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Critical Care Nephrology (CCN)

Critical Care Nephrology (CCN)

by | Jan 9, 2025 | Blog

Critical Care Nephrology (CCN) is a specialized field focused on managing and preventing acute kidney injury (AKI) in critically ill patients, often admitted to intensive care units (ICUs). AKI significantly impacts patient outcomes, leading to increased morbidity, mortality, prolonged ICU and hospital stays, and higher healthcare costs, particularly when renal replacement therapy (RRT) is required. CCN addresses these challenges by providing expert care for kidney-related complications, often in conjunction with other organ failures.

This field emphasizes multidisciplinary collaboration, integrating nephrologists, intensivists, nurses, and other healthcare professionals to offer comprehensive and coordinated care for critically ill patients. One of the key goals of CCN is to optimize the use of renal replacement therapies, such as hemodialysis or continuous renal replacement therapy (CRRT), while managing fluid balance, electrolyte imbalances, and other kidney-related concerns. Additionally, it involves dynamic monitoring to assess kidney function and the patient’s response to treatment.

Through early intervention and close monitoring, CCN aims to reduce the incidence and severity of AKI, improve outcomes, and shorten the duration of intensive care, ultimately enhancing the quality of life for critically ill patients.

Critical Care Nephrology (CCN) is an emerging medical specialty focusing on the management and prevention of acute kidney injury (AKI) in ICU patients. AKI in critically ill patients leads to increased morbidity, mortality, longer ICU and hospital stays, and higher healthcare costs, especially when renal replacement therapy is required. CCN aims to provide integrated, multidisciplinary care in the ICU, ensuring coordinated efforts in preventing, diagnosing, and treating AKI. It also emphasizes dynamic monitoring of patients and offering renal and multiorgan replacement therapies to improve patient outcomes and reduce complications.

 

Critical Care Nephrology (CCN)

Insertion of Permanent Catheter / Tunnelled Dialysis Catheter

by | Jan 9, 2025 | Blog

Insertion of Permanent Catheter / Tunnelled Dialysis Catheter

For patients undergoing haemodialysis for chronic kidney disease (CKD), a permanent or tunnelled dialysis catheter may be necessary if arteriovenous fistula or graft formation is not possible or suitable. This catheter provides access to blood for filtration by the haemodialysis machine.

A tunnelled haemodialysis catheter is a soft plastic tube inserted into a large vein in the neck or groin. It tunnels under the skin to the chest or thigh and has a cuff to secure it and reduce infection risks. These catheters may be temporary or long-term solutions, depending on individual needs and medical recommendations.

A tunnelled dialysis catheter is a soft, flexible tube inserted into a large vein, typically in the neck or groin, for patients requiring haemodialysis. It provides a reliable blood access point for filtration by the dialysis machine when fistula or graft creation is not feasible. The catheter is “tunnelled” under the skin to the chest or thigh, with a cuff promoting tissue growth to secure it and reduce infection risk. This catheter can remain in place temporarily or long-term, depending on the patient’s needs and treatment plan, until a more permanent vascular access, like an arteriovenous fistula, is available.A tunnelled haemodialysis catheter is a medical device used for long-term access to the bloodstream during haemodialysis in patients with chronic kidney disease (CKD) who are unable to have a permanent vascular access, such as a fistula or graft. This catheter is a soft, flexible tube made from biocompatible materials and is inserted into one of the large veins, typically in the neck (internal jugular vein) or sometimes in the groin (femoral vein).

The catheter is inserted through the skin, and a short tunnel is created under the skin before it emerges at the front of the chest or thigh. The catheter has two lumens: one for drawing blood for filtration and the other for returning filtered blood back to the body. To secure the catheter and reduce the risk of infection, a small cuff is placed under the skin, promoting scar tissue formation that helps anchor the catheter in place.

This tunnelled catheter is designed for long-term use, either until a permanent access, like an arteriovenous fistula, is ready, or, in some cases, as a long-term solution if other access methods are not viable.

 

Critical Care Nephrology (CCN)

Insertion of Temporary Dialysis Catheter

by | Jan 9, 2025 | Blog

Insertion of Temporary Dialysis Catheter

Temporary dialysis catheters provide immediate vascular access for short-term hemodialysis, often in emergencies like acute kidney injury. Common insertion sites include the internal jugular, femoral, or subclavian veins, chosen based on accessibility and patient condition. The procedure involves ultrasound-guided vein cannulation, guidewire placement, and catheter insertion under sterile conditions. Proper placement is confirmed using imaging. Catheters have dual lumens for blood flow during dialysis. They are secured, flushed, and dressed to prevent complications like infection or thrombosis. Temporary catheters are essential for urgent dialysis but should be replaced with permanent access, like a fistula, for long-term renal support.

Temporary dialysis is performed for a short duration, often initiated in emergency situations, using a temporary or uncuffed catheter for hemodialysis.

These catheters are typically inserted into a large vein, such as the jugular vein in the neck or the femoral vein near the groin crease, ensuring rapid access for urgent treatment.

Temporary dialysis catheters are used for short-term hemodialysis.

These catheters provide immediate vascular access in emergencies.

Common emergency conditions include acute kidney injury or fluid overload.

The procedure begins with identifying an appropriate vein.

Large central veins, such as the jugular or femoral, are preferred.

The jugular vein in the neck is commonly used.

Femoral veins near the groin can also serve as access points.

Catheters may also be placed in the subclavian vein in some cases.

The site choice depends on patient condition and accessibility.

Ultrasound guidance is often used to locate the vein.

Critical Care Nephrology (CCN)

Pyelonephritis (Kidney Infection): Symptoms, Treatment, and Nephrology Care

by | Jan 9, 2025 | Blog

Pyelonephritis (Kidney Infection): Symptoms, Treatment, and Nephrology Care

Pyelonephritis is a severe type of urinary tract infection (UTI) that affects one or both kidneys. It typically starts in the lower urinary tract (bladder or urethra) and progresses to the kidneys. Timely treatment is crucial to avoid complications such as permanent kidney damage or a life-threatening systemic infection (sepsis).

Understanding Pyelonephritis

  • Causes: Most kidney infections result from bacteria entering the urinary tract, typically Escherichia coli (E. coli).
  • Risk Factors:
    • Female anatomy, due to the shorter urethra.
    • Blockages in the urinary tract (e.g., kidney stones or enlarged prostate).
    • Compromised immune systems.
    • Structural abnormalities in the urinary tract.

Signs and Symptoms

Common symptoms of pyelonephritis include:

  • Systemic Symptoms:
    • High fever with chills.
    • Nausea and vomiting.
    • Fatigue or general malaise.
  • Urinary Symptoms:
    • Burning or painful urination (dysuria).
    • Frequent and urgent need to urinate.
    • Cloudy, foul-smelling, or bloody urine.
  • Localized Pain:
    • Pain in the groin, side (flank), or lower back.
    • Abdominal discomfort.

Complications if Untreated

  • Permanent Kidney Damage: Scarring or reduced kidney function.
  • Sepsis: Bacteria entering the bloodstream can cause a life-threatening infection.
  • Chronic Kidney Disease (CKD): Repeated or severe infections may lead to CKD.

Diagnosis

  • Urinalysis: To detect bacteria, blood, or pus in the urine.
  • Urine Culture: Identifies the specific bacteria causing the infection.
  • Blood Tests: To assess kidney function and detect signs of systemic infection.
  • Imaging: Ultrasound or CT scans may be used to identify blockages or structural abnormalities.

Treatment

  1. Antibiotics:
    • Oral antibiotics for mild cases.
    • Intravenous (IV) antibiotics for severe infections or complications, often requiring hospitalization.
  2. Symptomatic Relief:
    • Pain relievers and hydration.
    • Anti-nausea medications.
  3. Addressing Underlying Issues:
    • Removal of kidney stones or treatment of structural abnormalities, if present.
  4. Follow-up:
    • Repeat urine tests to ensure the infection has resolved.

When to Seek Immediate Medical Attention

Seek urgent care if you experience:

  • Persistent high fever or chills.
  • Severe pain in the flank or groin area.
  • Symptoms of systemic infection (e.g., confusion, rapid heartbeat).

Expert Care with Dr. Sandip Bhurke

Dr. Sandip Bhurke, a leading nephrologist in South Mumbai, specializes in diagnosing and managing kidney infections and related complications. With expertise in treating complex kidney conditions, Dr. Sandip Bhurke provides personalized care, ensuring timely intervention to prevent complications and promote kidney health.

 

Critical Care Nephrology (CCN)

Renal Transplantation is a life-saving procedure for individuals with end-stage renal disease (ESRD)

by | Jan 9, 2025 | Blog

Renal Transplantation is a life-saving procedure for individuals with end-stage renal disease (ESRD). This surgery involves placing a healthy kidney from a donor—either living or deceased—into a patient whose kidneys have lost their ability to function effectively. When kidney function drops below 10%, harmful levels of waste and fluid build up, necessitating intervention via dialysis or transplantation.

Types of Kidney Transplants

  1. Deceased-Donor Kidney Transplant
    • The kidney comes from a recently deceased individual.
    • It remains the most common source for organ donation.
  2. Living-Donor Kidney Transplant
    • A healthy individual donates one of their kidneys.
    • Offers advantages such as better outcomes and shorter waiting times.
  3. Preemptive Kidney Transplant
    • Performed before the patient begins dialysis.
    • Associated with better long-term outcomes and quality of life.

Why Renal Transplantation is Preferred

A kidney transplant is often the treatment of choice for ESRD because of its numerous benefits compared to long-term dialysis:

  • Improved Quality of Life: Patients often experience more energy, fewer health restrictions, and the ability to resume normal activities.
  • Lower Mortality Risk: Studies show lower risks of death compared to patients on chronic dialysis.
  • Dietary Freedom: Transplant recipients generally have fewer dietary restrictions than those on dialysis.
  • Cost Efficiency: While the initial cost of transplantation is high, it is less expensive in the long run compared to years of dialysis treatments.

Preemptive Kidney Transplants

  • Receiving a kidney transplant before starting dialysis can reduce complications associated with dialysis initiation.
  • It improves survival rates and preserves the patient’s overall health.

Would you like to dive deeper into any particular area, such as the transplant process, immunosuppressive therapy, or living donor considerations?