Nephrology

The Critical Care Nephrology Program at Sir H. N. Reliance Foundation Hospital is a specialised initiative dedicated to managing kidney-disease treatment for critically ill particularly ICU patients. This program integrates nephrology with intensive care to address conditions such as acute kidney injury (AKI), chronic kidney disease (CKD), diabetic kidney disease, glomerulonephritis treatment, electrolyte imbalances, fluid overload, sepsis, poisoning, cardiac, oncology, liver, multi organ dysfunction and treatment of kidney disease related to hypertension. It also provides advanced therapies like ICU dialysis, continuous renal replacement therapy (CRRT), and dialysis services, ensuring comprehensive kidney care for critically ill patients.

We offer a one-year Fellowship programme for Post MD/ DNB / DrNB Anaesthesia, Critical Care and Nephrology, culminating in an exit exam. The training includes hands-on experience in haemodialysis units, kidney biopsy procedures, and nephrology consultations, enhancing expertise in managing complex kidney disorders. Additionally, we host an annual International Critical Care Nephrology conference, bringing together national and international delegates and speakers.

Key Components of the Program

Our Critical Care Nephrology Program is dedicated to managing complex kidney-related conditions in critically ill patients, particularly those in the ICU. This program integrates nephrology and intensive care medicine to provide specialized treatment for acute kidney injury (AKI), electrolyte imbalances, sepsis-associated kidney dysfunction, multi-organ failure, and other critical conditions. With a multidisciplinary approach, we ensure comprehensive care by collaborating with intensivists, cardiologists, and infectious disease specialists.

• Acute kidney injury (AKI) management
  • Early diagnosis and timely intervention
  • Preventive strategies to alleviate nephrotoxic injury
• Renal replacement therapy (RRT)
  • Continuous renal replacement therapy (CRRT) for critically ill patients
  • Intermittent haemodialysis (IHD)
  • Sustained low-efficiency dialysis (SLED)
  • Peritoneal dialysis (PD) for select ICU patients
  • Use of Adsorbtion filters (OXIRIS, Cytosorb) for sepsis management
  • Plasmapheresis for immune-related kidney conditions
• Electrolyte & acid-base balance management
  • Correction of hyperkalaemia, hyponatremia, hypercalcemia , metabolic acidosis, and other imbalances.
  • Close monitoring of sodium, potassium, calcium, and bicarbonate levels
• Management of sepsis-associated kidney dysfunction
  • Specialized nephrology care for septic patients
  • Optimizing haemodynamic stability to prevent AKI progression
• Multidisciplinary approach
  • Collaboration with intensivists, cardiologists, and infectious disease specialists
  • Active involvement of nephrologists in ICU rounds for early interventions
• Fluid & nutrition management
  • Personalized fluid therapy to prevent overload or dehydration
  • Nutritional strategies tailored to reduce metabolic stress
• Post-ICU Kidney Recovery & Follow-Up
  • Long-term monitoring of kidney function in ICU survivors
  • Transitioning AKI patients to outpatient nephrology care
  • Personalised and holistic care to support kidney recovery

This program ensures that critically ill patients receive comprehensive, evidence-based nephrology care, improving outcomes and enhancing quality of life post-recovery.

Patients benefiting from this program

Our Critical Care Nephrology Program is designed to support critically ill patients with complex kidney-related complications. It provides specialized care for individuals facing acute and chronic kidney challenges in intensive care settings, ensuring timely interventions and optimal recovery.

• Patients with sepsis-induced AKI who require targeted nephrology management
• ICU patients on ventilators with fluid overload, benefitting from precise fluid management strategies
• Individuals requiring dialysis in a critical care setting, including those with multi-organ failure
• Post-cardiac surgery or transplant patients with kidney complications, ensuring close monitoring and intervention
• Patients with acute or chronic liver failure experiencing kidney dysfunction, necessitating specialized care
• Poisoning cases, where kidney support is crucial for toxin elimination

Cutting-Edge Technologies for Advanced Care

Our program utilizes state-of-the-art nephrology technologies to provide the highest level of care for critically ill patients. These advanced tools enhance treatment precision, improve patient outcomes, and support kidney function in life-threatening conditions.

• Bedside CRRT machines enabling continuous dialysis for haemodynamically unstable patients
• High-efficiency haemodiafiltration (HDF) machines offering superior toxin clearance fluid balance

At Reliance Foundation Hospital, a leading nephrology hospital in Mumbai, we offer a comprehensive range of advanced diagnostic and therapeutic services for kidney care. Our patient-centric approach focuses on using cutting-edge healthcare technology and innovative solutions to ensure the best possible outcomes for conditions like chronic kidney disease (CKD), kidney transplant, and dialysis needs.

• Renal function tests: These tests evaluate waste products from the body such as urea, creatinine, check electrolyte balance e.g. sodium, potassium, calcium), and acid levels (bicarbonate) to assess kidney health.
• 24 hr creatinine clearance testing: This test estimates kidney function by measuring the clearance of creatinine, a waste product, from the body through urine.
• USG, Doppler studies for evaluation of the renal system and to plan for AVF: Ultrasound and Doppler waves help assess kidney number, size, echotexture, corticomedullary differentiation such as scars, stones, or growths ( malignancy ) in kidney, ureter or bladder.
• USG-guided kidney biopsy: Performed under ultrasound guidance, this procedure identifies the cause of kidney diseases while minimising risks such as bleeding.
• AV fistula creation: The gold standard for dialysis access is an AV fistula. It reduces the risk of infection, blockage or failure and is placed on the non-dominant hand by a vascular surgeon.
• Haemodialysis catheter insertion: Haemodialysis catheter is used to provide temporary access in an emergency for urgent dialysis initiation, transplant or fistula creation or AV fistula repair. It is inserted in the neck (Internal Juglar vein or IJV) or leg (femoral ), usable for a few weeks.
• Permanent tunnelled catheter insertion: Permanent tunnel catheter insertion or Permacath is done under fluoroscopic guidance and provides long-term access in dialysis, lasting for 3-6 months. It has less chances of infection and blockage than Haemodialysis catheter.
• Peritoneal dialysis catheter insertion: Inserted through a minimally invasive technique, the peritoneal dialysis catheter is inserted in the abdomen under fluoroscopic or laparoscopic guidance or open surgery. It provides access for peritoneal dialysis which can be done anywhere, anytime, 3-4 a day including automated overnight with a PD machine.
• Haemodiafiltration: Haemodiafiltration is a newer version of haemodialysis using diffusion and convection method for dialysis. It mitigates complications such as renal amyloidosis, and eliminates middle molecule to improve cardiac outcomes.
• Continuous Renal Replacement Therapy (CRRT): Designed for critically ill ICU patients with unstable haemodynamics, this therapy offers continuous kidney support over 24 hr in patients with septic and cardiogenic shock.
• Kidney transplant – We perform ABO-compatible and incompatible transplants, including paediatric cases, with both live-related donor and deceased donors.

Our Nephrology Department provides comprehensive care for a wide range of kidney-related conditions, offering advanced diagnostics, personalised treatment plans, and holistic support to improve patient outcomes. Below is the list of conditions that we specialise in treating.

• Acute Kidney Injury (AKI): Rapid treatment is provided for sudden kidney dysfunction to minimise complication
• Chronic kidney disease (CKD): Rapid management is ensured for sudden kidney dysfunction to minimise complications.
• End-stage Renal Disease (ESRD) requiring maintenance haemodialysis (HD): Regular haemodialysis sessions are provided for patients with ESRD to effectively replace kidney function and manage overall health.
• Dialysis related complications: Comprehensive management and treatment is provided for complications arising from dialysis, such as hypotension, electrolyte imbalance, anaemia, and more prioritising patient comfort and safety at every step.
• Vascular access issues: Expert care is available for addressing and resolving challenges related to vascular access, including maintenance and creation of AV fistulas or catheter placement.
• Glomerulonephritis: Comprehensive care for nephrotic syndrome, nephritic illnesses, autoimmune kidney diseases, and thrombotic microangiopathy (TMA), including conditions such as haemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP).
• Fluid and electrolyte disturbances: The department provides diagnosis and management of imbalances in body fluids and essential electrolytes to restore optimal health.
• Hypertension: The department provides specialised care for hypertension, particularly when related to or affecting kidney function.
• Cystic disease of the kidney: The department also provides treatment for conditions like autosomal dominant polycystic kidney disease (ADPKD) and related complications.
• Congenital kidney disease: The department has expertise in managing inherited conditions, including Alport’s syndrome and congenital nephrotic syndrome.
• Renal calculus diseases and obstructive nephropathy: Comprehensive care is available for kidney stones and conditions causing urinary obstruction.
• Diabetic kidney disease: Focused care is available to prevent and manage kidney complications in diabetes patients.