Nephrology · Ahmedabad
Critical Care Nephrology & ICU Kidney Support in Ahmedabad
Critical care nephrology manages kidney failure in patients who are severely ill in intensive care — from sepsis, multi-organ failure, major surgery or poisoning. These patients are often too unstable for conventional dialysis and require continuous renal replacement therapy, delivered slowly and under constant monitoring.
Medically reviewed by Dr. Pritish Shah, MBBS, MD (Internal Medicine), DrNB (Nephrology) · Last reviewed
Kidney failure in the ICU is a different clinical problem from kidney failure in the outpatient clinic. The patient may be on ventilator support and vasopressors, with unstable blood pressure, deranged clotting and several organs failing at once. Removing fluid too quickly can cause cardiac arrest; removing too little allows the lungs to flood.
This is the area of nephrology that most rewards experience and judgement, because the decisions are made under pressure and revised hour by hour. It is also, for many families, the moment they first meet a nephrologist — usually at the worst point of an illness, needing information delivered clearly and without evasion.
Recognising it
When a critical care nephrologist is involved
Book an OPD consultation
Want a second-opinion consultation to review a relative's reports? Message on WhatsApp with the latest reports.
Before your visit
- Consultation fee ₹1,000
- Consults in English, Hindi, Gujarati
- Monday – Saturday: 10:00 AM – 5:00 PMSunday: By prior appointmentClinic address and timings
- No referral needed. Bring your reports — which reports to bring.
Investigation
Assessment in the critical care setting
Determining the mechanism of injury
Separating hypoperfusion, sepsis-associated injury, nephrotoxic exposure, obstruction and intrinsic disease — because the treatment for each is different, and the wrong assumption costs time.
Volume status assessment
Clinical examination combined with bedside ultrasound and dynamic parameters, to answer the central ICU question: does this patient need fluid, or fluid removal?
Continuous biochemical monitoring
Frequent electrolyte, acid–base and lactate measurement, since these change rapidly and drive urgent decisions.
Timing of renal replacement therapy
Judging when to start — early enough to prevent catastrophe, but not so early as to expose an unstable patient to unnecessary risk.
Management
Modalities and support
The technique is matched to how unstable the patient is, and changed as they improve or deteriorate.
Continuous renal replacement therapy (CRRT)
Slow, continuous filtration over 24 hours. Because fluid and solute are removed gradually, it is far better tolerated by patients on vasopressor support than conventional dialysis.
Sustained low-efficiency dialysis (SLED)
An extended, gentler haemodialysis session that bridges conventional dialysis and CRRT, useful as patients begin to stabilise.
Urgent intermittent haemodialysis
For life-threatening hyperkalaemia, severe acidosis or pulmonary oedema in a patient stable enough to tolerate rapid clearance.
Therapeutic plasma exchange
For specific immune-mediated conditions and certain poisonings where removing circulating antibodies or toxins is the treatment.
Precision fluid and electrolyte management
Hour-by-hour balance targets set jointly with the intensivist, with anticoagulation strategy tailored to the patient's bleeding risk.
Communication with the family
Plain-language explanation of what is happening, what is being attempted and what the realistic possibilities are. Families in intensive care deserve honesty, not vagueness.
Kidney follow-up after an ICU stay: see chronic kidney disease.
Emergency — go to a hospital immediately
Critical care nephrology is delivered to admitted patients. If any of the following apply, this is not an OPD matter.
- No urine passed for 12 hours or more
- Severe breathlessness, or inability to lie flat
- Confusion, drowsiness or unresponsiveness
- Known kidney failure with chest pain, palpitations or muscle weakness — possible high potassium
- Suspected poisoning or overdose
Questions
Critical Care Nephrology — frequently asked
What is CRRT and how does it differ from normal dialysis?
CRRT is continuous renal replacement therapy — dialysis delivered slowly over 24 hours rather than in a four-hour session. Because fluid and waste are removed gradually, blood pressure stays far more stable, which makes it suitable for critically ill patients who could not tolerate conventional dialysis.
If my relative needs dialysis in the ICU, will it be permanent?
In most cases, no. ICU dialysis usually supports the kidney through an acute illness, and the majority of survivors recover enough function to come off it. A minority with severe or prolonged injury go on to need long-term dialysis, and this becomes clear over the weeks after recovery.
Why can't conventional dialysis be used in the ICU?
It often can, but conventional dialysis removes fluid quickly, which can cause dangerous drops in blood pressure in patients already on vasopressor support. For unstable patients, CRRT or SLED delivers the same clearance far more gently.
Can I request a nephrologist review for a relative admitted elsewhere?
Formal ICU care requires admission under the treating hospital. For families seeking clarity, a second-opinion consultation to review reports and explain the situation can be arranged — but urgent clinical decisions must always be made by the team physically caring for the patient.
See more ICU kidney care questions on the FAQ page.
Please note: This page is general health information, not personal medical advice. Kidney disease varies significantly between individuals. Please consult a qualified nephrologist about your own reports before making any change to your treatment.