Out Patient Services
Patients with complaints relating to kidney function are referred to the department. After an initial assessment, the treating nephrologist orders appropriate diagnostic tests such as blood tests, urine tests, ultrasonography, kidney biopsy etc. Based on the test results a diagnosis is made and appropriate care/treatment is given or advised. The outpatient clinic also has nephrology nurse educators to provide counseling regarding life style modification, diet and options of renal replacement therapy.
Nephrology out-patient services is located in the first floor of the Ranipet Campus building- A block (A102). We also run a Child Kidney Care clinic (CKCC) for the management of children with kidney diseases at the same location.
The timings of the outpatient services are as follows.
Nephrology I
Monday, &Thursday (8 am onwards)
Dr. Vinoi G. David
Dr. Athul Thomas
Dr Selvin Sundar Raj
Nephrology II
Tuesday, Friday (8 am onwards)
Dr. Santosh Varughese
Dr. Jeethu Joseph Eapen
Dr Nisha Jose
Dr. Utkarash Mishra
Nephrology III
Monday, & Thursday (8 am onwards)
Dr. Suceena Alexander
Dr Elenjickal Elias John (on study leave)
Dr Joseph Johny
Dr T Jayaprakash
CKCC (Child Kidney Care Clinic)
Tuesday, Friday (8 am onwards)
Dr. Santosh Varughese
Dr. Jeethu Joseph Eapen
Dr. Utkarash Mishra
Dialysis
While many kidney problems can be treated by medication, diet and life style changes, in some patients the extent of kidney damage may be too severe to allow any improvement through medicines alone. In such cases the treating nephrologist would advise the patient to opt for renal replacement therapy to replace the function of the failing kidneys, namely – hemodialysis, peritoneal dialysis or renal transplantation. The advantages and disadvantages of each dialysis modality are discussed in detail with the patient and his/her family by the nurse educator and the treating nephrologist before a final decision is made
Hemodialysis
In hemodialysis, the patient is connected to a dialysis machine (either through a dialysis catheter inserted into a neck or leg vein or through an AV fistula) and the patient’s blood is pumped through the machine for removal of waste products and then returned back to the patient. Thus, these machines are actually artificial kidneys. CMC was involved in carrying out the first hemodialysis in India, in the year 1962.
The nephrology department has a dialysis unit which presently houses 50 beds in Ranipet and 25 beds in the town campus of CMC. Dialysis is done by trained hemodialysis therapists along with nursing staff under the supervision of a junior nephrologist and a consultant nephrologist. Dialysis Unit is located on the first floor of “B” Block – B101, of Ranipet Campus.
Continuous Ambulatory Peritoneal Dialysis (CAPD)
In this form of dialysis, a peritoneal dialysis catheter is inserted into the patient’s abdominal cavity either by a nephrologist in the AK Lab minor operating room, or by a team of surgeons in the main operating room complex. Fluid stored in sterile bags is infused through the catheter into the abdomen and waste products from the blood move into the fluid over a period of 3-4 hours, after which the fluid is drained out and fresh fluid is infused. The process is repeated 3-4 times every day.
So far, more than 200 patients have been initiated on CAPD at our center. The department has a CAPD room attached to Dialysis Unit where patients and their relatives are intensively trained by our CAPD nurses, so that they can carry out CAPD by themselves at home.
Patients are followed up by consultant nephrologists at the CAPD clinic from 2.30-3.30 pm every Wednesday except the first Wednesday of the month. Our CAPD nurses can be contacted via phone round the clock for advice and feedback by patients who live outside Vellore.
Transplantation
Transplantation is the most effective form of renal replacement therapy, as the new kidney is able to perform all normal kidney functions. Patients need to identify a suitable related donor of a compatible blood group aged 18-60 years of age, who does not have diabetes or any major medical or surgical illness. CMC accepts first and second degree relatives and spouses. After an extensive workup of the patient and the donor, if both are found medically fit to undergo surgery, and if their tissue matches, transplantation is done. The transplant surgery is performed by transplant surgeons (urologists) and after the surgery; patients are followed up by nephrologists.
Outpatient service to patients who have had their kidney transplant at CMC is provided separately at the Transplant OPD, which is located in the first floor of A block Ranipet Campus (A102). The Nephrology Post Transplant OPD timings are between 8 to 10 am on Mondays, Wednesdays and Fridays and are attended by all consultants and transplant registrars.
The Pretransplant OPD clinic is also run on the same premises on Tuesday Thursday and Saturday. CMC has the distinction of performing the first kidney transplant in India in 1971 and has since then been at the forefront of innovations in transplantation in India.
In 1991 CMC performed the first kidney transplant from a deceased donor. In 2009 we performed the first swap donor kidney transplantation and the same year the first successful across-the-blood group kidney transplantation in India without spleenectomy.
Diagnostic Tests:
Depending upon the patient’s condition, various tests may be required to arrive at the correct diagnosis. These tests are done in the appropriate labs (biochemistry, microbiology, clinical pathology etc). In collaboration with the department of Clinical Pharmacology, the blood levels of various immunosuppressive drugs in transplant patients are monitored and drug dosage is adjusted to ensure the clinical well being of the patient. HLA and Cross match along with donor specific antibodies assessment is done in collaboration with the department of Transfusion Medicine and HLA Lab
Biopsies:
The nephrology department is well equipped to perform kidney biopsies and on an average about 1200 biopsies is done every year (both native and transplanted kidney)
Patient education:
In addition to diagnosis and treatment, patients with chronic renal problems who come to the department are also educated on life style changes, the need for compliance with prescribed medications and given training on basic techniques to be self reliant in terms of daily follow-up of their clinical situation. Transplant patients and their relatives are trained by our nurse educators to measure blood pressure and check blood sugar using glucometers which they can then continue to do on their return home
Nephrology Research Laboratory
The diagnostic and research services of the Nephrology Lab are as follows:
Kidney Genetic Services with in house bioinformatics has been started in our department. Genetic testing done by “Whole Exome Sequencing” after pre-genetic counselling and consent is available inhouse as a clinical service to aid in the diagnosis of genetic kidney diseases. Kinship testing (using DNA profiling techniques) is offered to ascertain biological relationship between a transplant patient and the prospective organ donor. Our lab also performs other molecular diagnostic tests to supplement the clinical services such as Anti PLA2R quantitation, Anti GBM quantitation, Anti Factor H quantitation, Endotoxin testing of dialysis water quality. Our research focus includes: Transplant Immune Monitoring; Evaluation of Pharmacogenomic tools to aid individualized immunosuppression; Study of biomarkers such as FGF23 etc in Mineral Bone disorders; Genetic tests for inheritable renal disorders like Fabry’s Disease; clinical utility of novel biomarkers in hemolytic uremic syndrome etc.
Individuals seeking training in laboratory techniques are accepted as visitor-observers and oriented and trained on various serological and molecular assays performed in the lab.
