Dr. Dinesh Khullar -

About the Doctor

Dr. Dinesh Khullar has vast experience of over 25 years as a renal transplant physician, having been associated with over 5000 successful kidney transplants, including more than 1200 performed at Max Hospital, Saket. This includes among the most challenging transplants, such as ABO-incompatible, transplantations in highly sensitized recipients, and high-risk transplants associated with significant comorbidities.

Specialization

Nephrology

Awards

Dr. Sushil Malik Memorial award oration ‘Pertinent use of drugs in chronic kidney disease’ at the annual convention of SDB IMA
Lifetime Achievement Award by Human Care Charitable Trust 2011
J.M. Patel Oration at Annual Conference of Indian Society of Organ Transplantation – 2015
D.K. Pal Chaudhary memorial oration at Annual Meeting – 2005 of Indian Medical Association, (SDB)
Sushil Malik memorial oration at the Annual Convention of Indian Medical Association, (SDB)
Lifetime Achievement Award by Human Care Charitable Trust – 2011

Frequently Asked Questions About Nephrology

What is Dialysis?

In medicine, dialysis is a process for removing waste and excess water from the blood, and is used primarily to provide an artificial replacement for lost kidney function in people with renal failure. Dialysis may be used for those with an acute disturbance in kidney function (acute kidney injury, previously acute renal failure), or progressive but chronically worsening kidney function–a state known as chronic kidney disease stage 5 (previously chronic renal failure or end-stage renal disease). The latter form may develop over months or years, but in contrast to acute kidney injury is not usually reversible, and dialysis is regarded as a “holding measure” until a renal transplant can be performed, or sometimes as the only supportive measure in those for whom a transplant would be inappropriate.

The kidneys have important roles in maintaining health. When healthy, the kidneys maintain the body’s internal equilibrium of water and minerals (sodium, potassium, chloride, calcium, phosphorus, magnesium, sulfate). Those acidic metabolism end-products that the body cannot get rid of via respiration are also excreted through the kidneys. The kidneys also function as a part of the endocrine system, producing erythropoietin and calcitriol. Erythropoietin is involved in the production of red blood cells and calcitriol plays a role in bone formation. Dialysis is an imperfect treatment to replace kidney function because it does not correct the endocrine functions of the kidney. Dialysis treatments replace some of these functions through diffusion (waste removal) and ultrafiltration (fluid removal).

What is Renal Calculus?

Renal stone or calculus or lithiasis is one of the most common diseases of the urinary tract. It occurs more frequently in men than in women.. It shows a familial predisposition.
Urinary calculus is a stone-like body composed of urinary salts bound together by a colloid matrix of organic materials. It consists of a nucleus around which concentric layers of urinary salts are deposited.

Clinical Features

Symptoms

Quiescent calculus
Pain
- Fixed renal pain
- Ureteric colic
- Referred pain
Hydronephrosis (a lump in the loin and a dull ache)
Haematuria(blood in urine)
Pyuria (pus in urine)

Physical Signs

Tenderness at the ‘renal angle’ posteriorly.
Muscle rigidity over the kidney
Swelling in the flank when there is hydronephrosis or pyonephrosis associated with renal calculus.
Abdominal distension and diminished peristalsis may accompany ureteric colic.

When a stone causes no symptoms, watchful waiting is a valid option. For symptomatic stones, pain control is usually the first measure, using medications such as nonsteroidal anti-inflammatory drugs or opioids.

More severe cases may require surgical intervention. For example, some stones can be shattered into smaller fragments using extracorporeal shock wave lithotripsy. Some cases require more invasive forms of surgery.

Examples of these are cystoscopic procedures such as laser lithotripsy or percutaneous techniques such as percutaneous nephrolithotomy. Sometimes, a tube (ureteral stent) may be placed in the ureter to bypass the obstruction and alleviate the symptoms, as well as to prevent ureteral stricture after ureteroscopic stone removal.

What is Benign Prostatic Hyperplasia?

Benign prostatic hyperplasia (BPH), benign enlargement of the prostate (BEP), adenofibromyomatous hyperplasia and incorrectly referred to benign prostatic hypertrophy, is an increase in size of the prostate. When sufficiently large, the nodules compress the urethral canal to cause partial, or sometimes virtually complete, obstruction of the urethra, which interferes with the normal flow of urine. It leads to symptoms of urinary hesitancy, frequent urination, dysuria (painful urination), increased risk of urinary tract infections, and urinary retention. Although prostate specific antigen levels may be elevated in these patients because of increased organ volume and inflammation due to urinary tract infections, BPH does not lead to cancer or increase the risk of cancer.[citation needed]

What is kidney failure?

Renal failure or kidney failure (formerly called renal insufficiency) describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood. The two forms are acute (acute kidney injury) and chronic (chronic kidney disease); a number of other diseases or health problems may cause either form of renal failure to occur. Renal failure is described as a decrease in glomerular filtration rate. Biochemically, renal failure is typically detected by an elevated serum creatinine level. Problems frequently encountered in kidney malfunction include abnormal fluid levels in the body, increased acid levels, abnormal levels of potassium, calcium, phosphate, and (in the longer term) anemia as well as delayed healing in broken bones. Depending on the cause, hematuria (blood loss in the urine) and proteinuria (protein loss in the urine) may occur. Long-term kidney problems have significant repercussions on other diseases, such as cardiovascular disease.

What is Chronic kidney disease?

Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive loss in renal function over a period of months or years. The symptoms of worsening kidney function are unspecific, and might include feeling generally unwell and experiencing a reduced appetite. Often, chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a blood relative with chronic kidney disease. Chronic kidney disease may also be identified when it leads to one of its recognized complications, such as cardiovascular disease, anemia or pericarditis.Chronic kidney disease is identified by a blood test for creatinine. Higher levels of creatinine indicate a lower glomerular filtration rate and as a result a decreased capability of the kidneys to excrete waste products. Creatinine levels may be normal in the early stages of CKD, and the condition is discovered if urinalysis (testing of a urine sample) shows that the kidney is allowing the loss of protein or red blood cells into the urine. To fully investigate the underlying cause of kidney damage, various forms of medical imaging, blood tests and often renal biopsy (removing a small sample of kidney tissue) are employed to find out if there is a reversible cause for the kidney malfunction. Recent professional guidelines classify the severity of chronic kidney disease in five stages, with stage 1 being the mildest and usually causing few symptoms and stage 5 being a severe illness with poor life expectancy if untreated. Stage 5 CKD is also called established chronic kidney disease and is synonymous with the now outdated terms end-stage renal disease (ESRD), chronic kidney failure (CKF) or chronic renal failure (CRF).

There is no specific treatment unequivocally shown to slow the worsening of chronic kidney disease. If there is an underlying cause to CKD, such as vasculitis, this may be treated directly to slow the damage. In more advanced stages, treatments may be required for anemia and bone disease. Severe CKD requires renal replacement therapy, which may involve a form of dialysis, but ideally constitutes a kidney transplant.

What is Kidney transplantation?

Kidney transplantation or renal transplantation is the organ transplant of a kidney into a patient with end-stage renal disease. Kidney transplantation is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantation depending on the source of the donor organ. Living-donor renal transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants, depending on whether a biological relationship exists between the donor and recipient.

Types of Donors

The names of the different types of transplants refer to the kidney donor. There are three types of transplant organs

Cadaveric
Living related
Living unrelated

Cadaveric

A cadaveric transplant is a kidney removed from someone who has died. Cadaveric kidneys are only removed after a series of tests have established that the donor is brain dead. This means that the part of the brain called the brainstem, which controls breathing, has permanently stopped working. A brain-dead patient is only being kept alive by a life-support machine.

Depending on your country, your local transplant center or a regional or national agency maintains a waiting list for cadaveric transplants. (The United Network of Organ Sharing (UNOS) maintains a national waiting list for the US.) Each country also has its own system for matching and distributing cadaveric kidneys. An available kidney is not given to the person who has been waiting the longest, but to the patient best suited to receive it. The wait, therefore, could be one day or several years. A patient may be taken off a waiting list if they are ill, have an infection or traveling abroad. Removal from the transplant waiting list can be temporary or permanent. Patients who are on the waiting list may not receive a lot of notice that a kidney is available. It must be possible to contact them at all times, and they must be prepared to go to the hospital at short notice.

Once at the hospital, some final tests will be done to assure the best possible chance of a successful transplant. If the patient has a cold, for instance, he or she may be sent home, since this illness would reduce the chances of the operation being successful. Looking after yourself while on dialysis will increase your chances of being fit for a transplant when the right kidney becomes available.

Living related

In living related transplants, a living relative donates a kidney for transplant. A living related transplant is more likely to work than a cadaveric transplant because it is more likely to be a better match than from an unrelated donor.

The relative needs to consider the decision to donate a kidney very thoroughly especially since there is no guarantee the transplant will work. Most donors and recipients receive in-depth counseling before a final decision is reached.

If a kidney patient has a relative who is at least 18 years old, healthy, and willing to donate a kidney, they should speak to the transplant coordinator at their unit. A number of tests will then need to be arranged for both the patient and the donor.

Living unrelated

Sometimes an unrelated person will donate a kidney for transplant. It is usually someone close to the patient, such as a husband, wife, partner or close friend. It is illegal in many countries to buy or sell organs. As with a living-related transplant, both the donor and recipient will be given a number of tests and will receive in-depth counselling.