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Department of Nephrology, Dialysis & Renal Transplantation

The Kidneys and How They Function

The Kidneys, two bean-shaped organs located on either side of the spine at the level of the lowest ribs, perform a variety of vital functions. At the junction of the circulatory and urinary systems, the kidneys' primary function is to remove excess fluid and waste material from the bloodstream, thus beginning the process of elimination from the body as the urine flows through the ureters, into the bladder, finally exiting through the urethra. The kidneys also regulate the body's levels of sodium, potassium, calcium, and other chemicals which can become toxic if left to build up. In addition, the kidneys function as glands, producing hormones to help maintain normal blood pressure, enable the production of red blood cells, and aid in the formation of bones.

The kidneys have a remarkable operating capacity - a single kidney, working at just 20% of its capacity, can still provide all the needed renal filtration and regulation. The kidneys are capable of altering their activities from day to day, constantly adjusting to the variety and amounts of foods and liquids that are consumed. Whether we fast one day, or binge the next, the kidneys compensate to keep the body's tissues from bloating with fluids or dehydrating.

Through a network of millions of nephrons in each kidney, blood entering from the renal arteries is filtered, and through complex biochemistry, substances that are not required by the body (typically urea, creatinine and ureic acid) are removed, and others, such as blood cells, proteins, and a specific volume of water, are retained and reabsorbed. Thus, the blood that leaves the kidney through the renal veins contains the necessary salts, protein, sugar, calcium and other vital substances in the right proportion, while excess chemicals, toxins and fluids are sloughed off into the urinary tract.

Congenital anomalies, inherited disorders, direct injury, hypertension, exposure to toxins, kidney stones, tumors, and even infections in other parts of the body can result in compromised renal function. Many diseases of the kidney have no noticeable symptoms until substantial and irreparable damage has been done. When the kidneys can no longer function well enough on their own - termed as "end-state renal disease" or ESRD, Hemodialysis or Peritoneal dialysis will be required to help eliminate waste and excess fluids from the blood. Dialysis however, cannot replicate the kidneys' hormonal benefits. Transplantation has proven to be one way to recover the quality of health and the quality of life, enjoyed before the onset of end-stage renal disease.

At Risk for Kidney Disease?

You are at risk for kidney disease if you have:

  • Diabetes
  • High blood pressure
  • Heart disease
  • A family history of kidney failure

If you have any of these risk factors, get tested for kidney disease. Early kidney disease has no signs or symptoms.

Kidney disease can affect people of all ages and races. African Americans, Hispanics, and American Indians tend to have a greater risk for kidney failure. This is mostly due to higher rates of diabetes and high blood pressure in these communities. There may be other reasons, too.

Get checked for kidney disease and learn about what you can do to keep your kidneys healthy. You can help delay or even prevent kidney failure by treating kidney disease early.

Diabetes and Kidney Disease

Diabetes is the leading cause of kidney failure. In fact, 44 percent of people starting dialysis, point out that their kidney failure was caused by diabetes.

Diabetes can damage your kidneys. This damage can happen over many years, without you feeling it. That is why it is so important for people with diabetes to manage their diabetes and get tested for kidney disease. Both type 1 and type 2 diabetes can cause kidney disease.

More on Diabetes ?

For more information on managing diabetes, visit our Diabetes Education Program

High Blood Pressure and Kidney Disease

High blood pressure is the second leading cause of kidney failure. High blood pressure can damage your kidneys. This damage can happen over many years, without you feeling it. That is why it is so important for people with high blood pressure to control their blood pressure and get tested for kidney disease.

For most people, a blood pressure of 140/90 or above is considered high. Talk to your health care provider about your optimal blood pressure level. See tips on how to keep your kidneys healthier longer.

More on High Blood Pressure ?

For more information on controlling high blood pressure, visit the National Heart, Lung, and Blood Institute's "Your Guide to Lowering High Blood Pressure" website.

Heart Disease and Kidney Disease

There is a connection between kidney disease and cardiovascular (heart or blood vessel) disease. People with heart disease are at higher risk for kidney disease and people with kidney disease are at higher risk for heart disease.

Researchers are working to better understand the relationship between kidney disease and cardiovascular disease.

See tips on how to keep your kidneys healthier longer.

Family History and Kidney Disease

Family history of kidney failure is a risk factor for kidney disease. Kidney disease tends to run in families. If your mother, father, sister, or brother has kidney failure, you may be at risk. Talk to your health care provider about getting tested for kidney disease.

If you have kidney disease, tell your family members to talk to their provider about their risk and getting tested for kidney disease.

Center for Urology

Our Urology Department speciailizes with problems of the urinary tract and male genital tract. The Department of Urology at AUM is equipped with the latest endo-urological instruments for excellent management for all elective and emergency urological procedures. Our services are provided to in-patient and out-patient centers.

Our Facilities:

Minimally Invasive Urinary Stone Management

Rigid Ureteroscopy

  • Rigid Ureteroscopy
  • Treats ureteric stones of all sizes.
  • Stones are broken down with the aid of pneumatic or laser energy into smaller fragments.
  • Minimal morbidity
  • Patients can be discharged within 24 hours.
  • Retrograde Intrarenal surgery
  • Flexible Ureterorenoscope is commonly used
  • Passed into the kidney, stones in any location are then fragmented with the Laser.
  • Minimal hospital stay and the patient can resume daily activity within a couple of days
  • More applicable for smaller renal stones (less than 2 cm) and stones that have failed extracorporeal lithotripsy (ESWL).
  • PCNL (Percutaneous Nephrolithotomy)
  • A Fluroscopy (C-Arm) is employed for this procedure, by making a small tract into the kidney through the skin
  • Stones are fragmented using Pneumatic, ultrasound and Laser energy sources.
  • This procedure is applicable for large renal stones
  • Hospitalization is about 48 to 72 hours.

Lower Tract Endourology

All our facilities are available to treat Prostates (TURP), Bladder Tumors (TURBT), Urethral Strictures and Bladder stones. These procedures are performed with minimal discomfort to the patients and most patients are discharged within 48 to 72 hours.

All open urological procedures like urethroplasty, incontince procedures, radical cystectomy, nephrectomy and partial nephrectomy and renal transplantations are also done at AUM.

Acute Trauma

Direct trauma affecting the urinary organs such as kidney injury, bladder and uerthral rupture are managed on a routine basis.

Radiology

Imaging of urinary organs is done efficiently and accurately at our Diagnostic and Imaging services centre,AUM

Dialysis

When healthy kidneys fail, serious complications arise: the body retains fluids and harmful wastes, blood pressure rises, and the body cannot produce enough red blood cells. Hemodialysis is one such treatment for kidney failure, in which a machine called a dialyzer, or filter, is used to purify blood by filtering out wastes and extra fluids. It controls blood pressure and maintains the body's homeostasis, or proper balance of elements such as potassium sodium and chloride.

How is Hemodialysis Performed?

Hemodialysis entails the use of a machine, the dialyzer, to remove and filter wastes from the blood. This process helps control blood pressure and regulate the levels of minerals, salts, and fluids in the body.

Hemodialysis can be done at home or at a hemodialysis center. It is usually done three times a week, and each session takes around two to four hours. Some patients experience side effects from dialysis, and these should be discussed with your physician. It is important to maintain a proper diet and take prescribed medications while undergoing dialysis.

Adjusting to hemodialysis is a significant phase, as there could be potential adverse effects and complications. To achieve optimal results from hemodialysis, it is very important to learn how to care for yourself and to adhere to the required schedule.

Peritoneal Dialysis

An alternative to Hemodialysis is Peritoneal Dialysis, which removes excess water, wastes, and chemicals from the body. It works by passing a cleansing solution, called dialysate, into a lining of the abdomen, called the peritoneal membrane. After several hours, the dialysate is drained out of the abdomen, along with blood wastes. There are three types of peritoneal dialysis Continuous Ambulatory (CAPD), Continuous Cyclic (CCPD), and Intermittent (IPD). Each of these types of dialysis have their own dietary requirements.

Beyond Dialysis

While hemodialysis and peritoneal dialysis both offer life-saving options to many patients with chronic kidney failure, they still cannot replicate the kidneys' hormonal function and benefits. Given the inconveniences and adverse effects associated with dialysis, many patients find that dialysis does not provide the level of health maintenance they desire.

Kidney transplantation has proven to be one way to recover the quality of health, and the quality of life, enjoyed before the onset of end-stage renal disease. Also, kidney transplantation yields a longer life expectancy than dialysis. With the expanded availability of organs from living donors, pre-emptive transplantation now enables individuals to avoid the discomfort and inconvenience of dialysis altogether.

 


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