Acute Kidney Injury (AKI)

Acute Kidney Injury (AKI), formerly known as acute renal failure, is a sudden and often reversible decline in kidney function that occurs over a short period, usually hours to days. This condition is characterized by a rapid accumulation of waste products, electrolyte imbalance, and fluid overload due to the kidneys’ inability to filter blood efficiently. AKI is a medical emergency and requires immediate intervention to prevent permanent damage or progression to chronic kidney disease (CKD).

At Primax Hospital, we provide timely diagnosis and evidence-based management of AKI through a multidisciplinary approach involving nephrologists, intensivists, and critical care specialists. We offer round-the-clock laboratory monitoring, fluid and electrolyte management, renal replacement therapy (dialysis), and support for underlying medical conditions causing AKI.

Causes of AKI

– Hypovolemia – due to dehydration, blood loss, or severe diarrhea.

– Sepsis – severe infection leading to systemic inflammation and low blood pressure.

– Cardiac failure – reduced perfusion to kidneys.

– Medications – such as NSAIDs, ACE inhibitors, aminoglycosides, contrast agents.

– Obstruction – due to kidney stones, tumors, or enlarged prostate.

– Glomerulonephritis or interstitial nephritis.

– Hepatorenal syndrome in patients with liver failure.

Signs and Symptoms

– Reduced urine output (oliguria or anuria).

– Swelling in legs, feet, or face.

– Shortness of breath due to fluid retention.

– Fatigue, confusion, or drowsiness.

– Nausea and vomiting.

– Seizures or coma in severe cases.

– Abnormal heart rhythms from electrolyte imbalance.

Diagnostic Approach at Primax

– Serum creatinine and blood urea levels.

– Urinalysis – for protein, casts, or infection.

– Electrolyte panel – sodium, potassium, calcium, bicarbonate.

– Ultrasound – to assess kidney size and rule out obstruction.

– CT scan with caution – if contrast is needed.

– Fluid balance charting and vital monitoring.

– Renal biopsy in rare, unexplained cases.

Treatment and Management

– Correction of fluid status – intravenous fluids for hypovolemia, diuretics for overload.

– Antibiotics for infections, especially in septic AKI.

– Avoidance of nephrotoxic drugs and contrast agents.

– Dialysis initiation in cases of severe AKI – in-house hemodialysis and CRRT available.

– Monitoring and correction of electrolyte imbalances, especially potassium.

– Management of underlying causes such as heart failure, liver disease, or obstruction.

– Nutritional support and metabolic correction.

Prognosis and Follow-up

– Most patients recover partially or fully if treated early.

– Some may progress to CKD or need long-term dialysis.

– Regular renal function monitoring after discharge.

– Avoidance of further insults to kidneys (medications, infections).

– Patient education on signs of recurrence or complications.

Hemodialysis and Peritoneal Dialysis

Dialysis is a life-saving therapy used to perform the functions of the kidneys when they fail to work adequately. It helps to remove waste products, excess fluid, and toxins from the blood, restore electrolyte balance, and control blood pressure. There are two main types of dialysis: Hemodialysis (HD) and Peritoneal Dialysis (PD). The choice of modality depends on the patient’s medical condition, lifestyle, and personal preference.

At Primax Hospital, we offer advanced in-center hemodialysis and assist patients with the setup and training for peritoneal dialysis at home. Our dialysis unit is equipped with state-of-the-art machines, round-the-clock monitoring, and an expert team of nephrologists and dialysis nurses to ensure safe and comfortable treatments.

Hemodialysis (HD)

Hemodialysis involves diverting blood from the body to a dialysis machine (artificial kidney), where it is filtered and returned to the body. This is typically done three times a week and each session lasts 3 to 5 hours.

Key Features

– Performed at our in-house dialysis unit under expert supervision.

– AV Fistula or catheter used for vascular access.

– High-flux dialysis machines with infection control protocols.

– Monitored for blood pressure, weight, electrolytes, and dialysis adequacy (Kt/V).

– Emergency dialysis support available for ICU patients (CRRT).

Peritoneal Dialysis (PD)

Peritoneal Dialysis is a home-based dialysis option that uses the patient’s peritoneal membrane (lining of the abdomen) as a natural filter. A sterile solution is introduced into the abdominal cavity via a catheter, and after a dwell time, the waste-laden fluid is drained out.

Key Features

– Continuous Ambulatory Peritoneal Dialysis (CAPD) – manual exchanges done 4 times a day.

– Automated Peritoneal Dialysis (APD) – machine-assisted exchanges at night.

– Greater flexibility for patients wishing to continue work or studies.

– Training provided for self-care and caregiver support.

– Regular follow-up at Primax to monitor infection risk (peritonitis), catheter care, and fluid balance.

Indications for Dialysis

– End-Stage Kidney Disease (ESKD) with GFR <15 mL/min/1.73 m².

– Fluid overload unresponsive to medication.

– Severe electrolyte imbalances (e.g., hyperkalemia).

– Uremic symptoms like nausea, confusion, or pericarditis.

– Acute Kidney Injury not resolving with conservative treatment.

Dialysis Access & Support Services at Primax

– Surgical AV fistula creation in collaboration with vascular surgeons.

– Tunnelled and non-tunnelled catheter insertion for emergency dialysis.

– Dietary counseling for dialysis patients – protein, fluid, and potassium control.

– Psychosocial support and counseling to improve adherence.

– Vaccination and infection screening as part of regular protocol.

Kidney Transplant Evaluation and Follow-up

Kidney transplantation is the preferred treatment for patients with end-stage kidney disease (ESKD), offering improved quality of life and long-term survival compared to dialysis. It involves surgically placing a healthy kidney from a living or deceased donor into a patient whose kidneys no longer function effectively. Transplantation eliminates the need for dialysis and allows the patient to resume a more normal lifestyle.

At Primax Hospital, we offer a comprehensive transplant evaluation program including medical, surgical, psychological, and immunological assessments. We collaborate with leading transplant centers to ensure a seamless process from donor selection to surgery and post-transplant care. Our nephrology team remains actively involved in long-term follow-up, ensuring optimal graft function and overall well-being of the patient.

Pre-Transplant Evaluation

– Blood tests – blood group, HLA typing, CBC, LFT, RFT, viral markers (HBV, HCV, HIV).

– Urine tests and 24-hour urine collection (if residual function present).

– Cardiac assessment – ECG, ECHO, and stress testing.

– Radiological investigations – CT/MRI abdomen and pelvis, renal Doppler.

– Cancer screening – based on age and history (PAP smear, mammography, colonoscopy).

– Psychological counseling and social assessment.

– Assessment of suitability for immunosuppression and compliance.

Types of Kidney Donors

– Living Related Donor – family members with matching blood groups.

– Living Unrelated Donor – spouse or altruistic donor (under legal approval).

– Deceased Donor – organ harvested from brain-dead individual with family consent.

– ABO-Incompatible Transplants – possible with specialized desensitization protocols.

– Swap/Paired Exchange Transplants – between incompatible pairs under registry programs.

Surgical Procedure

Kidney transplant surgery involves placing the donor kidney in the lower abdomen and connecting it to the recipient’s blood vessels and bladder. Native kidneys are usually left undisturbed unless infected or causing complications. The procedure typically takes 3–5 hours and requires hospital stay of 7–10 days.

Post-Transplant Medications

– Calcineurin Inhibitors (e.g., Tacrolimus, Cyclosporine).

– Antiproliferative agents (e.g., Mycophenolate mofetil).

– Steroids (e.g., Prednisolone).

– Induction therapy – basiliximab or antithymocyte globulin at surgery time.

– Prophylactic antimicrobials – to prevent infection post-transplant.

Possible Complications

– Acute rejection – usually in first 3 months; managed with increased immunosuppression.

– Chronic rejection – slow loss of kidney function over years.

– Infections – viral (CMV, BK virus), fungal, bacterial due to immunosuppression.

– Post-transplant diabetes or hypertension.

– Medication side effects – toxicity, cosmetic changes.

– Malignancies – long-term immunosuppression increases cancer risk.

Long-Term Care and Monitoring

– Regular blood tests – creatinine, drug levels, CBC, LFT, electrolytes.

– Urine monitoring – protein, infections.

– Ultrasound and Doppler – for graft evaluation.

– Blood pressure and sugar control.

– Lifestyle counseling – hygiene, diet, activity restrictions.

– Vaccination and cancer surveillance protocols.

Diabetic Nephropathy

Diabetic Nephropathy is a serious complication of both type 1 and type 2 diabetes mellitus that affects the kidneys’ ability to function normally. It is characterized by progressive damage to the nephrons—the kidney’s filtering units—due to long-standing high blood glucose levels. It is the most common cause of chronic kidney disease and end-stage kidney failure globally.

At Primax Hospital, we follow a proactive and multidisciplinary approach to manage diabetic nephropathy. Early detection through urine and blood tests, aggressive blood sugar and blood pressure control, kidney-protective medications, and patient education are key components of our management plan. Our goal is to delay disease progression and reduce the risk of dialysis or transplant in patients with diabetes-related kidney complications.

Causes and Risk Factors

– Long-standing diabetes (especially >10 years).

– Poor blood sugar control (HbA1c > 7%).

– High blood pressure (systolic >140 mmHg).

– Genetic predisposition or family history of kidney disease.

– Smoking and sedentary lifestyle.

– High cholesterol levels.

– Frequent urinary tract infections or other kidney insults.

Symptoms

– Swelling in the feet, ankles, or around the eyes.

– Foamy or bubbly urine (due to proteinuria).

– High blood pressure.

– Fatigue and generalized weakness.

– Nausea, vomiting, and poor appetite.

– Frequent urination, especially at night.

– Difficulty concentrating or mental fog in advanced stages.

Diagnosis at Primax Hospital

– Urine albumin-to-creatinine ratio (UACR) – detects microalbuminuria.

– Serum creatinine and estimated GFR (eGFR).

– Blood pressure monitoring.

– Lipid profile and HbA1c testing.

– Renal ultrasound – to assess size and cortical thickness.

– Fundus examination – to check for diabetic retinopathy (often coexists).

– Kidney biopsy – in atypical or rapidly progressive cases.

Stages of Diabetic Nephropathy

– Stage 1 – Hyperfiltration phase with increased kidney size and GFR.

– Stage 2 – Silent stage with mild microalbuminuria and normal GFR.

– Stage 3 – Incipient nephropathy with persistent albuminuria.

– Stage 4 – Overt nephropathy with macroalbuminuria and declining GFR.

– Stage 5 – End-stage renal disease requiring dialysis or transplant.

Management and Treatment

– Strict blood glucose control using oral antidiabetics or insulin (target HbA1c < 7%).

– Blood pressure control using ACE inhibitors or ARBs (target <130/80 mmHg).

– Low-protein diet and salt restriction to reduce kidney workload.

– Cholesterol-lowering agents (statins).

– Smoking cessation and weight management.

– Management of complications like anemia, acidosis, and electrolyte disturbances.

– Regular monitoring of kidney function every 3–6 months.

Preventive Strategies

– Annual screening for albuminuria in all diabetic patients.

– Maintaining optimal glycemic and blood pressure control.

– Healthy lifestyle – balanced diet, regular exercise, and hydration.

– Avoiding nephrotoxic drugs like NSAIDs.

– Timely treatment of urinary infections and dehydration.

– Early referral to nephrologist when kidney parameters begin to decline.

Hypertensive Nephrosclerosis

Hypertensive Nephrosclerosis is a form of kidney damage that results from long-standing, poorly controlled high blood pressure. Persistent hypertension causes thickening and narrowing of the renal blood vessels, leading to decreased blood flow, scarring, and loss of nephron function. This condition is one of the leading causes of chronic kidney disease (CKD), particularly in older adults and individuals of African descent.

At Primax Hospital, we aim to identify and manage hypertensive nephrosclerosis early through accurate diagnosis, stringent blood pressure control, lifestyle counseling, and multidisciplinary care. By managing this condition effectively, we can delay or even prevent the onset of kidney failure and associated cardiovascular complications.

Risk Factors

– Chronic high blood pressure (especially untreated for years).

– Family history of hypertension or kidney disease.

– African ancestry – genetic predisposition.

– Diabetes coexisting with hypertension.

– High salt intake, obesity, and sedentary lifestyle.

– Smoking and excessive alcohol consumption.

– Male gender and age over 50.

Signs and Symptoms

– Often asymptomatic in early stages.

– Gradual rise in blood pressure over time.

– Protein in the urine (proteinuria).

– Swelling in legs and ankles (edema).

– Nocturia – frequent urination at night.

– Fatigue and decreased appetite.

– Headaches, dizziness, or visual disturbances in advanced stages.

Diagnosis at Primax Hospital

– Blood pressure monitoring and hypertension staging.

– Urinalysis – for protein, microscopic hematuria.

– Blood tests – creatinine, BUN, electrolytes, eGFR.

– Renal ultrasound – may reveal small, shrunken kidneys in chronic cases.

– 24-hour urine protein measurement.

– Fundus examination – to assess hypertensive retinopathy.

– Kidney biopsy – in atypical cases or rapid deterioration.

Types of Hypertensive Nephrosclerosis

– Benign Nephrosclerosis – Slow, progressive damage over years, often asymptomatic.

– Malignant Nephrosclerosis – Sudden severe hypertension with rapid kidney failure, retinal damage, and neurologic symptoms. Requires emergency intervention.

Treatment and Management

– Aggressive blood pressure control – goal <130/80 mmHg.

– Use of ACE inhibitors or ARBs for kidney protection.

– Diuretics to manage volume overload.

– Lifestyle modification – salt restriction, weight loss, regular physical activity.

– Smoking cessation and moderation of alcohol.

– Treatment of associated conditions – diabetes, hyperlipidemia.

– Monitoring kidney function every 3–6 months.

Potential Complications

– Progression to end-stage renal disease (ESRD).

– Cardiovascular disease – heart failure, heart attack, stroke.

– Hypertensive crisis requiring emergency care.

– Vision loss from hypertensive retinopathy.

– Severe anemia and electrolyte disturbances in advanced stages.

Prevention Strategies

– Regular blood pressure checks and compliance with medication.

– Diet low in salt and saturated fats.

– Early screening for kidney damage in hypertensive patients.

– Control of diabetes and cholesterol levels.

– Avoidance of nephrotoxic medications like NSAIDs.

– Annual urine and blood tests for kidney function assessment.

Glomerulonephritis

Glomerulonephritis is a group of kidney diseases characterized by inflammation of the glomeruli—tiny filtering units within the kidneys. This inflammation disrupts the normal filtration of waste, electrolytes, and fluids, leading to symptoms such as blood in the urine, proteinuria, swelling, and elevated blood pressure. Glomerulonephritis may be acute or chronic and can occur as a primary condition or secondary to systemic diseases like lupus or infections.

At Primax Hospital, we provide precise diagnosis and targeted treatment for all forms of glomerulonephritis. Our nephrology team collaborates with immunologists, pathologists, and rheumatologists when needed to manage complex cases with a personalized care plan.

Causes and Classification

– Primary Glomerulonephritis – IgA nephropathy, minimal change disease, FSGS, membranous nephropathy.

– Secondary Glomerulonephritis – due to lupus, vasculitis, hepatitis B or C, HIV, or diabetes.

– Post-infectious GN – usually following streptococcal infection.

– Rapidly Progressive GN – aggressive form leading to quick kidney failure if untreated.

Signs and Symptoms

– Hematuria (blood in urine) – may appear pink, cola-colored.

– Proteinuria (foamy urine).

– Swelling in face, hands, feet, or abdomen.

– High blood pressure.

– Decreased urine output in some cases.

– Fatigue and weakness.

– Nausea or loss of appetite.

Diagnosis at Primax Hospital

– Urinalysis – to detect red blood cells, protein, and cellular casts.

– 24-hour urine protein estimation.

– Blood tests – creatinine, BUN, complement levels, ANA, anti-dsDNA.

– Viral markers – for hepatitis and HIV.

– Kidney ultrasound – for size and echotexture.

– Renal biopsy – definitive diagnosis and classification of GN type.

Common Types of Glomerulonephritis

– Minimal Change Disease – common in children, responds well to steroids.

– Focal Segmental Glomerulosclerosis (FSGS) – can be steroid-resistant.

– Membranous Nephropathy – thickening of glomerular membranes, proteinuria.

– IgA Nephropathy – most common primary GN worldwide, follows URTI.

– Lupus Nephritis – secondary to systemic lupus erythematosus (SLE).

– Post-infectious GN – occurs after throat/skin infections.

– Rapidly Progressive GN – medical emergency needing immunosuppressive therapy.

Treatment and Management

– Immunosuppressive therapy – steroids, cyclophosphamide, MMF depending on type.

– ACE inhibitors or ARBs to reduce proteinuria and control BP.

– Diuretics for fluid overload and swelling.

– Plasma exchange therapy – in select rapidly progressive or vasculitis-related GN.

– Antibiotics – in post-infectious cases.

– Antivirals – if viral etiology suspected.

– Dialysis in advanced or refractory cases.

– Close follow-up with monitoring of proteinuria, creatinine, and BP.

Prognosis and Long-Term Outlook

– Some forms are completely reversible with early treatment.

– Others may lead to chronic kidney disease or require long-term dialysis.

– Relapses can occur in certain conditions like FSGS or lupus nephritis.

– Ongoing follow-up and compliance with medications is key.

– Kidney transplant may be needed in end-stage GN.

Polycystic Kidney Disease (PKD)

The bladder is a vital organ responsible for storing and releasing urine. When it becomes irritated, inflamed, or infected, it can lead to discomfort, urinary symptoms, and disruptions in daily life. One of the most common bladder problems is cystitis, an inflammation of the bladder, often caused by a urinary tract infection (UTI). While cystitis typically affects women, it can also occur in men and children.

At Primax Hospital, our Urology and Internal Medicine teams work together to diagnose and treat a wide range of bladder conditions, using evidence-based care and modern diagnostics to ensure accurate treatment and long-term relief.

Common Symptoms of Bladder Issues and Cystitis

Frequent urge to urinate

Burning sensation or pain during urination

Lower abdominal or pelvic discomfort

Cloudy, strong-smelling, or bloody urine

Difficulty fully emptying the bladder

Mild fever (in some cases)

If you experience flank pain, high fever, or vomiting, it may indicate a kidney infection and requires urgent medical attention.

Causes and Risk Factors

Bacterial infections (most commonly E. coli)

Poor hygiene practices or improper wiping techniques

Sexual activity (especially in women)

Prolonged catheter use

Incomplete bladder emptying due to neurological or anatomical issues

Irritants like perfumed soaps, bubble baths, or certain feminine hygiene products

Hormonal changes (e.g., post-menopause)

Types of Cystitis and Bladder Conditions

Acute bacterial cystitis – Common, treatable bladder infection

Chronic cystitis – Recurring bladder infections or inflammation

Interstitial cystitis (painful bladder syndrome) – A chronic, non-infectious condition causing bladder pain and frequent urination

Radiation cystitis – Inflammation after pelvic radiation therapy

Drug-induced cystitis – Caused by certain medications, like chemotherapy drugs

Diagnosis at Primax

Urinalysis & Urine Culture – To detect infection and identify the causative bacteria

Ultrasound of the Bladder and Kidneys – To rule out structural issues

Cystoscopy – A direct look inside the bladder for persistent or unclear symptoms

Post-void residual test – Measures how well the bladder empties

Treatment Options

Antibiotics – For bacterial cystitis (based on culture results)

Pain relievers – To ease bladder discomfort

Bladder instillations – For interstitial cystitis (special medications inserted into the bladder)

Behavioral therapy – Bladder training and pelvic floor exercises

Dietary modifications – Avoiding bladder irritants like caffeine, alcohol, and spicy foods

Hydration – Drinking plenty of water to flush the urinary tract

Complications if Left Untreated

Kidney infections (pyelonephritis)

Recurrent or chronic UTIs

Bladder scarring or reduced capacity

Impact on quality of life and daily functioning

In rare cases, sepsis (a life-threatening infection spread)

Prevention Tips

Urinate frequently and completely

Wipe front to back (especially for women)

Urinate after sexual activity

Avoid harsh soaps and irritants around the genital area

Stay well-hydrated

Wear breathable, cotton underwear

Why Choose Primax for Bladder Care?

Multidisciplinary team of urologists and internal medicine experts

Advanced diagnostics including cystoscopy and ultrasound

Personalized care plans for chronic or complex conditions

Focus on minimally invasive treatment and long-term relief

Patient education and preventive care programs

Don’t Ignore Bladder Discomfort – Get Relief Today

Recurring urinary pain or bladder irritation may be more than just a minor infection. Let the experts at Primax Hospital help you find answers and lasting relief.

📞 Call: 9666 46 0009
🌐 Visit: www.primaxhospital.com
Schedule a consultation today with our Urology and Internal Medicine teams.