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Nephrology

Nephrology is a challenging and complex super specialty requiring knowledge and skill which are applied with a human touch The Department of Nephrology at MMHRC is spread across 10000 sq. ft. and has grown to become one of the largest Nephrology centres in India. Since 1992 this department has become a tertiary referral centre for the management of high risk nephrology cases.

 This growth has been under the able leadership of Dr. K. Sampath Kumar, who started his career with two Drake-Willock old refurbished machines in a humble way and who has been associated with MMHRC for 18 years now. The department has made great strides in diagnosis, treatment and management, offering patients immense compassion and personalized care. The department has been treating the largest number of out patients in MMHRC for the last four years, with an average of 80 per day. Every year, a 20% increase in patient load and growth in all fields of nephrology is seen.

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Facilities

  • A modern Hemodialysis unit has been commissioned with a centrally air conditioned HD unit (unit A & unit B) which has 20 new HD machines and one CRRT machine.
  • GE Osmonics is providing ultra pure water through new RO Systems
  • Surgical procedures are performed in the Interventional suite
  •  Pre-dialysis counselling and CAPD exchanges are given in the CAPD Room.
  • To treat critically ill patients we have an intensive care unit called Renal ICU (RICU).
  • We have one post transplant room with 4 beds and all intensive care facilities.
  • For our other in-patients we have 22 general beds, 8 cubicles and 2 special rooms
  • 2 bio-medical waste processing rooms.
  • Library & class room
  • Consultant’s room and Nephrology office
  • The department has a total staff of 40.
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HD Program

  • MMHRC boasts of one of the largest HD units in South India.
  • Our modern dialysis machines include Braun, Fresenius, Kawasumi, Gambro and Cobe.
  • Our Hemodialysis unit contains treatment area A, B, C & D with 25 machines, separate washing room and dialyser locker for viral negative and positive patients, store for consumables, and administrative area.
  • We have separate machines for HCV and HbSAg infected patients.
  • We perform around 1500 Hemodialysis per month.
  • In our 24hr Hemodialysis program, we hope to start “nocturnal longtime Hemodialysis.”
  • The state of the art GE Osmonics Water Treatment system with Homespring is installed and will improve the already high standards of care in hemodialysis.
  • Plasmapharesis and acute peritoneal dialysis including automated cycler exchanges is performed regularly.
  • We are doing intensive care dialysis in the form of CAVH, CVVH, SCUF, CVVHDF and SLED for patients with liver, heart and kidney failure patients even if the blood pressure is low.
  • Our renal dietician takes care of the nutritional aspect of our ESRD patients.
  • Maintenance dialysis patients are enrolled in our deceased donor transplantations (cadaver transplantations).
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CAPD Program

  • The first CAPD in MMHRC, was done in 1996.
  • Since then we have initiated around 160 CAPD catheters with a good success rate in the CAPD program.
  • We started percutaneous CAPD catheter insertions in 2007 and since then we have introduced 250 Percutaneous CAPD Catheters.
  • Baxter PD Centre was established in December 2006, with the aim of counselling pre-dialysis patients’ regarding CKD management, life style modifications, diet, treatment planning etc.
  • A Video CD which narrates CRF treatment choices in the local language (Tamil) was released, being the first of this kind.
  • Every six months we conduct patients’ meet which has become a platform for our patients to interact with each other.
  • Automated PD was started in 2004.
  • The success of CAPD is measured by the lack of infection .In our patients the peritonitis rate is 1 in 36 patient months, which is comparable to international standards.
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Renal Transplantations

  • The MMHRC centre for renal transplantations is one of the leading Transplant centres in South India with an excellent success rate.
  • The first Transplant in MMHRC was done in 1991 and we have performed around 350 renal transplantations till date.
  • A separate ICU for post renal transplant care with 4 beds has been commissioned recently.
  • Latest protocols for post operative immunosuppresion are followed with prompt drug level monitoring which can be done in our well-equipped lab.
  • The surgical team has performed laparoscopic donor nephrectomy ushering in the era of shorter hospital stay and less painful surgery to the donor.
  • Renal allograft biopsy is routinely done in our centre.
  • Cadaver transplantation program was given a boost recently and our urology team has carried out 7 cadaver transplants successfully in 2009, this being the largest number in South India.
  • The first ever multiple organ procurement from a deceased donor in southern district of Tamilnadu was recently carried out.
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Interventional Nephrology

  • MMHRC can be considered one of the premier centres of Interventional Nephrology in India.
  • We have a dedicated Interventional team.
  • All interventions are done at our mini theatre, called the Interventional suite, adjacent to the dialysis Room. It is equipped with all modern equipment like OT Table, twin roof mounted 7+4 lamps, C-Arm, GE Multy para monitor, L&T Bipolar Cautery, crash trolley, surgical dressing instrument cart etc.
  • We regularly perform Tunnelled Internal Jugular catheters (Perm cath) in our Interventional suite.
  • The first live interactive Interventional Nephrology workshop of India was organized at Kanyakumari under the southern chapter of Indian society of nephrology by our Head of the Department, Dr. K. Sampath Kumar.
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Renal Intensive Care Unit (RICU)

  • We have recently started a new air-conditioned intensive care unit with state of the art monitors in eight beds for treating critically ill patients.
  • We have sophisticated monitoring devices like GE Multipara meter for swan - ganz monitoring, GE Cardiac monitors, L&T Pulse Oxymeters and a new generation Gambro CRRT Machine for Dialysing critically ill patients.
  • It is a challenge to dialyse Acute Renal failure patients with multi system involvement, coagulation abnormalities and low blood pressure. Although dialysis is life saving, conventional haemodialysis is impossible due to its inherent limitations. With CRRT Machine we are able to dialyse patients with hypotension.
  • RICU is equipped with continuous supply of RO Water for emergency Haemodialysis.
  • It is covered by specialist doctors, well trained renal nurses, physiotherapists and renal dieticians.
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Social activities and Charity

At MMHRC we follow in the foot steps of our Chairman and his vision
 "No man is too poor to afford first grade medical treatment."
  • All our regular HD patients are getting one FREE HD per month.
  • Procedure Charge for Central venous lines is waived for regular HD patients
  • We provide free Dialyzers and blood lines for the needy on a regular basis.
  • We are planning to provide a free renal diet during Dialysis session.
  • We provide free CAPD catheters for paediatric CAPD program.
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Kidney Donors’ Meet

MMHRC and MOHAN FOUNDATION together conducted a kidney donors’ meet in which 43 donors participated with their families. In this meeting we appreciated the family members of those who donated the organs of their loved ones for a great cause of altruism.
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Academic Activities

DNB Training Program
  • The Nephrology Department, MMHRC, is recognized by the National Board of Examinations, New Delhi, for conducting Nephrology super specialty training programmes since 2005.
  • Our first candidate Dr.Y S.Sooraj was the only one candidate to have passed from Tamilnadu in the first attempt. He was also one amongst the seven who passed from India.
  • We attract high quality aspirants for PG training every year.
  • Over 25 articles have been published in peer reviewed National and International Nephrology journals and papers have been presented in conferences all over the world.
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Activities

  • Monday - Case Discussion –Sr. PG
  • Tuesday –Lecture - Head of the Department
  • Wednesday -Clinical pathology- Head of the Department
  • Thursday - Topic Discussion By Jr.Consultant
  • Friday -Journal Review By Sr.PG
  • Saturday -Case Discussion By 2nd year PG
Monthly
  • HD Table rounds -1st Monday - Sr.PG
  • CAPD Table rounds -2nd Tuesday-2nd year PG
  • MANUS Presentation -3rd Wednesday-1st year PG
  • Clinical Society -4th Thursday -Sr .PG
  • Dept. Medical Audit -5th Friday -2nd year PG
Yearly
  • Periphery posting in Radiology and Imaging sciences - 1 month.
  • Periphery posting in other centres - 1 month.
  • Training Programme in Beijing University, China - 7 days.
Renal Nursing Program

We have a regular nursing program every month, to train our new staff and special classes on BLS and ACLS every six months. We are using CQI index to evaluate the work quality of our staff. We conduct regular CME program for our PGs, General Practitioners and Referral Doctors.

Library / Classroom

  • We have an excellent department library which works round the clock.
  • The library subscribes to all the important Nephrology journals like Kidney International, JASN, AJKD, Nature Nephron, NDT, Nephrosap etc.
  • The entire department is a free Wi-Fi zone.
  • All academic and departmental activities take place in the library hall which is equipped with an LCD Projector and a Binocular Teaching microscope for the students.
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Publications

  1. Sampathkumar K, Sooraj YS, Ajeshkumar RP, Mahaldar AR, Muthiah R.- The Case of Acute paraplegia with aneuric ARF. Occlusive aortic thrombus with ischemia of spinal cord and kidneys. Kidney Int. 2007 Sep;72(5):657-9.
  2. Sampathkumar K, Murali TR, Sooraj YS, Mahaldar AR. Emphysematous prostatitis in renal transplant. Indian J Urol 2007;23:476-8
  3. Sampathkumar K, Sooraj YS, Ajeshkumar RP, Mahaldar AR, Muthiah R. Rhabdomyolysis due to hair dye poisoning: An emerging threat. Indian J Crit Care Med 2007;11:212-4
  4. Sampathkumar K, Mahaldar AR, Sooraj YS, Ajeshkumar RP , Muthiah R:Milk Alkali Syndrome-Old Wine in a New Bottle. I journal of peritoneal dialysis April 2007,41- 43
  5. Sampathkumar K, Mahaldar AR, Sooraj YS, Ajeshkumar RP , Muthiah R Percutaneous CAPD catheter insertion by nephrologist. I J Nephrology April 2008
  6. Sampathkumar K, Sooraj YS, Ajeshkumar RP, Mahaldar AR, Muthiah R lathanum deposits in colon- a new phenomenon I J Nephrology April 2008
  7. Sampathkumar K, Sooraj YS, Ajeshkumar RP, Mahaldar AR, Muthiah R -Jouberts syndrome with renal failure- Kidney International, 2008
  8. Niacin for phosphate control - perspective from a developing country. Krishnaswamy sampathkumar, International urology and Nephrology journal, November,2008.
  9. Hair dye poisoning - An emerging threat in the developing country.Krishnaswamy sampathkumar, Sooraj YS.Journal of emergencies and trauma. February,2009.
  10. Granulomatous interstitial nephritis due to renal tuberculosis. Krishnaswamy Sampathkumar, Sooraj YS, Amol Mahaldhar, Ramakrishnan, Ajesh Kumar. Saudi Journal of Kidney disease and transplantation- 2009
  11. Is there an urban rural divide in the CAPD results- Indian journal of Peritoneal dialysis-June 2009. Amol Mahaldar, Sampathkumar, AjeshKumar, Ramakrishnan.
  12. Angiotensinogen gene polymorphism in South India dialysis patients- Journal of Clinica Chimica Acta 406 (2009) 108–112 .
  13. ANCA negative glomerulonephritis with systemic involvement- Accepted for Indian Journal of Nephrology,2010
  14. Norwegian scabies in renal transplant patient- Accepted for Indian journal of Nephrology,2010.
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Administrative Post

Our Head of the Department Dr.K.Sampath Kumar is the present honorary secretary of Indian Society of Nephrology, Southern Chapter. He has brought out the first Newsletter for this Nephrology Association. He is currently the Associate Editor of Indian Society of PD Journal.
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Future Plans

  • Plan to start a Dialysis Technician Course
  • Tie-up and interaction with international centres of excellence.
  • Collaboration with the International Society of Nephrology for sister renal unit programmes.
  • Collaboration with the International Society of peritoneal dialysis for academic exchange programmes
  • Setting up a Renal Research cell for South Indian Kidney diseases
    • Total Number of Kidney Transplantations
    • Total OP Patients
    • Total Review
    • Total Admission
    • Total New Cases
    • Total Hemodialyses
    • Renal Transplantations
    • CAPD
    • PD
    • Renal Biopsy
    • CRRT
    • Plasmapheresis
    • Tunnelled catheters
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Doctors

  • Dr. K. Sampath Kumar, MD., DNB, D.M (Nephro)., - Sr. Consultant & HOD
  • Dr. Anusha Gopi, MBBS., DNB (Gen. Med), - Registrar
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