nausea, vomiting, itching, pale, shortness of breath)
  • Elevation of creatinine and urea nitrogen in the blood test

How do you diagnose diabetes (kidney disease)?

  • Ideal: Diabetic patients should be tested for microalbuminuria and blood creatinine (or glomerular filtration rate) every year.
  • More practical: every three months blood pressure and urine dipstick tests are done. And every year we perform a blood creatinine (or glomerular filtration rate) test.

How can I prevent diabetic kidney disease?

The following are important to prevent diabetes (kidney disease).

  • Receive regular medical care from top nephrologist in Delhi.
  • Blood sugar control thoroughly. It is advisable to keep the glycated hemoglobin below 7%. Maintain blood pressure below 130/80 mmHg. Antihypertensive drugs such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are used to control blood pressure and albuminuria.
  • Sugar, salt, protein and fat intake should be reduced.
  • The microalbuminuria test and blood creatinine test (or glomerular filtration rate) should be performed at least once a year to determine the function of the kidneys.
  • Lifestyle therapy: Regular exercise and maintain ideal body weight. Do not smoke with alcohol, and avoid indiscriminate use of drugs such as an analgesic.

How do I treat diabetes (kidney disease)?

  • Thorough management of diabetes
  • Proper management of blood pressure is most important in protecting the kidneys. Therefore, blood pressure should be routinely measured and maintained below 130/80 mmHg. Treatment of hypertension is known to slow the deterioration of chronic kidney disease.
  • Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are antihypertensive agents that have particular advantages in diabetic patients. These antihypertensive agents have the advantage of slowing the deterioration of nephropathy and should be initiated from early nephropathy in which microalbuminuria is present for maximum benefit.
  • To reduce facial or back swelling, you should administer a drug that increases urine, such as diuretics, with salt and water restriction.
  • Diabetic patients with renal insufficiency have a greater risk of falling into hypoglycemia and need appropriate controls for diabetic agents. Fast-acting insulin is preferred for controlling glucose and persistent oral formulations are contraindicated. Metformin is at increased risk for lactic acidosis and should not be used in patients with plasma creatinine> 1.5 mg / dL.
  • In diabetic patients with high plasma creatinine, all treatments for chronic kidney disease should be performed (listed in Chapter 12).
  • Risk factors that can cause cardiovascular diseases such as smoking, lipid elevation, hyperglycemia, and hypertension should be assessed and managed.
  • Patients with advanced diabetic kidney disease eventually need treatment such as dialysis or kidney transplant in Delhi.

When should a diabetic kidney patient consult a doctor?

Diabetic patients with microalbuminuria must consult the best kidney specialist in Delhi. You should consult your doctor immediately if:

  • The sudden increase in body weight, sudden decrease in urine volume, worsening of the face or leg edema, or difficulty breathing
  • Chest pain, aggravation of hypertension, and very fast or slow heart rate
  • Severe placebo, anorexia, vomiting or pale
  • Persistent fever and chills, and pain or burning fever during urination, urine or hematuria
  • When there is frequent hypoglycemia or reduced demand for insulin or diabetes
  • When confusion, drowsiness or convulsions of consciousness occurs
Dialysis-Patient

Diet Suggested By Nephrologist in Delhi For Kidney Care

What you should eat to cleanse and take care of the health of your kidneys

Dialysis-Patient-Diet

Learn to identify the essential nutrients that help us purify the kidneys, those in charge of “filtering” everything we eat. Between the excesses of summer and the higher caloric intake that we consume in the fall, we have to take care of them.

If we take into account that the main function of the kidneys is the elimination of waste substances from the body through urine and that these are generated mainly from the food we eat every day, imagine how important is the diet to care for these organs.

FOODS THAT TAKE CARE OF YOUR KIDNEYS

And not only that, the main enemies of the kidneys (blood pressure and high blood sugar, which are the leading causes of kidney disease) also have a lot to do with everything we eat or, at least, can stay at bay with an adequate diet. So, Nephrologist in Delhi suggests watching the diet is a guarantee of health for your kidneys.

Keeping cholesterol at bay

Heart and kidney are very related. Therefore, to protect the kidney is essential to control cholesterol, one of the main cardiovascular risk factors. You get it by reducing in your diet the foods rich in saturated fats (red meats, whole milk …) and increasing the unsaturated ones (bluefish, nuts …). Use olive oil to cook, raise the good cholesterol.

Do not overdo the proteins

The kidney cleanses the blood of waste to expel it through the urine, and one of the main ones is urea, which is formed by the decomposition of proteins. Therefore, if you exceed your kidneys have to work more to eliminate urea and this can damage them. According to WHO, only 10-15% of daily calories should come from proteins. Red meats, whole milk products, and eggs are rich in them.

Control the salt

If you take a lot of salt the kidneys have a hard time removing excess sodium and that causes, in addition to thirst, fluid retention and hypertension, which can damage the blood vessels of the kidney. Kidney specialist in Delhi advises not to exceed 1.5 g of sodium per day. And do not forget that there is hidden salt in many foods (sausages, pre-cooked, cured cheeses, pickles …).

Do you control what you drink? This is how fluids affect the kidney

  • Water. To perform well its function is not necessary to drink more than 2 liters per day unless you have calculations because it helps to expel them.
  • Refreshments. The best are natural lemonades. Dark-colored sodas, fruit-flavored drinks or bottled or canned teas can have a lot of phosphorus.
  • Juices. If there is a kidney problem, the doctor for kidney in Delhi may recommend limiting the consumption of orange juice and replace it with apple, grape or pineapple.

Choose hydrates well

They are the main source of energy, but you must reduce the consumption of the simple ones (sugar, honey, jam, pastries, confectionery …) and increase the intake of complexes (whole grains and legumes). The reason? The first ones quickly turn into sugars and increase the risk of type 2 diabetes. And the high blood sugar we have already said is one of the main causes of kidney disease.

PAMPER YOUR KIDNEYS

If you have not hydrated well in the previous weeks, your kidneys may complain. So you can take care of them:

  • They need water to do their job well: Drink two liters of water of low mineralization daily. This helps them mobilize waste to be easily eliminated in the urine.
  • Fresh fruit and vegetables every day: These are the foods that most favor the purification function of the kidneys since, in addition to containing water, they are rich in potassium that increases the production of urine.
  • Go out in moderation and protect the jousts: According to the best nephrologist in Delhi, we should not exceed 5 grams of salt a day. When taken in excess, the kidneys can not eliminate it well and increases the risk of fluid retention and high blood pressure.

As for proteins, in a diet of 2,000 kcal, you should not eat more than 65g per day of this nutrient. It is proven that its excess hinders the work of the kidneys.

THE VEGETABLES RICHEST IN POTASSIUM

  1. Fruits: The banana, the apple, the orange, the apricot, the peach, and the strawberries are the fruits with more potassium.
  2. Vegetables: Potato, onion, celery, broccoli, cauliflower, and eggplant stand out as sources of this mineral.
  3. Legumes and nuts: Take 2 or 3 servings of legumes a week and 25 g of nuts per day.

BEWARE OF PHOSPHORUS

It is also not convenient for you to drink a lot of phosphorus. It is necessary to have strong bones, but if the levels of phosphorus in the blood are high, the kidneys have a hard time eliminating the excess and this increases the risk of cardiovascular disease and osteoporosis. That is why it is not convenient to take it in excess. It is found in protein-rich foods and is also used as an additive in processed foods and soft drinks.

It is important to remember that dairy products provide phosphorus, so you should not take more than 2 a day. Look for ideas to replace them, you can, for example, include 3 pieces of fresh fruit (at breakfast and snack) and 2 servings of vegetables a day to keep your kidneys healthy.

Dialysis-An-Artificial-Kidney

Dialysis: An Artificial Kidney

According to Dr. Vinant Bhargava, Nephrologist in Delhi, perfectly working kidneys minimize excess water, waste material, and different harmful particles from gathering in your body. Kidneys also support to regulate blood pressure level and also control the amounts of toxins in the blood, such as sodium, or salt, and potassium. Kidneys additionally trigger a type of vitamin D that boosts the ingestion of calcium.

Kidney Specialist in Delhi Dr. Vinant Bhargava further explains that whenever your kidneys are unable to execute these types of works as a result of disease or trauma, dialysis in Delhi can help in maintaining the body run as normal as possible. In the absence of dialysis, toxins and other waste products will gather in the blood and infect the body. Still, dialysis is not a permanent treatment for kidney disease or some other issues impacting the kidneys. Various treatments may possibly be recommended to handle those problems.

In general terms, Dialysis is a replica of kidney function which cleans your blood artificially. Dialysis is categorized into two types:

Hemodialysis

Hemodialysis is the most used form of dialysis. It utilizes hemodialyzer, which is also called an artificial kidney, to eliminate waste material and toxins from your blood. A doctor will create an access point into your blood vessels to get the blood flow to hemodialyzer. This access point enables a higher volume of blood to flow through your body during the course of hemodialysis treatment. This enables more blood to be filtered and refined.

dialysis in Delhi

Peritoneal Dialysis

Peritoneal dialysis consists of a surgical procedure to attach a catheter inside your stomach area. During the course of procedures, a specific liquid, referred to as dialysate, flows into your abdominal. As soon as the dialysate extracts waste product out of the blood, it is emptied from your stomach.