Critical Care Nephrology at Apollo Institute of Nephrology provides specialized care for patients with acute kidney injuries and related complications in intensive care settings. The department combines expertise in nephrology and critical care medicine to manage complex renal conditions in critically ill patients. 

1. Management of acute renal failure in ICU

This involves rapid assessment and intervention for acute kidney injury in critically ill patients. Utilizes advanced monitoring techniques and renal replacement therapies as needed. Focuses on preserving residual kidney function and preventing further damage. Customises  treatment to underlying causes while managing associated complications.

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2. Treatment of volume disturbances

Precise management of fluid balance in critically ill patients with kidney dysfunction. Employs advanced hemodynamic monitoring to guide fluid therapy and diuretic use. Utilizes ultrafiltration techniques when necessary to manage fluid overload. Aims to optimize organ perfusion while preventing pulmonary edema and other complications.

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3. Management of electrolyte and acid-base disorders

A comprehensive approach to correcting electrolyte imbalances and acid-base disturbances. Utilizes continuous monitoring and frequent laboratory assessments to guide therapy. Implements targeted interventions, including electrolyte replacement and buffer therapy. Addresses underlying causes while preventing arrhythmias and other associated complications.

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d] Continuous Renal Replacement Therapy (CRRT)

Continuous Renal Replacement Therapy (CRRT) is a type of dialysis treatment used primarily for critically ill patients with acute kidney injury (AKI), especially when they are hemodynamically unstable (e.g., low blood pressure). Unlike conventional dialysis, CRRT is performed continuously over 24 hours to provide a slow, gentle process of fluid and waste removal, making it ideal for unstable patients in intensive care settings.

How CRRT Works: CRRT uses an extracorporeal (outside the body) circuit to remove blood, filter it through a dialysis or hemofiltration membrane, and return the cleaned blood to the patient. 

It helps manage:

• Fluid overload
• Electrolyte imbalances (e.g., hyperkalemia)
• Acidosis
• Toxin removal

Types of CRRT:

There are four main types of CRRT, depending on how fluids and solutes are removed:

Continuous Veno-Venous Hemofiltration (CVVH):Removes solutes through convection (solvent drag) and primarily targets middle- and large-molecular-weight toxins. Requires the addition of replacement fluid to maintain balance.

Continuous Veno-Venous Hemodialysis (CVVHD):Removes solutes via diffusion (concentration gradient) to clear smaller molecules like urea and creatinine. Dialysate fluid flows countercurrent to the blood for effective clearance.

Continuous Veno-Venous Hemodiafiltration (CVVHDF):Combines diffusion and convection to maximize the removal of small, middle, and large solutes. Involves both replacement fluid and dialysate.

Slow Continuous Ultrafiltration (SCUF):Focuses on fluid removal without significant solute clearance. Useful for managing fluid overload in patients without severe waste accumulation.

4. Hemaabsorption

Specialized blood purification technique to remove specific toxins or inflammatory mediators. Utilizes adsorbent materials to selectively remove harmful substances from the blood. Particularly useful in managing sepsis, drug overdoses, and certain autoimmune conditions. Can be combined with other extracorporeal therapies for enhanced efficacy.

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5. Plasmapheresis

Therapeutic procedure that separates and removes plasma from the blood. Used to treat autoimmune disorders, thrombotic microangiopathies, and certain intoxications. Removes harmful antibodies, immune complexes, and other pathogenic factors from circulation. Can be performed in conjunction with plasma exchange to replace removed plasma with donor plasma or albumin.

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6. Extracorporeal therapies (including MARS)

Advanced blood purification techniques for managing liver failure and associated complications. Molecular Adsorbent Recirculating System (MARS) provides liver support by removing albumin-bound toxins. Other therapies include plasma exchange and albumin dialysis for various indications. Aims to bridge patients to liver transplantation or recovery of native liver function.

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