Renal Critical Care

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Diseases and Conditions

• Acute Renal Failure: This is a condition characterized by a sudden inability of the kidneys to filter waste materials from the blood. It results in the accumulation of waste in the blood. Patients experience nausea, reduced urine output, shortness of breath, fluid retention, chest pain, an irregular heartbeat, and weakness.
• Chronic Renal Failure: Patients suffering from chronic renal failure have a progressive loss of the kidney's ability to filter blood over several months or years. The severity of the symptoms depends upon the extent of the loss of kidney function.
• Renal Transplantation: It is a surgical procedure that involves the replacement of the failed kidney with a new, healthy donor kidney. The doctor recommends a renal transplant when other non-invasive and invasive treatment methods cannot provide relief from the symptoms.
• Severe Urinary Tract Infections: Urinary tract infections involve infection in one or more parts of the urinary tract. The urinary tract includes the kidney, ureters, bladder, and urethra. The symptoms of urinary tract infections are a strong urge to urinate, pain and burning sensation during urination, strong smelling urine, increased urination frequency, cloudy urine, and pain in the pelvic region.

Procedures and treatment

• Conventional Hemodialysis: Hemodialysis is a renal replacement therapy that involves filtering the blood through an external device in patients with reduced kidney function. Conventional hemodialysis is generally done thrice a week and requires 3-4 hours per session.
• Sustained Low-Efficiency Dialysis (SLED): It is a type of dialysis performed in the intensive care unit on patients with acute renal failure and hemodynamic instability. The advantages of SLED include excellent hemodynamic tolerability, effective small solute clearance, and flexibility in the treatment schedule.
• Continuous Renal Replacement Therapy (CRRT): This slow and continuous renal replacement therapy ensures fluid and solute homeostasis. It is used in patients with volume overload, hyponatremia, hyperkalemia, uremia, hyperphosphatemia, metabolic acidosis, encephalopathy, electrolyte abnormalities, pericarditis, and drug and chemical toxicity. The techniques for CRRT are continuous venovenous hemofiltration, continuous venovenous hemodiafiltration, and continuous venovenous hemodialysis.
• Plasma Exchange Therapy: Plasma exchange therapy, also known as plasmapheresis, is used to eliminate molecular substances of higher weight, such as immune complexes and immunoglobulins, from plasma. It is indicated as adjuvant therapy, with hemodialysis, in patients with severe acute kidney injury. Some important therapeutic plasma exchange modifications are immune adsorption, double membrane filtration, and microfiltration.
• Renal Infections Management: Antibiotics are considered first-line therapy in kidney infections. It is important to take the complete course of antibiotics even if the patient experiences reduction in symptoms within the first few days of treatment. If the patient has a severe kidney infection, hospitalization is recommended, and the management involves antibiotics and fluid resuscitation. In cases of recurrent kidney infections, the patient undergoes a comprehensive anatomical examination, and surgery may be required to correct the anatomical abnormality causing repeated infections.
• Dyselectrolytemia Management: Hemodialysis may be followed by several acute and chronic complications. Dyselectrolytemia is a condition that involves alteration in the levels of electrolytes in the blood when it comes in contact with the dialysate during dialysis. It results in cardiovascular complications and increases mortality and morbidity in patients undergoing dialysis. The treatment depends on the ionic profile of the patient and is customized accordingly.