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Nephrology

Nephrology is the study of the renal system. A nephrologist is responsible for the diagnosis and treatment of disorders of the kidney such as kidney stones, chronic kidney disease, dialysis, renal failure, electrolyte imbalance, renal cancer etc. Additionally Nephrologists also treat uncontrolled hypertension, renal function abnormalities due to autoimmune diseases. Nephrologists treat all post-renal transplant patients also.
Nephrologist use oral and IV medications; Ultrasound Guided Biopsies/ aspirations. Nephrologists use Hemodialysis/Plasmapheresis/CRRT/Peritoneal Dialysis to manage ESKD/AKI patients. Depending on the underlying cause, there are different procedures with different techniques. 

Different surgeries have different criteria for an ideal candidate.

For instance, in the case of end-stage kidney disease (ESKD), the right candidate must clear the following criteria:
 Proper heart-lung functionality
 No active infections in the recipient such as hepatitis, TB etc
 Any life expectancy limiting medical condition
 A full understanding and commitment to take medication regularly and following up with your nephrologist
 No smoking, drinking or recreational drugs 

Surgery is rarely required for the removal of stones. Reasons such as a big stone, spreading infection at the site of the stone, blocking of urine or severe bleeding may indicate surgery. 
A proper diet of low salt, calcium-rich and balanced diet along with adequate water intake is the first step in preventing recurrence of stones.
If untreated, the presence of kidney stones may lead to serious complications such as infection of the kidney, injury that may result in severe bleeding, blockage of urine. However, most kidney stones are too small to require treatment and pass on their own accord. 
Your kidneys are responsible to filter out your body’s blood, absorb minerals and produce urine. Due to end stage kidney failure, your kidney loses 85 – 90 % of its functionality, leading to the need of dialysis, which in turn help filter out the waste, salt and extra water.
Kidney failure can occur due to several reasons. Depending on the underlying cause of the kidney failure, it can be reversed. 

The kidney is one of the essential organs of the body. It is linked to pathologies of other organs and can be damaged irreversibly, which may result in dialysis or transplant.

Thus, there are certain precautions one can take:

 Quit smoking/recreational drugs
 A balanced diet: Low salt, low carb, balanced protein, balanced acidity, calcium-rich.
 Lose weight in a safe manner, avoid diet pills/crash diets
 Drink copious amounts of water, especially in the summers.
 Read food labels of all food to know the sodium content 

A chronic kidney disease slowly reduces the functionality of the kidney. When the kidney is not able to function properly or at all (<10%), to the point where it isn’t meeting the body’s daily needs, is known as end stage renal disease (ESRD)

ABO incompatible transplant is when the donor & recipients blood types don’t match. Earlier it was not undertaken as the rejection of the organ was extremely common.

However, with the help of a more aggressive regimen of immunosuppressives & a better understanding of immunology, ABO incompatible transplants are being done around the world. This has led to greater donor pool & a reduced number of deceased kidney transplants for patients with end-stage renal disease. In recent years, the outcome of ABO incompatible kidney transplant has been equivalent to ABO compatible kidney transplant.  

Depending on the kind of incontinence and the underlying cause responsible, there may be a few things your doctor might recommend:

 Drinking 6-8 glasses of water
 High fiber diet to avoid constipation
 Pelvic floor strengthening exercises
 Learning how to properly use the toilet e.g. not to use too much pressure, posture while sitting etc.
 Medications
 Pads, catheters, sponges etc. to aid in managing incontinence.

Depending on your physical examination, history of illness & symptoms, your nephrologist might ask you to get tested for the following:
 Complete blood test
 Urine routine/Microscopy and Culture Test
 Kidney function tests that include potassium, calcium, creatinine, BUN (blood urea nitrogen)
 Blood cholesterol, if you have high pressure
 Ultrasound Imaging of Kidneys
When you do an activity that build up pressure in the abdomen and presses down on the bladder such as coughing, sneezing, sometimes a small quantity of urine passes. This is known as stress incontinence. It is seen more in women who have just gone through pregnancy, childbirth and menopause. Try to do more of pelvic floor exercises to deal with the problem of stress incontinence. Those who are overweight have a higher chance of developing stress incontinence. Therefore, it is important to have a healthy weight to manage the problem

Benign prostate enlargement is a naturally aging process that leads to hypertrophied prostate.

Depending on the health status of the patient and the discretion of the surgeon, there are a few surgical options:
- TURP
- Bipolar TURP
- Laser Prostatectomy (HOLEP) 

While BPH is due to genetic and environmental factors, dietary changes may help reduce the risks of BPH:

 A low fat, low salt, low carb diet with fiber.
 5 or more servings vegetables/day
 Foods that have significant amount of vitamin C & zinc
 < or = 2 glasses of alcohol  

Pre-Surgery:

• Ask your doctor all your doubts prior to the surgery
• If using insurance, confirm with your insurance provider and hospital the documents needed.
• Nil by mouth (NBM) 12 hours before the procedure
• Pre-anesthetic checkup (PAC) will be done

Post-Surgery

Depending on the type of surgery, the post-operative instructions differ

• No solid food for 24 hours. Slow introduction of semi-solid meals for the next 2-3 days
• You will have an IV in your hand and will be given antibiotics, analgesics to ease the pain 

Depending on the disease & health status of the patient, your doctor might want to schedule follow up appointments. Ideally, you should follow up with your doctor once in 6 months. 

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