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Bilateral renal parenchymal disease reported on ultrasound scan. What next?

This is a common situation that I as a nephrologist face. An apparently healthy person who recently underwent an “executive” health check-up and was found to have “bilateral renal parenchymal disease- grade1” on the ultrasound scan. Everything else is perfectly normal. The only problem is that the “apparently” healthy person is now extremely anxious with hundreds of questions whizzing through his/her mind :

  • is it dangerous?
  • is it curable?
  • do I need to be on a specific diet for it?
  • will it worsen to renal parenchymal disease grade 2 and above?
  • how well are my kidneys working?
  • do I need any other tests?

This post attempts to answer these questions in a simple and straightforward manner.

The ultrasound picture looks something like this

Let us start by breaking down the words into easily understandable parts :

  • bilateral: means seen in both the kidneys
  • renal: means pertaining to the kidney
  • parenchymal: means pertaining to the substance of the kidney
  • disease: is self-explanatory

So basically, the kidneys on both sides are showing some changes on the ultrasound.


That is what the report means: the kidneys look abnormal on the ultrasound. Ultrasound doesn’t give any information about the working of the kidneys.

One more fact to be aware of is that ultrasound is inherently a very subjective test. There is a lot of interpretation of the images that is involved. Two very experienced doctors can interpret the images very differently. One may say that there is an abnormality and another may not agree.

So, the nephrologist(kidney doctor) needs to take all the available information into consideration. These include results of blood tests, urine tests, patient history, physical examination to decide on further course of action. In-fact, nothing can be said about the kidneys based on the ultrasound report alone.

Hence, the most important question is : How well are the kidneys working? The answer to that question comes from two other simple test: blood levels of urea and creatinine. These tests are collectively called as “kidney function tests(KFT)” or “renal function tests(RFT).”

Even the ultrasound reports almost invariably mention : “Kindly correlate with RFT.”

So, if these blood tests are normal, then your nephrologist will not give too much importance to the changes on ultrasound. On the other hand, if these tests are abnormal, then further testing/evaluation may be necessary.

In summary :

  • “Bilateral renal parenchymal disease” on ultrasound only tells about abnormal appearance of the kidneys
  • We need to do kidney function tests/renal function tests to know more about the functioning of the kidneys
  • Further tests may be needed to pinpoint the exact causes and extent of kidney disease

Hope this blog post was useful in clarifying your doubts about the topic. Take care!

Nephrology vs Urology : What is the difference between them?

Urology and Nephrology both deal with the study of the urinary tract and its diseases. So when you are told to have a “kidney problem”, you may become confused about which specialist to consult. At Dharma Kidney Care, where we provide nephrology services in Bangalore, we routinely get a lot of inquiries from patients who actually need to see a urologist.  This article aims to answer a very simple question you may have in such a situation….

State Of The Art Kidney Failure treatment From Dharma Kidney Care

Kidneys are the human organs on either side of the spine, below the ribs. Chronic kidney failure prevents them from performing most of its important functions such as filtering the waste from the blood and expelling it through urine, keeping the electrolytes at normal range, modulating the blood pressure, contributing strength to the bones and producing red blood cells. The common reasons for this disease are diabetes, high blood pressure, glomerulonephritis, interstitial nephritis, vesicoureteral reflux, polycystic kidney disease, obstruction of the urinary tract, diabetes and urinary infections. Once affected with chronic kidney failure, the only available route is to manage it effectively.

At Dharma Kidney Care facilities to manage all stages of chronic kidney failure are available. Only the latest equipment and highly qualified professionals manage patients at Dharma Kidney Care. Doctors in this hospital have qualified from some of the top institutes in India like PGI, Chandigarh and Sri Ramachandra Medical College, Chennai.

When to approach a nephrologist:

  • If you have diabetes or high blood pressure
  • If you feel tired
  • Poor appetite
  • Trouble in sleeping
  • Muscle cramping at night
  • Dry, itchy skin
  • Swelling in ankles and feet
  • In the morning, appearance of puffiness around the eye
  • Urinating often, especially at night.

As soon as you see or feel any of these symptoms, take an appointment with our nephrologist. We pay special attention to make everything hassle free for the patient. We give adequate time to go through the history of the patient so that nothing important is missed. Perform the tests prescribed by our doctors which will help them in further treatment. Newer treatment modalities are available for chronic kidney failure and Dharma Kidney Care is the ideal place to get the treatment because we concentrate all our efforts on this condition only.

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Vaccination in adults : Protect yourself from severe infections

Vaccination in adults is almost always neglected in India. This needs to change

Vaccination is the administration of antigenic material (a vaccine) to stimulate an individual’s immune system to develop immunity to a disease causing germ. While the importance of vaccination in children is well understood, vaccination in adults is almost always neglected. This results in a serious consequences because the adults can then develop serious but preventable infections. In the United States vaccine preventable diseases in adults claim more lives than traffic accidents! Unfortunately no statistics are available in India but experience says that we are paying a ig price for neglecting vaccine preventable diseases in adults.

Some reasons why adults need vaccinations are :

  1. Some vaccines given in childhood may become less effective as time passes and hence “booster” doses of some vaccines may be needed.
  2. “Healthy”  adults above a certain age are susceptible to specific infections which can be vaccine preventable. For example, the risk of pneumonia increases significantly above the age of 65 years and hence vaccination is advised for all adults above 65 years for bacteria causing pneumonia.
  3. “Flu” viruses causing influenza change their structure every year and hence flu shots are advised for all healthy adults at the start of the flu season in October.
  4. Some diseases decrease the overall immunity and increase susceptibility to infections. So, adults with diabetes,chronic heart/liver/kidney/lung ailments are advised vaccination.

Recommended injections for vaccination in adults are the following : 

  1. Flu vaccine
  2. Pneumococcal pneumonia vaccine
  3. Hepatitis B vaccine (to prevent an important cause of jaundice and liver failure)
  4. Other vaccines that you need are determined by considering the factors such as lifestyle, health condition, age, job and vaccines you have had in the past.

Take one step forward to save yourself and your loved ones

Keeping up to date with your vaccination is a great way to stay healthy especially for those who are suffering from chronic diseases.

Vaccines will help you to maintain your health

Vaccinations will help you to protect against many infections such as influenza, hepatitis B, pneumococcal disease. Skipping vaccination make yourself vulnerable to illness.

Vaccination in adults can mean the difference between a  healthy life  and serious illness

Hepatitis B and  pneumonia are serious illnesses with an extremely high cost of managing them and significant morbidity and mortality.

Keep your loved ones safe

Vaccinations can help prevent spread of infections within the family and community if all are vaccinated

Vaccines are safe

Studies show that vaccines are among the safest products in all of medicine. There were many proven studies pointing the safety of vaccines.

Vaccines are as important to overall health as exercise and diet

Vaccines play a vital role in keeping you healthy. These are one of the most convenient and safest preventive care measures available in medical field.

Make Sure You Have the Best Protection

Following are the steps to keep you healthy

  • Know about the vaccines recommended for adults based on their age and other factors
  • Talk with a health care professional about which vaccines are right for you
  • Get vaccinated
  • Keep updates with your vaccinations
  • Motivate your friends and loved ones to get vaccinated

Dharma Kidney Care a specialty Medical Centre in Bangalore. We understand the importance of prevention and provide vaccination services for adults.

High Flux Dialysis in Bangalore

Dialysis in Bangalore : Introducing high flux dialysis and its benefits

Type of Dialysis

While dialysis in Bangalore has been performed for almost 35 years now, it is in the last 10 years that the number of patients and also dialysis centers has increased exponentially. There are two type of of dialysis hemodialysis and peritoneal dialysis. In Hemodialysis an artificial kidney (hemodialyzer) is used to remove wastes and excess fluid from your blood while in peritoneal dialysis blood is cleaned inside the body with the help of a specially formulated sterile fluid.

High Flux Dialysis (HFD)

High flux dialysis refers to a form of hemodialysis that was developed in recent years to improve the efficiency of dialysis. It has succeeded in both improving the quality of dialysis and hence quality of life in dialysis patients.

The essential element of high flux dialysis is the use of dialyzers (artificial kidneys) that have larger pores for the removal both of uremic toxins and of fluid. Blood- Urea-Nitrogen (BUN) is measured and followed as a reflection of all the toxins that the kidney normally removes. With HFD, BUN clearly is removed more efficiently. Besides, evidence shows that larger molecules (which contribute to patient ill health), are also get removed with HFD. Such molecules are too big to be removed by conventional dialysis.

For instance, a molecule called beta 2 microglobulin, which can have a role in causing arthritis in dialysis patients, is removed only by HFD. In fact there are already reports of patients with less joint pain when switched from conventional to HFD. Thus, the removal of larger molecules may prove to be a crucial benefit of HFD.

Other Advantages:

High flux dialysis results in better hemoglobin levels and better control of phosphorus levels in the blood of dialysis patients. Loss of appetite and itching which are big problems in dialysis patients is also less common in patients on HFD.

Why we have not seen high flux dialysis in Bangalore/India so far

During each dialysis session about 100 litres of purified water is used. The water is purified using a Reverse Osmosis plant. Historically dialysis providers in India have been obsessed with lowering the costs and hence quality of treatment is a secondary consideration. We at Dharma Kidney Care believe that quality comes above all else, though cost is also an important consideration. Hence, we have installed the state of the art Fresenius Aqua B Plus reverse osmosis plant fully imported from Germany so that quality is not compromised at any stage. On the other hand we have kept the cost of High Flux Dialysis lower compared to even conventional dialysis in corporate hospitals. This is in order to provide the benefit of latest technology to as many patients as possible. Our practice is in keeping with the recommendations of the European Renal Best Practice guidelines which suggest high flux dialysis for almost everybody who needs dialysis.

About Dharma Kidney Care

Dharma Kidney Care is one of the best centers for dialysis in Bangalore  for kidney failure treatment. Dharma Kidney Care, is exclusively designed for kidney care. We are a team of ethical, sophisticated, professional medical experts working with great determination and responsibilities for better diagnosis and treatment of kidney disorders. Sooner the kidney disease is detected, the faster and better the chance of slowing or stopping its progression. But if detected late and patient needs dialysis, Dharma Kidney Care has the latest equipment and highly qualified professionals to provide world class dialysis therapy at reasonable cost.

Diabetic Kidney Disease – 7 Tips To Take Care in 2017

Diabetics are at a very high risk for chronic kidney disease. Diabetic kidney disease is the cause of kidney failure in one third of people on dialysis. 30-40 % of diabetics will develop some form of kidney disease over time.The kidney education section of this website has some information on chronic kidney disease  and this page is meant to supplement that information. Since the problems typically develop over years or decades in diabetes, there are ample opportunities to prevent more serious consequences of diabetes on the kidney. The medical term for this slowly progressive kidney damage due to diabetes is diabetic nephropathy. In fact the condition can be called by many names by the doctors in the context of diabetes and can lead to some confusion. This picture should clear some of it.

Diabetic kidney disease has many names!

Here are a few tips for diabetics to take care of their kidneys :

1. Get tested at least every year for diabetic kidney disease 

It is tragic that even today most of the patients with diabetic kidney failure are diagnosed in the last stages. This is because diabetic kidney disease can be without symptoms till even the last stages. Get tested every year to detect the early stages of the illness. Treatments are available to slow the progression of kidney disease if detected in early stages.

2. Keep the sugar level under control

Uncontrolled blood sugars increase the risk of kidney failure substantially. Keeping the blood sugar levels below the levels suggested by your doctor will help to prevent or slow the progression of kidney failure. It has other benefits also for the kidneys. For example good blood sugar control decreases your risk of serious urinary tract infections.

3. Control of blood pressure is important to prevent kidney damage 

While sugar control is very important, blood pressure reduction if you are a hypertensive is  equally important. The blood pressure target varies from patient to patient but it should be below 140/90 mm Hg for most patients.

4. Give up smoking

Smoking can cause additional damage to the kidneys. Though easy to advise smoking cessation is not easy. There are smoking cessation clinics which provide psychological support and help with the process.

5. Exercise regularly

Regular exercise as per your capacity helps with both sugar and BP control. Brisk walk of 30 minutes on five days a week should be a good schedule that can be easily carried out.

6. Maintain a healthy body weight

Diabetics tend to be obese. Slow weight reduction towards a healthy target utilizing diet, exercise is ideal. Morbidly obese patients may need to visit a dedicated obesity clinic for a more aggressive approach to the problem.

7. Gather correct knowledge about diabetic kidney disease 

Knowledge is power only if it is right. There are many unqualified practitioners peddling miracle cures for diabetes and kidney failure. They are not clinically proven and take your attention away from what can actually be achieved. Remember that at the end of the day it is your own body and every decision that you take has long term bearing. Don’t sacrifice long term well being for unproven short term measures.

Kidney Education

The kidney is extremely important for removing waste products and excess fluid from your body. This excess fluid and waste products are removed from your body in the form of urine. The kidneys are responsible for handling the production of urine. The kidneys follow a complex process of excretion and reabsorption for the production of urine.

What are your kidney’s functions?

Your Kidneys conduct some extremely complex processes. Below you will find some of its functionality due to those processes.

  1. Removing waste products from the body.
  2. Removing waste products from the body.
  3. Balancing the production or removal of bodily fluids.
  4. Releasing hormones that regulate blood pressure.
  5. Producing active form Vitamin D that helps maintaining strong and healthy bones.
  6. Controlling the production of Red Blood Cells.


Chronic Kidney Disease : The Indian Scenario

The status of Chronic Kidney Disease in India

So how is it to live with chronic kidney failure in India?

As with most things Indian there is no single answer but many possible ones. But on the whole, one would have to say that it is only a little better than dying of it.

The numbers are mind numbing. Almost 3,00,000 Indians are diagnosed with end-stage kidney failure (the last stage of chronic kidney disease)  every year. A full 80% of them die in the next one year. Only about 10-15% get any amount of dialysis that is the treatment for kidney failure. What contributes to this is a deadly cocktail of self-neglect by patients, a non-existent national policy on chronic renal failure, an army of quacks promising “definite cure” for the disease, a massive talent crunch of trained professionals and, of course, the large costs involved in the treatment. The number of people who suffer from milder forms of the disease is estimated to be at least 15% of the whole population! The numbers elsewhere in the world are similar. This is an article from the National Kidney Foundation of the US about chronic kidney disease in the US.

Diabetes is a big cause of chronic kidney disease in India

India is the diabetes capital of the world. And diabetic kidney disease is the commonest cause of kidney failure here. But all too often management of diabetes is reduced to popping a few pills every day and may be checking the blood sugar levels once in a few months. On a daily basis, one sees patients taking medicines prescribed to them years or even decades ago!! It looks as an event rather than as a process. A small but not insignificant minority display early stages of kidney failure but their management leaves a lot to be desired.

The first hurdle is accepting that one has “kidney failure.” I would say that this is the biggest hurdle to better management of kidney failure. Although it sounds daunting “kidney failure” is not a one size fits all description. In fact, most people with kidney failure fall into the milder categories and won’t require dialysis in their lifetime. It can be managed but not cured. Lack of acceptance leads to a series of behaviours which is counterproductive in the medium to long term.

Looking for miraculous cures hurts good long term outcomes

The first such behaviour is to look for non-existent cures for the disease. It is a well known medical fact that chronic kidney failure can be managed effectively but not cured. But this hasn’t stopped unscrupulous quacks from promising “guaranteed cure” or “definite cure” for the condition. Some promise to do it through herbs and others with various fad diets. The bolder ones might inject “ozone” into the patient’s veins while the boldest ones promise a cure by changing the direction in which the patient’s head points while he is sleeping and eating. Various systems of medicine endorse without any inhibitions. The “side effects of allopathic medicines” is a popularly invoked devil to lure the patient away from established treatments. The bait is very enticing and most fall for it. Very often I see highly educated and driven individuals misled by the peddlers of snake oil. For we nephrologists, it is very demoralising to lose so many otherwise manageable patients to all these unproven therapies.

And so it happens that the patients lose a lot of time while searching for the elusive cure. They become very anaemic (haemoglobin values of 5 and 6 are very common, the normal being at least 12), lose their appetite and tens of kilograms in weight, have severe nausea and vomiting, become breathless and puffed up with fluid retention. Very often they develop sudden serious events like fits, cardiac arrhythmias (ineffective heart beats), cardiac arrest, etc. By the time, the gravity of the situation is realised it is often very late. The task for the nephrologists and others in the team is very steep and uphill once the patient is brought in such a state. Sometimes we succeed in getting the patients out of the woods but many times we don’t.
If all this was not enough, patient and relatives then have the unenviable task of negotiating the humongous Indian health system looking for a hospital that provides the most bang for their buck in dealing with chronic kidney disease.  Once the patient is sick the already high cost of care increases further exponentially. Most patients pay out of their savings that can be drained very quickly. Some states have no infrastructure at all and often patients traverse from one end of the country to another looking for treatment. There are only 1,300 nephrologists for a population of 1.3 billion (by comparison South Korea has the same number for 25 times less population). While there are many honourable exceptions, generally state run hospitals outside of capital cities are not equipped to handle such patients. The better state run hospitals are chronically overloaded and are under intense pressure to stabilise the sick ones and refer them elsewhere for further dialysis. The cost of dialysis in private hospitals even though modest by global standards (about USD 25 -40 compared to USD 400-500 in the U.S.) is still prohibitively high for most Indians. Most just stop dialysis for purely financial reasons. Many charitable hospitals provide highly subsidised dialysis but again it is not nearly enough. In southern states, the government pays for dialysis but it is a one size fits all approach that many times does not benefit the patient.

Proper and timely treatment can lead to good long term outcomes

The situation need not be so bleak. With the treatment options that are available one can lead a productive life even after being diagnosed with chronic kidney failure. Erythropoietin injections can keep the haemoglobin and energy levels up. Medicines are available to keep the fluid content of the body under control and manage other consequences of chronic kidney disease. Some basic dietary modifications will keep the kidneys from being overly stressed and prolong the time to dialysis. Once the kidney function reaches about 20% of normal one must start preparation for dialysis. With proper preparation starting dialysis can be a very smooth affair with no admission to the hospital required at all! If a suitable kidney donor is available, then preparations for transplant can occur simultaneously.

All this is not to say that there are no bright spots at all. Though the number of kidney specialists is meagre and they tend to get concentrated in large cities, many tier 2 cities have caught up in the last decade. Most of the kidney specialists are well trained and able to handle the patients competently. People are more aware than before and proactively seeks treatment. In spite of so many hurdles, we do see a few patients who follow our advice religiously and do very well. Patients surviving on dialysis for several years and leading very meaningful lives in not as rare as it used to be. Many social service organisations have taken up the task of improving the care of kidney failure patients and are doing a commendable job of it. The huge number of patients presents a real opportunity to understand the disease better and may develop therapeutic interventions. There is an opportunity to try different models of providing patient care in chronic kidney disease and choose what works best. All this needs that the various stakeholders (patients, doctors, support staff, government, NGOs, etc.) come together and work with a common purpose. Let us hope that they do so.