KING EDWARD MEMORIAL HOSPITAL

Seth Gordhandas Sunderdas Medical College

Acharya Donde Marg, Parel,
Mumbai 400 012. India.
Tel.: 91-22-2410 7000 Fax: 91-22-2414 3435

Department of Nephrology

Background History

 

History

The Division of Nephrology had its origin in the early 60’s due to the foresight of the late Dr. P. Raghavan who could be deemed responsible for the establishment of an independent branch of Nephrology today. The Department of Medicine had received a gift of an Alwall’s hemodialysis machine through the Swedish philanthropist Mr.Alex Axison Johnsonin 1962. Over the years and under the guidance and efforts of Dr.Smt.V. N. Acharya and her band of dedicated workers which included Mr.Claud Lobo and Sr. Bagayatkar. The Division had many achievements that placed it among the premier divisions of the country.The dialysis unit was among the first to provide this facility in the country and the first in the western India. The first cadaver renal transplant of the country was performed here from a non-beating heart donor. The division provided training for the postgraduate course in Nephrology of the National Academy of Medical Sciences .The division matured and became a full-fledged Department of the Seth GS Medical College providing training for the DM postgraduate course in Nephrology in the early 80’s. Since then, the Department has been training young nephrologists to provide service for the ailing renal patients.

 

The Birth & the Growth of the Division of Nephrology

The Division of Nephrology, conceived in 1962, came into being in the following year with the introduction of the Dialysis Unit. This brain-child of Prof. P. Raghavan, the then Professor & Head of the Department of Medicine has thenceforth not looked back. From humble beginnings, the division grew over the years with the introduction of newer dialysis systems to supplement the original Alwall’s kidney. The growth of the department was ensured through the induction of generous aid received from Rockefeller Foundation, N.M. Wadia Charities and the Dr. P. V. Cherian Trust.
This division was headed by Dr. Ms. V.N. Acharya who had been hand-picked by Dr.Raghavan himself. She had trained in the United Kingdom before she shouldered the responsibility of setting up the dialysis unit. The dialysis set up which had humble beginnings was equipped periodically with state-of- the-art dialysis systems. The provision of dialysis services soon led to the possibility of renal transplantation. In May 1965, the first ever kidney transplant (a Cadaver kidney transplant) was performed at these institutions. Over the years, the department has progressed and has an active live related donor transplant programme and a newly established Cadaver Donor Transplant programme.

 

Realising the need for an academic programme that would cater to the growing needs of the ailing renal population, the division sought and obtained the status of recognized training institute for the National Board of Examination in the sub-speciality of Nephrology (1977). Thereafter, with the introduction of the D.M. degree in Nephrology in the University of Mumbai in 1986, this division was recognized as a department which thereafter obtained the recognition of the Medical Council of India. As of date, the institution has produced and continues to produce nephrologists that have earned a name for themselves, both on the national scene and abroad.

Sections Units Branches

Location

The Department of Nephrology is located on the second and third floor of the Old building of the KEM Hospital.It has a single patient care unit. The Hemodialysis Unit is located on the Second Floor of the building. Part of the dialysis unit was recently renovated by the American Jewish Joint Distribution Committee in association with the State of Israel. The Third floor houses the Dr.MD Motashaw Memorial Renal Transplant Unit and the Aditya Textile Renal Research Laboratories. In addition to the Intensive Care unit for transplant patients, the Department has an intensive care area devoted to patients with nephrology problems. In addition to these areas, the Department admits patients to beds in the general wards for male and female patients located on the second and ground floor of the same building.

The dialysis Unit:

The Hemodialysis unit is located on the 2nd floor of the old hospital building. It is in close proximity to a six bedded ICU area which forms part of the Nephrology department.
The dialysis unit has two designated areas:

  1. For patients who are HbsAg negative (measuring about 1000 sq. feet).
  2. For patients who require isolation dialysis (measuring about 700 sq.feet).

Staff

 

Dr. N. K. Hase Professor and Head
Dr Tukaram Jamale Assistant Professor
Resident Positions 6
Nursing Staff : 24
Scientific Officers (Lab) : 3
Technicians (Lab) : 4
Dialysis Unit Staff : 10
Dietician : 1
Medical Social Worker : 1
Administrative Staff : 3

 

Facilities, Equipments & Special services

 

Facilities

 

  • The Department provides services for evaluation and management of clinical nephrology problems, dialysis for patients with acute renal failure, acute drug intoxication/overdose and acutely decompensated chronic renal failure patients. Maintenance hemodialysis facilities exist for chronic renal failure patients awaiting renal transplant but not for life long maintenance dialysis Facilities for renal biopsy, hemoperfusion, plasmafiltration / plasmapheresis, continuous renal replacement therapy, also exist.
  • The Department has a fledgling chronic ambulatory peritoneal dialysis programme and also provides acute peritoneal dialysis for patients with ARF, CRF and pediatric and neonatal patients.
  • The Department has an accredited transplant programme and performs live related donor and cadaver renal transplants along with the Department of Urology. Interested patients should attend nephrology opd for further counselling and evaluation.

Services

  • The dialysis unit has an allocated area measuring 200 sq ft. wherein the Water Treatment Plant is housed. The Water Treatment Plant has been designed to provide AAMI Standard quality water for dialysis. The water supply to this plant comes from the Municipal Corporation of Greater Mumbai (filtered and chlorinated water).
  • The Water Treatment Plant consists of an Up-flow sand filter followed by an activated carbon filter. Just proximate to the reverse osmosis module there is a 10 micron cartridge filter. The treated water is circulated with the help of a circulation pump through a Stainless Steel SS-316 Pipeline. There is on-line a 0.2 micron size filter and an ultraviolet sterilizer. In addition, there is a storage tank (SS316) with a 200 liter capacity.
  • A Store room exists for storing chemicals required for the cleansing and sterilization of the dialysis system and the circulating water pipeline. In addition, there are also chemicals stored for the reprocessing of hemodialysis. The reprocessing of hemodialyzers is carried out in non Hepatitis B positive, non HIV positive patients who do not have reuse programme. The patients with Hepatitis C have their dialysis processed in a separate area.
  • There are thus designated separate areas for processing patients with Hepatitis C and for patients who are not positive for hepatitis viral markers.
  • An on-duty doctor room is located near the dialysis area so as to provide immediate emergency care if required.
  • The present complement of Single Patient Dialysis systems number eight. They include 1 Nipro Surdial SPS, 4 B Brown machines, 2 Nipro Dimax machines and 1 480 BUF. In addition, 4 other SPS are to be purchased in the near future. The dialysis area has been planned so that 14 such Single Patient Systems can be used. The patients who are hepatitis B positive are managed on dedicated machines. All machines are sanitized and sterilized after use, adopting the approved machines.
  • Separate dialysis room personnel (technical, nursing and house keeping staff) are posted in the dialysis area (clean and isolation).
    The drainage of spent dialysate and the water etc used for reprocessing of dialyzers is separately drained. Dirty linen and dirty instruments are handled in a separate area located outside the dialysis area. Biomedical waste (sharps and other contaminated equipments) are handled as per the guidelines of the Hospital Infection Committee and the government.
  • The Nephrology Intensive Care Unit comprises of 6 beds wherein patients requiring close monitoring are accommodated in this area.
  • A pantry-cum-diet education area is located near the dialysis and Intensive Care area. In this area, preparation/distribution of patient’s food items as well as diet counseling by a renal dietician is performed.
  • The dialysis Unit is supplied with water from the Municipal Corporation which is treated and fulfills the standards set out by AAMI.
  • This treated water is used for both dialysis as well as reprocessing of dialyzers. The dialysis unit has electric supply from the electric company and also has provision for emergency electric supply through a generator lodged on the ground floor of the hospital building. In addition, three of the units have battery backup. The dialysis unit has Central air-conditioning. The Air Handling Unit is located near the dialysis theatres. Presently, the air-conditioning has not been extended to the ICU area. Entry of personnel to the dialysis area is restricted to staff of the unit and requires change of footwear and use of a mask. Thus, the areas are clearly demarcated as ‘sterile’ and ‘semi sterile’ with a separate ‘dirty’ area.
  • The Intensive Care Area as well the Dialysis Unit has central suction and central oxygen facilities. The air-conditioned areas are provided with a false ceiling and the walls have ceramic tiles which facilitates cleaning and sterilization.

For Students

Academic

The Department is recognized for the DM Course of the Maharashtra University of Health Sciences, Nashik addition, and students are enrolled for M.Sc / Ph.D in Applied Biology.

The Seth GS Medical College enrolls 2 students per year for the DM course. The selection is based on an All-India Entrance examination conducted by the Directorate of Medical Education and Research of the Government of Maharashtra . This 3 year course prepares students for the practice of Nephrology. The students are also eligible to appear for the qualifying examination, Diplomat of the National Board in Nephrology, conducted by the National Board of Examinations, New Delhi.

Enrollment for the M.Sc/Ph.D course by research in Applied Biology is through the University of Mumbai.

Observership & Training

Observer-ship for Medical Practitioners for periods varying from 1 to 3 months is possible in the department.
The applications for observer-ship should be addressed to :

TheDean ,
Seth GS Medical College & KEM Hospital,
Acharya Donde Marg,Parel, Mumbai 400 012
India

An Observership fee is Rs.3200/- per month.

Training for Dialysis Technicians is also provided .The training period is not less than 3 months. A certificate will be provided after successful completion of the training programme. A fee (Rs. 3000/- at the rate of Rs.1000/- per month) will be required to be paid on acceptance for the training programme. Applications should be made to the Dean at the aforementioned address. Eligibility: – Bsc, D.M.L.T. / 12th with science.

Academic and Research Activities

Academic:

The Department teaching activities are as follows:

  • Monday : symposium/case discussion
  • Tuesday : Nephro-urology Discussion
  • Wednesday : Review guideline/Teaching Rounds /Journal Review / Mumbai Nephrology Group meeting
  • Friday : Rounds with Residents / Nephrology forum/Case discussion
  • Saturday : Case Discussion/Renal Biopsy Conference with renal pathology

Department of Nephrology, Teaching programme: January 2012

Time Monday Tuesday Wednesday Thursday Friday Saturday Sunday
 7  –   8.30 Ward Round Resident Ward Round Resident Ward Round Resident Ward Round Resident Ward Round Resident Ward Round Resident Ward Round Resident
8.30 –   9.00 Ward Round Sr.Resid / Lect. O.P.D. 8.30 – 3.00 Ward Round Sr.Resid / Lect Ward Round Sr.Resid / Lect Ward Round Sr.Resid / Lect Ward Round Sr.Resid / Lect Ward Round Sr.Resid / Lect
9.00 – 10.00 Apprasial of New cases / Symposium Apprasial of New cases / Guide lines Apprasial of New cases and Guidelines Discussion 9.00 – 9.10 Nephro /Path Meeting CPC 9 – 11.00 Apprasial of Ward cases to  Consultant
10– 12.30 Ward Round New Cases/ followup Ward Round Transplant And CAPD OPD Grand  Round Round/ WARD Consultant 11 – 12.30 Emergency on Calls onwards
1.30 –   4.00 Renal Clinic / Case discussion CKD Reports / Followup OPD Patients & Rounds 1st Journal Club 2nd Journal Club 3rd Journal Club 4th  Mumbai Nephro. Group  meeting Renal clinic follow up Glomerular Disease Vasculitis SLE / 1.Case presentation 2.Nephro. meet. 3 Death Audit Dialysis/ Transplant Meeting 4.Case presentations 1.Theory paper 2.Question writing 3.Mumbai Nephro. Teaching Web Cast
4.30 –   5.00 Reports & Evening rounds Evening rounds Reports & Evening rounds Reports & Evening rounds Evening rounds Reports discussion
7.00    p.m. Emergency on  Call Emergency on  Call Emergency on  Call Emergency on  Call Emergency on  Call Emergency on  Call
Research :

Current areas of interest are:

  • Acute kidney injury
  • Dialysis strategies and their impact on outcome of AKI.
  • AKI in patients with chronic liver disease

Glomerular Diseases:

  • Antiproteinuric efficacy of various angiotensin receptor blockers
  • Adult onset nephrotic syndrome: study of clinicopathological correlation

Chronic Renal Failure and Dialysis:

  • Efficacy and safety of darbopoetin in anemia of chronic kidney disease
  • Dialysis practice patterns in western Maharashtra.
  • Transplantation
  • Posttransplant diabetes
  • Posttransplant erythrocytosis

 

Publications

National:

1. Dr. N.K. Hase. Living Donor kidney transplantation – is it safe? Journal of Association of physicians of India 2007 – 55, 263 – 264.
2. Dr. N.K. Hase: Rehabilitation of patient with End Stage Renal disease API Text book of Medicine 8th Edition.

*International – Accepted for Publication:

1. Dr. Tukaram Jamale, Dr. N.K. Hase, Dr. Anwar M.I.
“Laparosopic vs open Donor Nephroctomy:Recipient”s Perspective”. In Saudi Journal of Kidney Diseases and Transplantation.
2. Dr. Tukaram Jamale Dr. N.K. Hase
“A case of shoulder pain post Kidney transplant:unusual etiology” in Nephrology dialysis & transplantation plus Oxford University Press, U.K.

*National:

1. M.G. Kulkarni ,P. Shetty, T. Jamale, N.K. Hase
“A study of quality of life and cost utility in Renal transplantation in resource limited setting. Indian journal of Nephrology Vol.20 Dec. 2010:544
2. N.K. Hase”Pregnancy in underlying Renal disease”
3. In pregnancy at risk (eds)V. Kirshna & Duru Shah FOGS India Jaypee Publish 5th edition 2010,P.P. 311-318

1) Tukaram Jamale , Niwrutti K. Hase, Gwendolyn C. Fernandes.”A of shoulder pain Post-renal transplant, an Unusual etiology—- NDT (plus) 2011;4:136 – 137
2) Tukaram Jamale, N.K. Hase Acute Kidney inury due to assenic cantained in Ayurvedic medicines in the setting of adult Nephrotic Syndrome. Clinical Toxicology. Jan. 2011.
3) Tukaram Jamale, Niwrutti Hase, Manjunath Kulkarni. Hereditary ADAMTS 13 deficiency presenting as recurrent AKI. Accepted for publication in Indian J of Nephrology.

For Patient

Clinics

Nephrology OPD (‘N OPD’):

The Department runs an outpatient clinic on Tuesday morning between 8.00 am and 10.30.am at the Ground Floor of the New Multistoried Building. In this Outpatient clinic, new patients are screened and evaluated and old patients with problems are followed up. Patients attending the Outpatient Clinic on Tuesday should preferably have a referral note from the referring physician.

Renal Clinic:

Patients seen earlier in the N OPD are subsequently followed up, by appointment only, in the Renal Clinics conducted on Monday and Thursday afternoon between 1.30pm and 4.00pm.

Transplant Clinic:

Transplant Clinic is conducted on Thursday morning between 9.30am and 11.30am in the Transplant Unit area on the third floor.

CAPD Clinic:

CAPD clinic is conducted every Thursday morning at 11.30 am on the third floor.

Other

Location

2nd & 3rd Floor, Old Building, KEM Hospital

Contact Detail

Dr. N.K Hase,
Professor & Head, Department of Nephrology,
Seth GS Medical College & KEM Hospital,
Parel, Mumbai 400 012.
INDIA.
o Tel: 91 22 24132118
o Fax: 91 22 24143435
o Ext: 2061

Dr Tukaram Jamale
Dept of Nephrology. Wd no 34A, old hospital building,
3rd floor,
KEM Hospital, Parel,
Mumbai 12
o tukaramjamale@yahoo.co.in

News & Updates

Poster:

Department of Nephro

Photo Gallery