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.
Reviewed by Dr. Pritish Shah, MBBS, MD (Internal Medicine), DrNB (Nephrology) — Senior Consultant Nephrologist, Apollo Hospitals International Limited, Ahmedabad.
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
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.
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
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.
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.