Kidney questions, answered straight

"Best" depends on your specific condition, and any doctor claiming the title outright should be treated with caution. What you should look for is verifiable super-specialisation in nephrology, hospital affiliation and whether the doctor explains your reports in a language you follow. Dr. Pritish Shah holds MBBS, MD (Internal Medicine), DrNB (Nephrology), is registered with the Gujarat Medical Council (G 45244), and practises at Apollo Hospitals International Limited, Ahmedabad, consulting in English, Hindi and Gujarati.

See a nephrologist if your eGFR is below 60, if protein or blood appears in your urine on more than one test, if your creatinine is rising, if your blood pressure needs three or more medicines, or if you have diabetes and have never had a kidney screen. A physician manages risk factors well; a nephrologist is needed once the kidney itself is involved.

In early stages there are usually none — which is the central problem with kidney disease. When signs do appear they include swelling of the feet or face, foamy urine, passing urine more often at night, persistent fatigue, poor appetite and blood pressure that is becoming harder to control. Detection before this point requires a blood and urine test.

Consultation with Dr. Shah is ₹1,000 as listed on his Apollo 24|7 profile. Investigations are billed separately by the hospital. A basic screening — creatinine with eGFR plus a urine albumin-to-creatinine ratio — is inexpensive relative to what it detects.

At Apollo Hospitals International Limited, Apollo Hospitals International Ltd, Plot No. 1A, Bhat GIDC Estate, Gandhinagar 382428, Gujarat. The hospital is on the Ahmedabad–Gandhinagar highway near Indira Bridge, convenient for patients from Chandkheda, Motera, Sabarmati, Gandhinagar and north Ahmedabad. Online consultation is also available through Apollo 24|7.

English, Hindi or Gujarati — whichever you are most comfortable in. This matters more than it sounds: patients who understand their own diagnosis follow treatment far more reliably, and kidney care depends almost entirely on long-term adherence.

Yes. Second opinions are welcome and common in nephrology, particularly before starting dialysis or committing to a transplant pathway. Bring the complete set of reports in chronological order — the sequence of values over time usually tells more than any single result.

Yes, through Dr. Shah's Apollo 24|7 profile. Online consultation suits follow-up reviews, report interpretation and second opinions well. A first consultation for a complex problem, or anything involving swelling, breathlessness or reduced urine output, should be in person.

No. You can book directly. If a physician, diabetologist or cardiologist has referred you, bring their note along with your reports — it gives useful context, but it is not a requirement.

At least annually if you have diabetes, hypertension, obesity, a family history of kidney disease, or are over 60. Every three to six months if an abnormality has already been found. Testing means both a blood eGFR and a urine albumin test — the urine test is the one most often skipped.

Yes. Good control lowers the risk substantially but does not remove it. Blood pressure, duration of diabetes, genetics and albumin leak all contribute independently. Annual kidney screening is recommended regardless of how good your HbA1c is.

It means small amounts of albumin are leaking into urine — an early, still-treatable stage of kidney damage. It matters a great deal, because intervening at this point can prevent progression, and in some patients it can be brought back to normal.

Early damage can sometimes be substantially reversed, particularly at the microalbuminuria stage. Once significant scarring and a reduced eGFR are established, the realistic goal shifts to slowing progression and protecting the function that remains.

They are approved and beneficial down to fairly low eGFR levels and are often continued even as function declines. There is usually a small, expected dip in eGFR when starting, which is not harm — it reflects the drug working. This needs a nephrologist's supervision.

Two are essential: serum creatinine with eGFR from a blood sample, and a urine albumin-to-creatinine ratio. Blood pressure should be measured at the same visit. This combination detects the large majority of early kidney disease and is inexpensive.

Not necessarily. Most standard packages include creatinine but omit the urine albumin test — and albumin frequently turns abnormal years before creatinine does. If your package did not include a urine ACR, an important part of the assessment was missed.

At least once a year, starting from the diagnosis of type 2 diabetes and from five years after diagnosis in type 1. If an abnormality is already present, testing is repeated more frequently — typically every three to six months.

Normal hydration is good, and it reduces kidney stone risk. But deliberately drinking very large volumes does not improve kidney function and can be harmful in people with heart failure or advanced kidney disease, where it causes dangerous fluid overload and low sodium.

Much of it can. The majority of kidney failure in India stems from diabetes and hypertension, both of which are modifiable. Controlling blood sugar and blood pressure, avoiding habitual NSAIDs, staying at a healthy weight and screening annually prevents or substantially delays a very large proportion of cases.

Outcomes vary, but living-donor kidneys commonly function well for fifteen to twenty years or more, and deceased-donor kidneys somewhat less. Longevity depends heavily on medication adherence, blood pressure control and how promptly rejection episodes are detected and treated.

Under Indian law, living donation is permitted from near relatives — parents, siblings, children, spouse and grandparents — with authorisation committee approval required for others. Donors must be adults, medically fit and donating voluntarily without any financial inducement.

For a properly evaluated donor, the risks are low and long-term life expectancy is close to that of the general population. The remaining kidney compensates for most of the lost function. Donors do need lifelong annual monitoring of blood pressure and kidney function.

Yes, and it is preferable where possible. Pre-emptive transplantation, performed before dialysis begins, is associated with better graft and patient survival. This requires referral at CKD stage 4 rather than waiting until dialysis becomes necessary.

The graft will be rejected, often within weeks, and the loss is frequently irreversible. This is the leading preventable cause of transplant failure. If cost, side effects or availability are a problem, raise it at your appointment — there are almost always alternatives.

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.

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.

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.

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.