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Obstructive Nephropathy

Obstructive Nephropathy: Diagnosis and Treatment

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What is it and what are the reasons?

Obstructive nephropathy is an abnormality in the structure and function of the kidneys, which is caused by obstruction of the outflow of urine due to partial or complete obstruction of the urinary tract (most commonly ureters or urethra), explains the best nephrologist in Delhi.

The most common causes are prostatic hyperplasia and cancer, tumors (uterus, ovary, large intestine), uterine prolapse, retroperitoneal fibrosis, narrowing of the ureter or its opening to the renal pelvis or bladder (may be acquired or congenital), posterior urethral valve (usually congenital in boys).

The cause of obstructive nephropathy may also be impaired urinary tract function, most often the bladder after a spinal cord injury or as a result of a malformation of the spinal cord (e.g. cerebrospinal hernia) or so-called neurogenic bladder (bladder neck spasm).

A variant of obstructive nephropathy is drainage nephropathy caused by long-term backward reflux (reflux) of urine from the bladder to the ureter and kidney.

How common is obstructive nephropathy?

Obstructive nephropathy is a fairly rare kidney injury in adults, while it is the most common cause of chronic renal failure in children (due to urinary congenital malformations), says the nephrologist in Delhi.

How is it revealed?

An obstacle to the outflow of urine from the kidney leads to the development of hydronephrosis, i.e. the widening of the pelvis and the renal calyces. If the urine outflow from the kidney suddenly almost completely closes, renal colic appears.

When hydronephrosis develops slowly, it may not have any symptoms, but if it reaches a large size, it manifests itself like a tumor in the abdomen – a large kidney can be felt by touch examination or press on other organs in the abdomen. Sometimes urinary tract obstruction is partial or changes over time, and then large (polyuria) and small (oliguria) urine volumes may alternate. Symptoms of a urinary outflow obstruction may be urinary tract infection or haematuria. When permanent, severe damage occurs to both kidneys, symptoms of chronic renal failure occur, says the nephrologist in Noida.

What to do if symptoms occur

Always seek medical attention if you experience symptoms suggestive of a urinary tract disease, i.e.

  • urination disorders
  • pain in the lumbar region or lower abdomen
  • haematuria
  • palpable tumor in the stomach
  • symptoms of urinary tract infection.

How does the doctor make a diagnosis?

Reported symptoms (as above) indicate a disease of the urinary tract which may lead to obstruction of urine outflow (and development of obstructive nephropathy). The most important are imaging of the urinary system, first of all USG, then usually urography or CT They show unilateral or bilateral hydronephrosis, and when the obstacle is located low – widening of one or both ureters or bladder distension. These tests also help to identify the cause, i.e. the type of obstacle to the proper outflow of urine, explains the nephrologist in Gurgaon.

What are the treatments?

The goal of treating obstructive nephropathy is to restore effective drainage of urine from the kidneys, which involves removing or bypassing an obstacle that obstructs urine outflow. Usually urological treatment is needed. If the obstacle cannot be removed and the urine outflow is restored, urological procedures are carried out by the urologist in Noida to avoid the obstacle. This can be the introduction of a catheter into the bladder, ureter or directly into the renal pelvis through body shells in the lumbar region (so-called transcutaneous nephrostomy). Usually these are urgent interventions that ensure urine outflow until the patient is ready for elective surgery for the final treatment of the obstacle (e.g. prostate surgery, bladder tumor or urinary reconstruction).

Is it possible to cure completely?

Complete cure for obstructive nephropathy is possible provided the obstruction has been permanently cured before irreversible kidney changes have occurred. Removing an obstacle if chronic kidney damage has already occurred does not lead to cure because chronic kidney disease is progressive, states the kidney specialist in Delhi.

What do you need to do after treatment?

In obstructive nephropathy, urological supervision and periodic monitoring of urinary tract function are usually necessary. When there is permanent kidney damage (chronic obstructive nephropathy), periodic nephrological monitoring is required, says the kidney specialist in Noida.

What to do to avoid getting sick?

To avoid obstructive nephropathy, obstacles to urine outflow should be detected and treated early. Particular attention should be paid to any urination disorders, suggests the nephrologist in Delhi.

Diabetic Kidney Disease

Diabetic Kidney Disease

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Diabetes is the leading cause of kidney failure in the developed world, says the best nephrologist in Delhi.

The diabetes, characterized disease excess blood glucose can affect various organs of the body including the kidneys (diabetic nephropathy) or eyes (diabetic retinopathy). Good diabetes control is able to prevent, delay or decrease the appearance of these and other complications of the disease.

The constant maintenance of high levels of glucose (sugar) in the blood causes a disturbance in the wall of the arteries. As a consequence, the blood does not correctly reach the tissues and this leads to a disorder in the structure and function of different organs in the body, explains the nephrologist in Delhi.

The mechanism by which excess glucose affects the arteries is very complex. On the one hand, the wall of the arteries is made up of proteins. Glucose tends to bind to these proteins, and this phenomenon can ultimately deconstruct the arterial wall. On the other hand, the insulin deficiency characteristic of diabetes means that the transformation of glucose for energy is carried out through a specific type of metabolic pathway. As a consequence, the body accumulates a series of substances that can also cause alterations in the walls of the arteries, says the nephrologist in Noida.

The appearance of complications in a diabetic person also depends on their personal susceptibility to changes caused by high glucose levels.

Diabetes is the leading cause of kidney failure in the developed world, accounting for approximately 35-40% of new cases of kidney failure each year, says the nephrologist in Gurgaon. It should be known that:

– The development of early stages of diabetic nephropathy is frequent

Throughout life, around 50% of people with type 1 diabetes develop microalbuminuria – presence of the albumin protein in the urine, which is an indicator of impaired kidney function.

– Approximately 20% of people with type 1 diabetes develop kidney failure.

In Caucasian people with type 2 diabetes, between 5 and 10% go on to develop end-stage chronic kidney failure (CRFD), while among non-Caucasians the proportion is even higher.

Diabetic kidney failure is the most common cause of admission to kidney replacement programs, dialysis or transplantation, in most countries of the world, says the kidney transplant doctor in Delhi.

In India, around a third of people with end-stage chronic kidney disease have diabetes. This population is estimated to grow at an annual rate of 8%.

– Up to 40% of new cases of IRCT can be attributed to diabetes.

The risk of CKD is 12 times higher in people with type 1 diabetes compared to those with type 2 diabetes, says the kidney specialist in Delhi.

–There are two treatment options when the kidneys fail.

Dialysis – peritoneal dialysis or hemodialysis – and kidney transplant. The costs of both treatments are high. Diabetes is estimated to represent between 5 and 10% of the national health budget in western developed countries.

– Diabetic kidney failure develops so slowly that it may not give symptoms for many years.

The best way to detect the problem is to test your urine for proteins, which should not normally be present, such as albumin. The Kidney Specialist in Noida recommends that every person with diabetes undergo a urine test for albuminuria each year.

– Close control of the blood glucose level reduces the risk of microalbuminuria, and therefore of future chronic terminal renal failure, by up to 35%.

There is conclusive evidence that good blood glucose levels can significantly reduce the risk of developing complications and slowing their progression in all types of diabetes.

Control of high blood pressure and high levels of fats in the blood (hyperlipidemia) is also very important, says the nephrologist in Delhi.

Prevention and Early Diagnosis of Kidney Diseases

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Most kidney diseases can behave like ” silent killers “: they work undisturbed, without symptoms, for years and, when their effects are revealed, it can be late to run for cover. Attention to them is dictated by the need to prevent chronic renal failure and to reduce cardiovascular risk, which increases significantly already in the presence of mild renal failure.

We cannot therefore think that our kidneys are indestructible, or worse that they do not deserve any consideration; we don’t even have to think that kidney disease is always a deadly trap.

If the diagnosis is early, the treatments can be very effective. A healing is common. In any case, the evolution of the disease can be significantly slowed down, says the nephrologist in Delhi.

So, what can you do to find out about kidney injuries in time?

First of all, be careful of the signs that may indicate their appearance.

Here are the main ones:

  • Emission of dark colored urine (up to a “coca cola” color) or blood red, or with bad smell. Even the formation of a lot of foam can have a meaning of abnormality;
  • Significant increase in urinary volume, especially at night, and persistent thirst;
  • Edemas, in the lower or diffuse limbs;
  • Increase in blood pressure values ​​beyond the maximum normal limits;
  • Pain in the lumbar area (up to real colic), sense of weight in the kidney not referable to lumbosciatalgia;
  • Unexplained anemia, fatigue, significant malaise for no apparent reason;
  • Burning urinating, fever (especially if with chills), need for frequent urination;

First of all, a fresh urine test must be performed (to avoid alterations caused by fermentation).

Most kidney diseases cause urinary changes, with the presence of:

  • blood, mostly not evident to the naked eye, but only on chemical (hemoglobin) and microscopic (micrometry) examination;
  • albumin (albuminuria) isolated, or associated with other blood proteins (proteinuria);
  • white blood cells, a sign of inflammation of the kidney or urinary tract, often, but not always, of infectious origin;
  • other elements, such as the so – called cylinders, which are “molds” of proteins, cells or cellular debris, precipitated in the lumen of the tubules and then mobilized by the flow of urine;

A separate case is that of cancer cells that can be highlighted by the so-called urinary cytological examination.

Abnormal amounts of albumin, blood and white blood cells can be easily searched for by immersing a test strip in the urine. It is this safe and rapid research method that is used in the screening of kidney disease. In case of abnormality, the examination will be supplemented by the microscopic one of the urinary sediments.

Very reliable and rapid automatic equipment is now spreading in the most modern laboratories, which allow to combine the chemical examination with that of the urinary sediment.

As always happens in medicine, there are exceptions to the kidney disease rule = urinary alterations. The most common exception is that of nephroangiosclerosis and some hereditary diseases, at least in the initial phase, such as polycystic kidneys, which can be present without there being obvious urinary changes.

It should also be borne in mind that, in the course of their progression towards an ever more serious renal failure, chronic kidney diseases often cause arterial hypertension.

In turn, kidney damage can be caused by an arterial hypertension that is not initially linked to nephropathy (by far the most common condition is that of the so-called essential arterial hypertension).

Measuring blood pressure is therefore another important step to discover nephropathy in time and, often, to prevent it.

A simple urine test and a blood pressure check therefore allow you to suspect the existence of a kidney disease, but unfortunately the normal results are not enough to rule it out categorically.

For this reason, it is necessary to identify people at risk of developing nephropathy in order to subject them to more detailed investigations.

Detecting the presence of a condition at risk of developing nephropathy, and not rarely if more than one is associated with it, is however very important if you want to prevent the onset of kidney damage.

To prevent kidney disease, the most important risk conditions for their appearance must be taken into account and, if possible, prevented and corrected, suggests the nephrologist in Noida.

Here are the main risk conditions for the development of a kidney:

  • aging (over 60 years)
  • hypertension
  • diabetes
  • prolonged use of medications without medical supervision, especially non-steroidal anti-inflammatory drugs
  • severe hypercholesterolaemia
  • important obesity
  • kidney stones
  • recurrent urinary tract infections
  • lower urinary tract obstruction (e.g. high prostate hypertrophy)
  • previous kidney disease
  • ongoing immunological diseases (lupus, rheumatoid arthritis etc.)
  • presence of kidney disease in family members

Taking these conditions into account, nephrologist in Delhi suggests some good rules for defending our kidneys.

  1. Prevention means first of all treating diseases that can induce kidney damage: first of all arterial hypertension, arteriosclerosis and diabetes. Naturally, first of all, the conditions that can favor their appearance must be corrected, such as obesity, the so – called dysmetabolic syndrome, too sedentary life, varying, if necessary, the lifestyle.
  2. In keeping with the previous rule, avoid diets very rich in calories, sugar, sweets, animal fats and salt, and smoking.

The traps are many. Canned and preserved foods are generally rich in salt; even the bread of some regions is quite rich: in case of need, consuming bread without salt can be useful. It is always good to drink water with a certain abundance: a liter and a half or two a day is a safe dose. The smoke can also be harmful to the health of the kidneys, warns the nephrologist in Gurgaon.

  1. Do not resign yourself to living with high cholesterol and excess body weight, which can promote arteriosclerosis, high blood pressure and diabetes.
  2. Regularly check the blood pressure, knowing that it is considered an optimum pressure equal to or less than 130 of 80 mm of mercury, and that values above 140/90 are defined as pathological, at any age (although in diabetics is suggested keep the pressure at values ​​lower than 130/80), suggests the kidney specialist in Delhi.
  3. If you are hypertensive, have diabetes or signs of arteriosclerosis, also take care to protect the kidneys, by implementing all the measures recommended by the doctor for kidney in Delhi. However, it is not enough to be content with following treatments: it is also necessary to check that the results are really what you want. For example, in the case of high blood pressure, the treatment can be considered effective only if blood pressure values ​​lower than the classic “140 out of 90” are obtained. Today there are many drugs to control arterial hypertension and it is often obtained by combining several medicaments in small doses, with reduction of negative side effects and enhancement of the positive effect. It is also important to know that some of these drugs, such as ACE inhibitors and so-called receptor antagonists, in addition to the antihypertensive effect, also have a specific renoprotective action.
  4. In the case of diabetes, make sure to obtain well-controlled glycemic levels, with values ​​of the so-called glycated hemoglobin as close as possible to the norm, and also in this case check blood pressure very well and resolve any overweight conditions, says the kidney specialist in Noida.
  5. Maintaining a proper diet and careful control of body weight, which is always important: taking medications does not authorize you to neglect dietary rules.
  6. Do not resign yourself to living with urinary tract infections, kidney stones or chronic obstruction of the urinary tract, for example from prostatic hypertrophy.
  7. Avoid prolonged use of potentially nephrotoxic drugs, such as analgesics or anti-inflammatory drugs, especially if taken without medical supervision; this does not mean that those who need it should give it up, but it is advisable, if you use them frequently, to remember to check the kidney situation periodically, advices the kidney specialist in Gurgaon.
  8. Carry out, even if it feels good, a simple urinalysis during other laboratory tests, or in any case with a two-year deadline, and do not neglect any minor anomalies revealed by the urinalysis, such as blood or proteins in very large quantities modest. On the other hand, it should not be forgotten that in some situations, such as in the presence of kidney damage due to high blood pressure or arteriosclerosis, the urine test is often normal for a long time.
  9. Perform, under all risk conditions, a check on renal function with the determination of creatininemia, possibly repeating it at regular intervals, for example annual, or every six months if the risk is high. Creatinine is a muscle mass product which is eliminated by the kidney and accumulates in the blood when kidney function decreases. Blood values ​​above 1.2 mg / dl in women and 1.4 mg / dl in men may indicate functional kidney damage and warrant further investigation. Using simple mathematical formulas and commonly used calculators it is easy to deduce the value of renal filtration from creatininemia. This control, which has supplanted the traditional one of blood urea nitrogen, can constitute a first alarm bell, particularly important when the urine test is normal, for an evolutionary nephropathy.
  10. Be careful of minor and nonspecific signs of kidney disease, such as edema of the lower limbs, hypertension, even if not constant, chronic or relapsing urinary tract infections, the emission of urine of a different color or odor than usual.

All these signs do not always indicate the presence of kidney disease or urinary tract, but it is best to make sure that they are truly harmless, suggests the nephrologist in Delhi.

CKD TREATMENT IN DELHI

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The therapeutic objectives of referral to a nephrologist in Delhi are aimed at reducing and treating the associated complications of CKD, and preparing adequately and sufficiently in advance, the replacement treatment for renal function. Early detection and appropriate referral to Nephrology of patients with CKD reduces complications and improves long-term survival, since it allows early identification of reversible causes, decrease the rate of progression, decrease associated cardiovascular morbidity and mortality, and prepare the patient adequately for dialysis if necessary.

The improvement of the care and the prognosis of CKD must be made through early detection plans in the population at risk, which implies close coordination and collaboration between Primary Care and Nephrology, says the nephrologist in Noida.

According to the nephrologist in Delhi, the treatment of Chronic Kidney Disease aims to avoid or reduce risk factors for disease progression, prevent the onset of symptoms and minimize complications.

The low protein diet delays the appearance of excess urea symptoms (pruritus, insomnia, neurological, neuromuscular, gastrointestinal and other disorders), by reducing its generation. Although controversial, it is suggested that protein restriction slows the progression of CKD. This concept is not applicable to patients with polycystic kidney disease, but protein restriction is especially beneficial in diabetic nephropathy, says the nephrologist in Gurgaon.

Before prescribing the diet, the patient must undergo a nutritional evaluation. Also, the diet must include an adequate energy supply. There is a favourable circumstance that phosphorus restriction is proportional to protein restriction, so both guidelines are consistent.

In addition, the low protein diet prevents part of metabolic acidosis, by reducing the generation of acids in the body. A low protein diet is especially useful in patients with CKD grade 4 and 5, although it is less important if the patient has very well controlled blood pressure. The low protein diet can cause malnutrition, so it should be provided between 0.6 and 0.8 g / kg / person / day, in those with moderate-severe or severe kidney failure, and some parameters should be evaluated periodically corporal like the index of corporal mass, the triceps fold or the circumference of the arm, and biochemicals (in the analytical ones) like albumin and serum cholesterol, or lymphocyte levels. On the other hand, the diet must contain 35-40 kilocalories per kilogram of weight per day, suggests the kidney specialist in Delhi.

With a low protein diet, acid production is reduced, but despite this, in an advanced CKD situation, the kidney is not capable of producing the bicarbonate necessary to replace what is lost, and it is necessary to replace it as a supplement (3 -4 grams daily in the form of oral stamps or bicarbonated water). This amount depends on kidney function and the animal protein content of the diet, explains the kidney specialist in Noida.

The water intake depends on the diuresis that is conserved. Diet salt is often limited to control excess fluids and high blood pressure. However, the loss of the ability to dilute urine associated with CRF implies that a minimum intake of salt is necessary to guarantee that the patient can eliminate, for example, 2 liters of water; otherwise water is retained, and sodium in the blood drops too low (hyponatremia). This process is frequent during hospitalization, in which very restrictive diets can be indicated in salt and liquids are provided in the form of glucose serum.

Salt restriction reduces the sodium load reaching the end places of the nephron where sodium is exchanged for potassium (the tubule reabsorbs sodium and expels potassium), thus favouring the dangerous increase in potassium in the blood (hyperkalemia), says the kidney specialist in Gurgaon.

The different alterations in bone-mineral metabolism (hyperphosphoremia, hypocalcaemia, hyperparathyroidism, osteoporosis, etc.) are secondary to the progressive loss of mass and kidney function. As glomerular filtration decreases, a discrete but significant decrease in calcitriol can be seen secondary to the loss of renal mass, and to phosphate retention, which in turn decreases the renal synthesis of calcitriol. Furthermore, with this deficit of calcitriol synthesis, intestinal calcium absorption decreases, producing hypocalcemia. The positive balance of phosphorus, the deficit of calcitriol and the hypocalcemia, lead to an increase in PTH and trigger a situation of secondary hyperparathyroidism. Control of the phosphocalcium balance is essential to prevent it, and its values ​​must be kept in range according to the degree of renal failure of the patient. The basic treatment is with phosphorus chelating drugs, which manage to “catch” it from the diet and eliminate it with the faeces. A normal diet provides about 1,200 mg of phosphorus a day; When urinary phosphorous excretion is less than 700 mg / day, hyperphosphoremia and stimulation of PTH secretion begin to occur. At this time, emphasis should be placed on restricting foods rich in phosphorus, and if necessary, combining chelators and vitamin D, suggests the doctor for kidney in Delhi.

People with Chronic Kidney Disease have a much higher cardiovascular risk than the general population, and it is essential to fight all the factors that increase that risk. It is as important to try to slow down the progression of CKD as to combat factors such as high blood pressure, excess cholesterol, obesity, which multiply the complications in these vulnerable patients. Most patients with CRF have anemia, due to the relative deficit of renal synthesis of erythropoietin. Specific treatment improves survival, decreases morbidity, and increases quality of life in both dialysis and pre-dialysis patients, says the nephrologist in Delhi.

Tobacco use is the most common cause of preventable cardiovascular mortality worldwide. The immediate deleterious effects of smoking are related to activation of the sympathetic nervous system, which increases myocardial oxygen consumption through an increase in blood pressure, heart rate, and myocardial contractility.

Furthermore, smoking induces a progressive increase in arterial stiffness and is a major risk factor for cardiovascular disease, coronary heart disease and cerebrovascular disease. Furthermore, tobacco induces and accelerates the progression of CKD. In patients with advanced CKD, smoking is a cardiovascular risk factor and is associated with an increased risk of developing heart attacks, peripheral vascular disease, heart failure, and mortality. Quitting smoking is an essential therapeutic goal in CKD patients.

DIABETIC NEPHROPATHY

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Diabetes is the leading cause of kidney failure in the developed world, says the nephrologist in Delhi.

The diabetes characterized disease excess blood glucose can affect various organs of the body including the kidneys (diabetic nephropathy) or eyes (diabetic retinopathy). Good diabetes control can prevent, delay or reduce the appearance of these and other complications of the disease, explains the nephrologist in Noida.

The constant maintenance of high levels of glucose (sugar) in the blood causes an alteration in the wall of the arteries. Consequently, the blood does not reach the tissues correctly and this results in a disorder in the structure and function of different organs of the body.

The mechanism by which excess glucose affects the arteries is very complex. On the one hand, the wall of the arteries is made up of proteins. Glucose tends to bind to these proteins and this phenomenon, in the long run, can deconstruct the arterial wall. On the other hand, the insulin deficit of diabetes itself means that the transformation of glucose for energy is carried out through a specific type of metabolic pathway. Therefore, the body accumulates a series of substances that can also cause alterations in the walls of the arteries.

The occurrence of complications in a diabetic person also depends on their personal susceptibility to changes caused by elevated glucose levels.

According to the nephrologist in Gurgaon, diabetes is the leading cause of kidney failure in the developed world and accounts for approximately 35-40% of new cases of kidney failure each year. It is important to know that:

– The development of early stages of diabetic nephropathy is common.

During life, around 50% of people with type 1 diabetes develop microalbuminuria – presence of albumin protein in the urine, which is a deterioration indicator of renal function.

– Approximately 20% of people with type 1 diabetes develop kidney failure.

In Caucasian people with type 2 diabetes, between 5 and 10% develop chronic end-stage renal failure (IRCT), while among non-Caucasians the proportion is even higher.

Diabetic renal failure is the most common cause of admission to renal replacement, dialysis or transplantation programs, in most countries of the world, says the kidney specialist in Noida.

In India about one third of people with end-stage chronic renal failure suffer from diabetes. It is estimated that this population will grow at an annual rate of 8%.

– Up to 40% of new cases of IRCT can be attributed to diabetes.

The risk of IRCT is 12 times higher in people with type 1 diabetes compared to those with type 2 diabetes.

–There are two treatment options when the kidneys fail.

Dialysis in Delhi – peritoneal dialysis or hemodialysis – and kidney transplant in Delhi. The costs of both treatments are high. It is estimated that diabetes represents between 5 and 10% of the national health budget in developed western countries.

– Diabetic renal failure develops so slowly that it may not show symptoms for many years.

The best way to detect the problem is the analysis of urine for proteins, which normally should not be present, such as albumin. It is recommended that every person with diabetes undergo a urinalysis every year for albuminuria.

– A close control of the blood glucose level reduces the risk of microalbuminuria, and therefore of future terminal chronic renal failure by up to 35%.

There is conclusive evidence that good blood glucose levels can significantly reduce the risk of developing complications and slowing their progression in all types of diabetes.

The control of high blood pressure and high levels of blood fats (hyperlipidemia) is also very important, advices the kidney specialist in Gurgaon.

KIDNEY BIOPSY

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What it is and why it is prescribed?

The renal biopsy is the procedure with which it picks up a very small fragment of kidney which will then be observed under the microscope.

It is the final examination to distinguish the various types of kidney diseases, in particular those affecting the glomerulus which typically occur with an increase in creatinine and the presence of proteins in the urine, explains the nephrologist in Delhi.

It is an invasive test that must be carried out in selected cases after a careful visit of nephrologist in Noida, in which the indication of the procedure will be evaluated based on the result of blood, urine and instrumental tests.

An early biopsy diagnosis is very important to treat kidney disease before it evolves towards a picture of chronic kidney failure, says the nephrologist in Gurgaon.

Kidney biopsy is prescribed for:

  • diagnosing kidney disease that cannot be classified differently is the case of glomerulopathies;
  • evaluate the degree of progression of an already diagnosed kidney disease;
  • assess the cause of a malfunction of a kidney transplant;

How kidney biopsy is done?

Before the biopsy

  • Before practicing the kidney biopsy, the kidney specialist in Delhi informs the patient on how the procedure is performed and, on any measures, to be taken before and during the examination;
  • Some blood and urine tests are performed in order to exclude the presence of ongoing infections and alterations of blood clotting;
  • A few days before the examination it is advisable to suspend some drugs, mainly those that alter blood clotting, such as warfarin (Coumadin) or antiplatelet agents (aspirin, ticlopidine, etc). The nephrologist in Delhi will give information on the drugs to be taken or not;
  • On the day of the exam, fasting for about 8 hours is often required;

During the biopsy

The native kidneys are located in the back of the abdomen. Therefore, kidney biopsy is usually performed by positioning the patient on his stomach so that the kidneys are as close to the back wall as possible. In the case of a biopsy of the transplanted kidney, the patient is on his stomach.

With an ultrasound of the kidney, the urologist in Noida identifies the point of the kidney where to take the sample and the path that the needle will follow. After a thorough cleaning of the skin, a light local anesthesia is practiced and a small cut is made at the entrance site. The patient will feel like a pinprick. With the help of ultrasound, the needle is introduced, without the patient feeling any pain. At this point the patient is invited to take a deep breath in order to bring the kidney closer to the needle. You will then hear the sound of a click; it is the sign that the sampling has taken place. The needle is then withdrawn and reinserted, usually, to take another sample.

After the biopsy

Blood pressure and heart rate are checked for a few hours while the patient is resting in bed with his stomach up. A pain may be felt at the needle entry point which is often checked with pain relievers. The hospital stay varies according to the clinical conditions and the opinion of your doctor for kidney in Delhi. At discharge the patient is advised not to practice efforts and behaviors to be performed.

Risks

Kidney biopsy is a safe procedure and is rarely associated with complications:

  • blood loss in the urine (hematuria) may appear after a kidney biopsy and persist for a few days. It rarely becomes so important that it requires a transfusion or surgery to stop the bloody;
  • Pain is frequent after a biopsy, but usually lasts a few hours;
  • A further complication may be due to the creation by the needle of a communication between an artery and a vein. An arteriovenous fistula is thus determined. Usually the patient does not feel anything, and the diagnosis is made during a check-up ultrasound. This anomalous communication resolves itself;
  • More rarely, bleeding around the kidney may occur. This usually stops on its own and disappears over time, when it is more conspicuous it may require surgery;

At discharge, notify your doctor in case of:

  • Temperature
  • Reddish urine more than a day after discharge
  • Severe pain where the biopsy was done
  • Difficulty urinating
  • Weakness

Results

The collected kidney tissue is sent to the laboratory for analysis under a microscope.

This procedure requires a variable time depending on the investigations to be performed on the fabric itself.

The report describes how the kidney tissue is composed and the anomalous elements in favor of one of the kidney diseases.

Renal hypertension: what it is, causes, diagnosis and treatment

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The problem accounts for up to 10% of cases of famous hypertension, but it is still little known by the population.

Have you ever heard of kidney hypertension?. The condition is similar to classic hypertension (the chronic and dangerous elevation of blood pressure), except that, in this case, it starts in the kidneys and only then affects the rest of the body. It is estimated that up to 10% of hypertensive patients are in this category, says the kidney specialist in Delhi.

It all starts with a kind of false alarm. Nephrologist in Delhi explains: in addition to filtering the blood, the kidney detects decreases in its flow. When they occur, it is a situation of probable emergency, such as hemorrhage, for example. Hence, the organ starts to secrete renin, a hormone that leads to an increase in another one, angiotensin 2, in the circulation.

In the kidneys, such angiotensin 2 compresses the vessels to reduce urine production and thus save as much water as possible. In the sympathetic nervous system, which controls heartbeat, breathing and the like, it helps to raise blood pressure. It is a necessary move to guarantee the blood supply when it is threatened.

“Only, in renal hypertension, this happens for no apparent reason, when there is no real urgency”, differentiates the nephrologist in Delhi. The alarm, issued constantly by the kidneys to the rest of the body, causes blood pressure to rise chronically unnecessarily.

The causes of renal hypertension

Abnormal activation of the renin-angiotensin system, the technical name for this joint action of hormones, usually occurs when there is an obstruction in the renal artery. The main responsible for this is atherosclerosis, a blockage caused by the deposition of fat plates on the vessel wall.

The process is also linked to essential hypertension – also called primary, when it is not possible to establish a single cause for the disease. Old age, smoking, obesity, diabetes and high cholesterol are risk factors for both of these problems.

Kidney health is another point of attention. “Disorders that attack the kidneys, such as chronic kidney disease or stones and nephritis that develop into permanent inflammation at the site, can lead to the condition”, points out the nephrologist in Noida.

Symptoms and diagnosis

The constant rise in pressure is the main sign. Therefore, in general the diagnosis of renal hypertension is confirmed during investigations to understand what is causing blood pressure to take off.

When renal hypertension has not yet reverberated into blood vessels, it is more difficult to catch, but not impossible.

“A routine abdominal ultrasound can detect the state of the arteries that supply the kidney and changes in blood flow to the organ”, comments the kidney specialist in Noida.

Treatment

It is similar to that of the most famous hypertension. Especially because, in most cases, the disease is treated with drugs that inhibit the renin-angiotensin system. Even if it is not the only cause of the high pressure, it will always be involved in its control.

But it is important to make this differentiation because, if the source of the problem is kidney trouble, you will have to fight it too. Faced with a situation of difficult control, the doctor sometimes resort to surgery that restores the flow of blood in these organs, explains the nephrologist in Gurgaon.

Better than waiting for all this to happen is preventing it, right? Then write down the tips given by the kidney specialist in Gurgaon, which also apply to cardiovascular disease in general:

  • Don’t smoke
  • Adopt a balanced diet
  • Avoid being overweight
  • Exercise regularly

Kidney Transplant: How it works and What are the risks?

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Kidney transplant in Delhi aims to restore renal function by replacing a sick kidney with a healthy kidney from a healthy and compatible donor.

Generally, kidney transplantation is used as a acute renal failure treatment in Delhi or in the case of patients who do several hemodialysis sessions per week. Transplantation usually lasts between 4 and 6 hours and is not very suitable for people who have injury in other organs, such as cirrhosis, cancer or heart problems, as it can increase the risks of the surgical procedure.

How the transplant is done?

Renal transplantation is indicated by the nephrologist in Delhi in cases of multiple hemodialysis per week or, more often, advanced chronic kidney disease after renal function analysis by laboratory tests. The transplanted kidney can be from a living donor without any disease, and may or may not be related to the patient, or from an already deceased donor, in this case the donation can only be made after confirmation of brain death and authorization of the family.

The donor kidney is removed along with a portion of the artery, vein and ureter, using a small incision in the abdomen by the kidney transplant doctor in Delhi. Thus, the transplanted kidney is placed in the receptor, the portions of the vein and artery are linked to the veins and arteries of the receptor and the transplanted ureter is linked to the patient’s bladder. The non-functional kidney of the transplanted person is usually not taken away, as its little function is useful when the transplanting kidney is not yet completely functional. The sick kidney is only removed if it is causing infection, for example.

Kidney transplantation is performed according to the patient’s health conditions, and is not very indicated in people who have heart, liver or infectious diseases, for example, because it can increase the risks of the surgical procedure, explains the nephrologist in Noida.

How to assess whether transplantation is compatible?

Before the transplant is performed, blood tests should be performed in order to verify the compatibility of the kidneys to thus reduce the chances of organ rejection. Thus, donors may or may not be related to the patient who will be transplanted, as long as there is compatibility, explains the nephrologist in Gurgaon.

How is the postoperative?

Recovery after kidney transplantation is simple and lasts about three months, and the person should be hospitalized for one week so that possible signs of reaction to the surgical process can be observed closely and treatment can be done immediately. In addition, during the three months it is indicated not to perform physical activities and perform weekly tests during the first month, spaced for two monthly consultations until the 3rd month due to the risk of rejection of the organ by the body.

The use of antibiotics is usually indicated after surgery to prevent possible infections, and immunosuppressive medications, to prevent organ rejection. These medicines should be used in accordance with medical advice by the nephrologist in Delhi.

Possible Risks and Complications

Some complications of kidney transplantation may be:

  • Rejection of the transplanted organ;
  • Generalized infections;
  • Thrombosis or lymphocele;
  • Fistula or urinary obstruction.

To avoid serious complications, the patient should be aware of warning signs that include fever greater than 38ºC, burning when urinating, weight gain in a short time, frequent cough, diarrhoea, difficulty breathing or swelling, heat and redness at the wound site. It is also essential to avoid contact with sick people and polluted places and make a correct and adapted diet, advises the kidney specialist in Noida.

Complications Associated with Immunosuppression

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In order for the renal transplant to function and not be rejected by our body for the work of the immune system, we need to reduce or block the action of certain components of the immune response.

We do this by administering drugs aimed at certain metabolic pathways as specific as possible that allow us to reduce the adaptive immune response without affecting the innate measure to a greater extent, but they entail another series of factors, entities or risks that we will detail in this post.

The risk of infections

Infections are the first cause of death after a kidney transplant in Delhi. Logically, by decreasing the body’s defenses the main risk is represented by infections. Both the usual and those called generated by the so-called opportunistic pathogens (those microorganisms that usually would not cause infection in a healthy patient, are able to infect and make an immunosuppressed patient sick). The greatest risk of infection occurs in the first 3 months after transplantation, since at the beginning higher doses of immunosuppressants are administered to avoid acute graft rejection, says nephrologist in Delhi.

The most common infections are respiratory infections and urinary infections, secondly gastrointestinal infections; There is usually a history of an infected relative who may have been the cause of the infection, explains nephrologist in Noida.

With respect to opportunistic pathogens, the most frequent are viruses starting with cytomegalovirus (CMV) and polyomaviruses (BK and JC viruses), hepatitis viruses, herpes, chickenpox, to name a few. Then we find bacteria such as Nocardia, listeria, pneumocystis, among others.

In some cases, we can reduce the risk of infection by getting vaccinated. All transplanted patients should receive a series of vaccines to reduce the risk of infection by these microorganisms; however, it should be noted that vaccines with live or live-attenuated microorganisms should NOT be administered, only those with inactivated, dead microorganisms or bacterial/viral proteins should be administered, says doctor for kidney transplant in Delhi.

Vaccination and prophylaxis

Another way to reduce the risk of infection is through prophylaxis (that is, preventive treatment). Depending on the epidemiological environment of the center where the transplants are performed, more or less prophylactic medications are administered and usually maintained only during the first 3 to 6 months.

However, if in spite of all this, a transplanted patient contracts an infectious disease, it is important that he notify his nearest health professional, and in the case of fever, go to the hospital emergency department as soon as possible, suggests kidney Specialist in Noida.

Immunosuppressive toxicity

Immunosuppressive medications can generate negative effects not only by their direct action, but also by indirect actions or adverse reactions of each family of medications.

On the one hand, we have the anticalcineurinics (cyclosporine and tacrolimus) almost indispensable in most immunosuppression regimens in some patients can general gum growth, hair loss, neurological disorders, insomnia and even direct kidney damage (in very high concentrations).

On the other, mycophenolate (purine nucleotide synthesis blocker) is characterized by generating gastrointestinal disturbances, commonly diarrhea. Another similar medication, azathioprine can cause anemia or leukopenia (decrease in white blood cells below adequate values).

Finally, another group of medications known as mTOR inhibitors, sirolimus and everolimus can cause anemia, hypertension, slow healing or generate joint pain.

As we can see, the effects that these drugs can generate are varied, but their usefulness and benefit outweigh these risks, so it is important that if you notice any alteration or change in normality related to the effects mentioned above, contact your kidney transplant doctor in Delhi.

Loss of Muscle Mass and Strength in Chronic Kidney Disease

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Muscle is one of the largest affected by chronic kidney disease (CKD), due to various factors associated with kidney degradation. To this are added factors that also contribute to this loss of muscle tissue, such as the patient’s age, comorbidities or a sedentary lifestyle. It is an inexorable process of difficult prevention that can be alleviated or counteracted through clinical nutrition and physical exercise.

“There are multiple observational studies that relate the loss of muscle mass and strength in CKD with an increased risk of hospitalization, of having a heart attack or even of dying. This patient is so complex that in the clinic we tend to prioritize only short-term metabolic risks. It is also important to focus on nutritional aspects and physical exercise programs that can benefit the patient, ”says the best nephrologist in Delhi.

This kidney specialist in Delhi explains that “patients with CKD are undergoing a process of progressive muscle loss due to many factors related to kidney degradation. These include an increase in muscle degradation mechanisms due to oxidative stress, metabolic acidosis and persistent inflammation; an impoverishment of muscle repair and synthesis mechanisms, such as resistance to the action of insulin, growth hormone or testosterone, and the catabolic process involved in the dialysis session itself, together with a small but continued loss of the amino acids of the diet in the blood filtrate during dialysis ”.

It is estimated that between 30 and 50% of patients on dialysis have the “energy protein wasting syndrome”, and that it refers to the confluence in the patient with CKD of a malnutrition process (due to a loss of appetite and sometimes to the dietary restrictions that must be maintained) and a hypercatabolism process (propitiated by the mechanisms described). This syndrome is associated with an impoverishment of the quality of life, an increased risk of hospitalization, cardiovascular events, and mortality, says nephrologist in Delhi.

“The way to avoid it is first, implementing identification and screening programs in the clinic,” says nephrologist in Noida and lists some examples such as “screening in patients looking for symptoms of malnutrition / muscle loss (every 6 months in patients not dialyzed in stages 4-5; every three months, in dialysis patients); in patients with symptoms, exploration of causes of malnutrition / muscle loss, and, thirdly, to implement a specific nutritional therapy, which may include various complementary strategies including the use of nutritional supplements, exercise programs (preferably resistance), use of anabolic agents and treatment of the triggering causes (such as inflammation and metabolic acidosis, among others)”.

The group of elderly patients on dialysis is growing, a subgroup of patients who require specific measures in terms of nutrition and exercise. Nephrologist in Gurgaon indicates that “the high age of patients usually limits the amount and intensity of the exercise that can be prescribed. However, any improvement in physical activity, however small, does great good in this population. The first step would be to encourage them to walk, about 30 minutes a day 3-4 days a week. This mild exercise has been associated with a decrease in inflammatory activity, improved exercise capacity, and muscle functionality, and is associated with a reduction in the rate of hospital admissions. In the elderly dialysis patient (and in all dialysis patients, of course), it is important to ensure that you consume enough calories and protein in the diet to compensate for these losses/catabolisms. The clinical guidelines recommend a protein intake of 1.0 or 1.2 grams per kilo of weight per day, and a caloric intake of 30-35 kcal /Kg/day. In an elderly person of appetite and reduced mobility, these requirements are not likely to be met spontaneously and the dietitian, endocrinologist or nephrologist in Gurgaon can assess the need to prescribe some type of oral supplement.”