Senior Consultant Surgeon, General Surgery, GI Surgery and Transplantation
Indraprastha Apollo Hospitals, New Delhi
Padam Shree Dr.(Prof) Sandeep Guleria is working as a senior consultant – transplant surgeon at the Indraprastha Apollo Hospitals, New Delhi, India. Prior to this Prof. Guleria has numerous firsts to his credit. He led the team that did the first cadaveric renal transplant in India from a brain dead donor. He also led the team that did the first two successful kidney pancreas transplants in India.
He was actively involved in the modifications of the Human Organ Transplant Act through the Rajiv Gandhi foundation.
Dr Guleria was trained in the UK and was appointed as a consultant surgeon in surgery and transplantation at Europe's largest teaching hospital the St. James's University hospital, Leeds.
He was till recently the Secretary of the Indian Society of Organ transplantation.
He is also a member of the ethics committee of the Transplantation Society.
Dr Guleria has been felicitated with numerous awards, has more than 106 indexed publications, 16 chapters in books and has given seven orations. He has been awarded Padam Shree by the Govt of India.
We have two kidneys. They are bean-shaped and about the size of a fist. They are located in the middle of the back, on the left and right of spine just below the rib cage.
The kidneys main job is to filter blood, removing wastes and extra water to make urine. They also help control blood pressure and make hormones that the body needs to stay healthy. When the kidneys are damaged, wastes can build up in the body.
Kidney disease – also known as chronic kidney disease (CKD) – occurs when kidneys can no longer remove wastes and extra water from the body or perform other functions as they should.
Kidney disease is most often caused by diabetes or high blood pressure.
Each kidney contains about one million tiny filters made up of blood vessels. These filters are called glomeruli. Diabetes and high blood pressure damage these blood vessels, so the kidneys are not able to filter the blood as well as they used to. Usually this damage happens slowly, over many years. As more and more filters are damaged, the kidneys eventually stop working.
Diabetes and high blood pressure are the two leading risk factors for kidney disease. Both diabetes and high blood pressure damage the small blood vessels in kidneys and can cause kidney disease – without you feeling it.
There are several other risk factors for kidney disease. Cardiovascular (heart) disease is a risk factor. So is family history: if you have a mother, father, sister, or brother who has had kidney disease, then you are at increased risk.
Kidney disease is often called a “silent” disease, because most people have no symptoms in early kidney disease. In fact, you may feel just fine until your kidneys have almost stopped working. Do NOT wait for symptoms; Blood and urine tests are the only way to check for kidney damage or measure kidney function.
You can keep your kidneys healthy longer by taking steps to control your diabetes and high blood pressure. Manage your diabetes and high blood pressure by
A blood test and a urine test are used to find kidney disease. If you have diabetes, high blood, heart disease, or a family history of kidney failure, you should also get tested regularly – ask your health care provider how often.
The blood test for kidney disease is called a GFR. (GFR stands for glomerular Filtration Rate). This test helps your doctor measure how much blood your kidneys filter each minute. This shows how well your kidneys are working.
GFR is reported as a number. A GFR below 60 may mean you have kidney disease. However, because GFR decreases as people age, other information may be needed to determine if you actually have kidney disease if you are older and your GFR is decreased. You can’t raise your GFR, but you can try to keep it from going lower. Ask your healthcare provider what you can do to keep your kidneys healthy.
The urine test for kidney disease looks for albumin (al-BYOO-min), a type of protein, in your urine. A healthy kidney does not let albumin pass into the urine. A damaged kidney lets some albumin pass into the urine. If you have albumin or protein in your urine, it could mean you have kidney disease. Your doctor might do additional tests to be sure.
Treatments for early kidney disease include both diet and lifestyle changes and medications. Diet and lifestyle changes, such as eating heart healthy foods and exercising regularly to maintain a healthy weight, can help prevent the diseases that cause kidney damage. If you already have diabetes and / or high blood pressure, keeping these conditions under control can keep them causing further damage to your kidneys.
Cutting back salt intake can be an important dietary change, since this helps control blood pressure. Also, eat the right amount of protein. Because excess protein makes your kidneys work harder, eating enough, but not too much, protein may help protect your kidneys. Talk to your dietician about how to choose the right combination of protein foods for you.
When your kidneys fail, they are no longer able to filter blood and remove from your body well enough to maintain health. Kidney failure causes harmful waste and excess fluid to build up in your body. Your blood pressure may rise, and your hands and feel may swell. Since the kidneys are not working well, the goal is to find treatments that can replace kidney function in order to maintain health. There are two main options for this: dialysis and transplantation.
Most often, kidney failure is a slow, progressive disease. Usually there are no severe tell-tale signs at the beginning stages of the disease. But you may experience:
Frequent trips to the restroom
Dialysis is a treatment to filter wastes and water from your blood. There are two major forms of dialysis: hemodialysis and peritoneal dialysis
In hemodialysis, blood is run through a filter outside of your body and the clean blood is returned to the body. Hemodialysis is usually done at a dialysis center three times a week, but it can also be done at home. Each session usually lasts between three and four hours.
Peritoneal dialysis is another way to remove wastes from your blood. This kind of dialysis uses the lining of your abdominal cavity (the space in your body that holds organs like the stomach, intestines, and liver) to filter your blood. It works by putting a special fluid into your abdomen that absorbs waste products in your blood as it passes through small blood vessels in this lining. This fluid is then drained away. A key benefit of peritoneal dialysis is that it can be done at home, while you sleep.
No. hemodialysis and peritoneal dialysis do not cure kidney failure. They are treatments that help replace the function of your kidneys and may help you feel better and live longer
Although patients with kidney failure are now living longer than ever, over the years kidney disease can cause problems such as depression, heart disease, arthritis, nerve damage, and malnutrition. To stay as healthy as possible while on dialysis, follow your dietician’s recommendations, take your medications, and continue to follow the lifestyle habits you adopted to slow the progression of kidney disease.
Instead of dialysis, some people with kidney failure – including older adults – may be able to receive a kidney transplant. This involves having a healthy kidney from another person surgically placed into your body. The new, donated kidney does the work that your two failed kidneys used to do.
Kidney transplantation is a treatment for kidney failure - not a cure. You will need to see your doctor regularly. And you will need to take medications for as long as you have your transplant to suppress your immune system so it doesn’t reject the transplanted kidney.
Indraprastha Apollo Hospitals, India's first JCI accredited hospital, is a joint venture between the Government of Delhi and Apollo Hospitals Enterprise Limited. Commissioned in July 1996, it is the third super-specialty tertiary care hospital set up by the Apollo Hospitals Group. Spread over 15 acres, it houses 57 specialties with more than 300 specialists and more than 700 operational beds, 19 operation theatres, 138 ICU beds, round-the-clock pharmacy, NABL accredited laboratories, 24-hour emergency services and an active air ambulance service. Apollo Hospitals Delhi has the leading programme in kidney and liver transplant in the country. The first successful paediatrics and adult liver transplants in India were performed at Indraprastha Apollo Hospitals. The hospital is at the forefront of medical technology and expertise. It provides a complete range of latest diagnostic, medical and surgical facilities for the care of its patients. The Hospital has introduced the most sophisticated imaging technology to India with the introduction of 64 slice CT and 3 Tesla MRI, Novalis Tx and the integrated PET Suite and Radixact X-9 Tomotherapy. Indraprastha Apollo has also pioneered the concept of preventive health check programmes and has created a satisfied customer base over decades. The Hospital has been consistently ranked amongst the best 10 hospitals in India by The Week survey for the past few years.