Max Super Specialty Hospital

I am Dr Waheed Zaman principal consultant neurology and renal transplant Max Shalimar Bagh and Max Pitampura. I have got clinic in Rohini Sector 13 that is Care Multispeciality Clinic and we are dealing complete urology specially pertaining to all urology problems specially stone disease, prostate problem then genitals urinary tract, cancers we are dealing, then infertility and about the importance and male infertility specially we are doing in our centres and my main topic of interest is renal transplant.

I have got experience of more than 1000 transplant and I am very much interested and I helped in people, I have given many lectures for cadaveric transplant and we try to promote it. But today I am discussing on different topics that is stone disease, this is very common in India, especially in North India. We get large number of kidney stone patient they usually present with the brain in emergency with a flying plane, radiating down, blood in urine and majority of the times in emergency severe colic pain. So immediately we give pain Killers, we settle this patient and we ask for ultrasound, urine test and kidney function test. On Ultrasound majority of the stones can be detected or indirect evidences maybe there are life dilatation of the kidney, kidney me sujan ho sakta hai or yadi doubt ho toh definitely hum log CT-SCAN karate hain, plain CT-SCAN se 99% stone detect kiya Ja sakta hai. Ek bar stone detect hua phir uske size pe cocern hota hai, jaise general public mein thinking hoti hai ki sab stone nikal jate hain dawai se ya pani se, yeh sahi nahi hai yadi aap dekhenge ki char millimeter se kam size ke jo stone hote hain almost 80 to 90% nikal sakte hain medicine pani se, mainly pani se aap nariyal pani le, pani piye kafi aur nimbu pani, shikanji yeh 3 apne indian drinks jo hain woh best drinks maane jaate hain, wo chote stone ko aaram se flush kar deta hai. 4 se 7 millimeter ke jo stone hote hain almost 50-50 chance hota hai nikalne ka, 7 millimeter se 10 millimeter ka jo stone hota hai around 10 to 20% chance hai or 8 centimetres se jayada 10 percemt se bhi kum chance hota hai ki nikale, par hamare log jayadatar yehi galat dharna bani rehti hai ki nai medicine se sab nikal jayega even ek-daid centimetre ka stone nikal jayega, yeh commonly hamhe OPD main kuch log puchte bhi hain log, sir aap toh medicine do bade se bade stone mein aur galado usko. Aise stone bahut kum hai jo medicine se galte hain specific uric acid stone wagairah hote hain, jo aur excess pani peene se chhote stone to niklenge hee, definitely. Ab ek baar yadi diagnosis ho gaya ki stone kis level pe hai kidney mein kya changes ho rahi hai yadi back pressure changes jyada hai kidney even phat jati hai itna back pressure rehta hai, infection ho jata hai, bleeding hoti hai, toh aise condition bukhar rehta hai infection ki wajah se, toh hum patient ko salah dete hain ki better hai aap operation ki ke liye jaiye aur wait mat kariye. Kyunki yadi do hafte se jyada yadi kidney block rehti hai stone ki wajah se toh reversible kidney damage start ho jata hai. So we have to be very careful, very judicious, listen to your doctor and there are many myths associated with the kidney stone disease, so try to be more judicious. Kidney stone nikalne ki kai padhatian aajkal adhunik lithotripsy ho sakti hai par ab utni popular nahi rahi hai, uske alawa ureteroscopy hai jisse ureter ke stone nikale ja sakta hain. Kidney stone hum log keyhole surgery se karte hain PCNL, mini PCNL techniques hain, aur aaj kal jo latest aagaya RIRS, that is Retrograde Internal Surgery, aaram se hum log peshab ke raste se hi bahut hi patle sukshm yantra aagye hain jisko flexible urteroscope bolte hain, woh peshab ke raste se bladder hote huye ureter or wahan se kidney per pahunchte hain, aur aise even ded-do centimetre ke stone hum log laser se tod sakte hain, aur ekdum dhul ke kann jaise ho jate hain aur woh peshab ke sath nikal jate hain. Bade kann hum log retreat karte hain, uska stone analysis karte hain aur based on that hum log ye plan karte hain ki aage kya treatment diya jaye. So iska follow-up bahut zaroori hai ek baar kisi ko stone banna hai to 70% chance hai ki dubara banega apna lifestyle change kijiye, salt kam le, fast food kam kare, pepsi wagera bilkul minimum karde, it is full of obsolete chai kam kare, coffee kam kare, chocolate band kare aur pani jyada piyen din mein barah se pandrah glass pani peena chahiye, shkanji piye, ek nimbu daily piye, shikanji uska istemal kare uske alawah anaras hai, kele hain inka sevan kare, karele ki sabji zaroor le isse kidney swasth rehti hai, kuch fruits hain jaise especially maine bataya banana and pineapple yeh kafi useful hota hai, jo sabjiya kam leni hai umne bhindi hai, baingun hai, gobhi, palak inka kam kare istemal band nahi karna hai. Sabse badi dawa pani hai, pani piye “one lemon day keeps the stone away”, aur iska sahi upchar kare otherwise kidney stone may lead to kidney failure even. So aap bade sachet rahey issme, doctor ki sune mein baar baar request karta hoon, hum log daily yrh a problem face karte hain hum log sahi salah denge aapko koi misguide nahi karta hai, yddi kidney damage ho raha hai toh definitely intervene hona chahiye otherwise medical management bhi possible hai chote stone ke liye.

Dhanyavad.

I am Dr Waheed Zaman principal consultant Urology and liver transplant Max Shalimar Bagh and Max Pitampura New Delhi. Mai yahan pe, I am the head of the transplant unit. I am looking after many CKD patients.

So I thought I will share my views on CKD, CKD is Chronic Kidney Disease and it has got 5 stages there are various causes of CKD and as we know in India diabetes and hypertension is quite common and CKD is the major cause of renal failure, patients are due to diabetes and hypertension. In India almost if you see 60% of chronic kidney failure cases are due to diabetes and hypertension, so we have to take care about the our lifestyle, you have to reduce weight, to exercise proper monitoring of weight and take less salt intake, control your sugar intake and do regular exercise, so we can prevent somehow these two diseases. The other factors are like stone disease, few congenital diseases that leads to kidney failure and a stone disease is quite common in India so that is another major cause of kidney failure or CKD can be divided into 5 stages, stage 1, 2, 3, 4 and 5. Stage 5 is that is the end state renal disease when GFR is less than 15 and hardly we can do anything with medicines, only option left is either hemodialysis or renal transplant. While in stage 1 to 4 we can have medicine, dietary modification and we can delayed this end stage renal disease. Once in a renal failure is diagnose and CKD is diagnosed within stage 5 then we have to consider about the hemodialysis, if patient is symptomatic. Kidney functions it filters the body toxins, it filters out the water from the body and it is responsible for the calcium metabolism, bone metabolism and blood formation. So it's a very important organ and if both kidneys are not functioning well that leads to kidney failure. If single kidney is ok, there will be no rise in serum creatinine that is the major blood test and very simply, simple blood test by this we can detect the kidney failure.

The other thing is urine protein that is another important, if urine protein urea is there is protein is coming out of the urine then you have to be alert consult your doctor. If renal failure is diagnosed stage 5 then plan for transplant, transplant is always a better option then hemodialysis, hemodialysis just temporary relief and it excrete de toxins and within 3 to 4 days again, we will back to the same. While kidney transplant will give the better quality of life, patient can lead normal life and average lifespan we can say with the transplant is around 12 to 15 years and there is myth in the society that somebody will donate, you will not have to take lifelong medicines that's not true, we are doing all donor nephrectomy laparoscopically and they are free and they are fit and up to work within 1 to 2 weeks. While kidney transplant is a standard technique worldwide and we have got excellent results now a days with the kidney transplant, that is around 90 to 95% success rate in our centres that is as part to the international level, and but one thing is very important they have to live discipline life, lifelong they have to be on immunosuppression. The another myth in the society that donors may lead to renal failure or later on but that is not true, because donors can lead normal life and of course discipline life then they can maintain the creatinine level don't take analgesic and unnecessary analgesic that also leads to kidney failure. For donation as far as the two types of donation one is live donation and other is cadaver kidney transplant and live donation of course only family members are allowed first degree and second degree relatives, wife and husband can donate while distant relatives are very difficult as per of the transplant law. Another is donor exchange we are doing that is the blood group match is not there in two groups then we are matching, predict transplant is possible in our centre, we are doing ABO incompatible transplant, elderly transplant, donors we are taking, so all sort of transplants we are doing and we have lot of excellent result. So transplant will definitely give better quality of life and I will request more and more people to come forward for donation that is when brain death is there, then donate your organs and even live after death that is the my request to all the audience because in India if you see we are lacking in the cadaver transplant program, so we need more and more donations, per year 2 lakh people are dying of roadside accidents if you use 10% of this we can get a huge bank of organs and from the brain death people and many-many people can be benefited with this. In India almost 2 lakh people are having renal needs renal transplant per year and hardly we are doing 8 to 9 thousand transplants per year. So definitely mai janta ko yahi kahunga ki jago aur, aur bhi organ aap donate kare, ang daan maha daan hai, aur isko samaj mein aap failaye. Yadi kisi ka brain death hota hai toh uss brain death se hum log 7-8 logo ko nayi zindagi de sakte hain. So jyada se jyada log organ donation kare isse donor badege aur jo organ failure ke patients hai unko benefit milega.

Thank you so much.