Frequently Asked Questions for Nephrology


What is dialysis?

Dialysis is a medical process through which a person’s blood is cleansed of the toxins or wastes that kidneys normally remove. It is used when a person’s kidneys no longer function optimally. The purpose is to keep the right levels of chemicals, fluids and salts in the body so that body functions normally.
A Nephrologist or a Physician with interest in kidney diseases.
Renal dialysis falls into two main divisions: haemodialysis and peritoneal dialysis.
Hemodialysis cleans and filters your blood using a machine to temporarily remove harmful wastes, extra salt, and extra water from your body. Hemodialysis is most often performed in a dialysis centre but home treatment options are also available.
Peritoneal dialysis uses the lining of your abdomen and dialysis solution (a mixture of minerals and sugar dissolved in water) to filter your blood removing wastes, chemicals and extra water from your body. After several hours, the used solution is drained from your abdomen through a tube and the cycle is repeated with fresh solution 
Both are good, choice usually depends on personal lifestyle of the patient and certain medical conditions like congestive heart failure, vascular access complications, diabetes etc. Hemodialysis is usually performed at a dialysis centre as compared to peritoneal dialysis which can be safely done at home .CAPD is usually preferred in children as they have small vessels which are difficult to cannulate and repeated needling is painful and difficult in them. Fluid intake can be more liberal in CAPD.
Putting on weight between dialysis is usual. It is because all food that is consumed by you has some water/ fluid which is not excreted by the diseased kidneys. The amount of weight gain should not be more than 2.5 – 3 kg between two sessions of hemodialysis.
Yes, this can lead to fluid overload and breathing problem. It can also increase your serum potassium level which can lead to serious cardiac complications. Therefore skipping dialysis can be life threatening. 
An access usually refers to a vein or vessel from which blood is taken to the dialysis machine and returned back .It can be a catheter, Arterio venous fistula or an Arterio venous graft.
The access which is usually a fistula, graft, or catheter should be taken care of and one should not wear tight clothing or jewellery on the access arm nor should blood pressure be checked on the arm.
While on dialysis you should watch your diet. In case of any breathing trouble you should contact your doctor as you may require urgent dialysis. Care of the vascular access should be ensured as advised by your physician.
Nephrology is the study of the renal system. A nephrologist is responsible for the diagnosis and treatment of disorders of the kidney such as kidney stones, chronic kidney disease, dialysis, renal failure, electrolyte imbalance, renal cancer etc. Additionally Nephrologists also treat uncontrolled hypertension, renal function abnormalities due to autoimmune diseases. Nephrologists treat all post-renal transplant patients also. 
Nephrologist use oral and IV medications; Ultrasound Guided Biopsies/ aspirations. Nephrologists use Hemodialysis/Plasmapheresis/CRRT/Peritoneal Dialysis to manage ESKD/AKI patients. Depending on the underlying cause, there are different procedures with different techniques.  
Different surgeries have different criteria for an ideal candidate. For instance, in the case of end-stage kidney disease (ESKD), the right candidate must clear the following criteria: (1) Proper heart-lung functionality (2) No active infections in the recipient such as hepatitis, TB etc (3) Any life expectancy limiting medical condition (4) A full understanding and commitment to take medication regularly and following up with your nephrologist (5) No smoking, drinking or recreational drugs  
Your kidneys are responsible to filter out your body’s blood, absorb minerals and produce urine. Due to end stage kidney failure, your kidney loses 85 – 90 % of its functionality, leading to the need of dialysis, which in turn help filter out the waste, salt and extra water.
Kidney failure can occur due to several reasons. Depending on the underlying cause of the kidney failure, it can be reversed.
The kidney is one of the essential organs of the body. It is linked to pathologies of other organs and can be damaged irreversibly, which may result in dialysis or transplant.
Thus, there are certain precautions one can take:
(1) Quit smoking/recreational drugs (2) A balanced diet: Low salt, low carb, balanced protein, balanced acidity, calcium-rich. (3) Lose weight in a safe manner, avoid diet pills/crash diets (4) Drink copious amounts of water, especially in the summers. (5) Read food labels of all food to know the sodium content
A chronic kidney disease slowly reduces the functionality of the kidney. When the kidney is not able to function properly or at all ( <10%), to the point where it isn’t meeting the body’s daily needs, is known as end stage renal disease (ESRD)
Our kidneys can compensate for the lost function and are highly adaptable. Therefore, most of the kidney diseases go undiagnosed until it's very late or difficult to reverse them. Some of the common kidney problems are Diabetic Nephropathy, Focal Segmental Glomerulosclerosis, Alport Syndrome, Glomerulonephritis, IgA Nephropathy (Berger’s Disease), Fabry Disease, Minimal Change Disease, Kidney Stones, Nephrotic Syndrome, and Polycystic Kidney Disease or PKD. Health problems (like diabetes) affect your kidneys, and they may cause Chronic Kidney Disease or CKD. CKD is like permanent damage to the kidneys that may get worse over time. If they're so damaged that they stop working, it's called kidney failure, or end-stage renal disease (ESRD) 
Nephrologists can help diagnose and treat the conditions like blood or protein in urine, Chronic Kidney Disease (CKD), Kidney stones, Kidney infections, Kidney swelling due to glomerulonephritis or Interstitial nephritis, Polycystic kidney disease, Haemolytic uremic syndrome, Renal artery stenosis, nephritic syndrome, End-Stage Kidney Disease (ESKD), Acute and Chronic kidney failure. They may also be involved in other diseases which could act as contributing factors to kidney disease or dysfunction like - high blood pressure, diabetes, heart disease, autoimmune conditions (Ex: lupus) or any other medications affecting kidney functions. 

Frequently Asked Questions for Oncology


What is cancer?

Cancer is the uncontrolled and uncoordinated growth of body cells which invade surrounding normal tissues and might spread to distant organs if not checked in time
Cancer is caused by damage to the DNA (genetic material) within our cells. Damage to the DNA happens in all normal cells, but the majority of this damage is repaired by our own body. Sometimes this damage is not repaired properly, which can lead to changes in the properties of the cell (for example cells may acquire the ability to grow and divide rapidly). Accumulated DNA damage can eventually lead to cancer
Cancer per-say is not an infection. However, long-term infection with some pathogens can cause cancer. For example, infection with Human Papillomavirus (HPV) can cause cervical cancer, infection with hepatitis B and hepatitis C virus can cause liver cancer, and persistent infection of gastric mucosa by Helicobacter pylori can cause stomach cancer. Epstein Barr virus (EBV) has been linked with lymphomas, nasopharyngeal cancers and some stomach cancers. However, most people infected with these cancer-causing pathogens never develop cancer 
Cancer can affect physically fit individuals as well as individuals in poor health. People who are very immunocompromised (e.g. individuals infected with HIV, or on immunosuppressive therapy) have an increased risk of developing certain types of cancers. However, most cancers are caused by a combination of factors that may include tobacco use, alcohol use, your genetic makeup, poor diet, physical inactivity, being overweight, and exposure to chemicals
Yes, smoking a cigarette, beedi, hookah, pipe or cigar increases your chance of getting cancers, some of them being preventable. Eating pan with tobacco and chewing tobacco increases your chance of getting cancers of the head and neck (mouth, lips, nose and sinuses, voice box, throat), esophagus (swallowing tube), stomach, pancreas, kidney, bladder, uterus, cervix, colon, rectum, ovary and acute myeloid leukemia (blood cancer) 
Studies have shown that people who drink alcohol are more likely to get mouth cancer, liver cancer, breast cancer, bowel cancer, and throat cancer, which includes pharyngeal cancer, laryngeal cancer and cancer of the food pipe (oesophagus) 
Injuries do not cause cancer 
No. Emotional stress alone has not been proven as a cause for cancer. However, prolonged stress may affect your overall health status and your ability to cope with cancer 
Cancer has been known since the birth of human civilization, although many cancers went unnoticed because we did not have the tools to diagnose them. In modern times, the number of new cancers has been increasing. Some of this rise is because of increased life span, and older people are more likely to get cancer. Factors such as industrialization, life style modifications and environmental pollution have also contributed to the increased risk of cancer. The availability of sophisticated diagnostic tools has also led to more cancer cases being picked up in early stages today 
Cancers of the mouth, throat, lung, skin, gullet, stomach, rectum, larynx, kidney, bladder and brain are more common in men than in women 
It is difficult to recognize cancer in the early stages since it produces few symptoms. One should be aware of the warning symptoms and signs of the common cancers. The best way to pick up cancer early is to have regular health checkups and undergo screening for different cancers. 
(1) A change in bowel or bladder habits
(2) A sore that doesn’t heal
(3) Unusual bleeding or discharge from any opening in the body
(4) Unexplained weight loss and loss of appetite
(5) Difficulty in swallowing or chronic indigestion
(6) An obvious change in a wart or mole
(7) A nagging cough or persistent hoarseness of voice
Many cancers do not cause pain in their early stages. Some cancers only cause pain in the last stages, when the cancer has already spread to other parts of the body
If you pass blood in your stools, it means there is bleeding somewhere in your digestive tract. A small amount of blood after going to the toilet is most commonly caused by piles (hemorrhoids) or an anal fissure. Haemorrhoids are swellings that can occur in the anus and lower rectum. However, bleeding can also be caused by cancerous or precancerous conditions of colon or rectum and therefore one should always consult a specialist
Passing blood in urine is not always due to cancer, but one should not ignore it. Blood in urine is known medically as hematuria. It can be caused by a variety of kidney diseases, stones, enlarged prostate, medications (aspirin, chemotherapy drugs), or tumors in the bladder kidney or prostate. All cases of hematuria should be carefully examined by a doctor to determine an underlying cause for this condition
If a woman notices a lump or any other changes in the breast, she should immediately consult a physician because it may be a cancerous lesion 
Not all breast lumps are cancerous. Most lumps are benign (harmless). However they have to be evaluated by a doctor 
Some reasons that people do not consult a doctor in a timely manner include:
(1) Fear of being diagnosed with cancer
(2) Possible financial burden on the family
(3) Worry about treatment procedures such as surgery and chemotherapy
(4) Difficulty in finding the right medical centre or hospital
(5) Worry about the social stigma of being branded as having cancer
It is important to overcome these fears since the sooner a cancer is detected, the more likely it is to be cured 
If we take care of the following, we can reduce the risk of getting cancer. (1) Awareness regarding healthy lifestyle (e.g. avoid tobacco, limit alcohol intake, maintain a health body weight). (2) Awareness of warning signs and symptoms of cancers (3) Regular health checkups (4) Undergo recommended screening for cancers
Cancer can spread in different ways. 1) It may directly invade the neighbouring tissues. 2) Cancerous cells may enter the lymphatic stream and be carried to lymph nodes. 3) Cancer cells may also pass through the blood stream to other parts of the body
Cancer is not infectious, and cannot spread from one person to another
No. However, persistent infection with certain sexually transmitted infections like HPV can lead to cancer many years later 
It is estimated that only 5-10% of all cancers are passed on from parents to children (hereditary cancers). Most cancers are not caused by these rare, cancer-predisposing inherited variants in the DNA  
Yes. Some cancers can be diagnosed early if the patient is aware of the warning symptoms and consults a health care provider in time. Cancers that have been diagnosed and treated early have a better survival than those treated in advanced stages
If the cancer is detected early:
(1) It increases the chances for successful treatment and full recovery
(2) Reduces cancer mortality and improves survival
There is no single test available that can precisely diagnose cancer, so we need to depend on combination of tests to detect and confirm cancer.
(1) A thorough history and clinical examination.
(2) Diagnostic tests/procedures generally used for cancer diagnosis may include:
(a) Imaging (X-rays, CT scans, and fluoroscopy)
(b) Laboratory tests (including tests for tumor markers)
(c) Tumor biopsy
(d) Endoscopic examination
A mammogram is an x-ray picture of the breast. It is a highly effective imaging method of detecting and diagnosing breast cancer at an early stage 
This is an abbreviation of “Papanicolaou test” (also known as Pap smear, cervical smear, or smear test). The Pap smear is a simple procedure to detect abnormal cells shed from the uterine cervix (neck of womb) in order to detect precancerous and cancerous lesions of uterine cervix  
It is advisable to approach a qualified medical professional in order to receive correct advice and timely treatment of cancer. If you approach an unqualified person, it might delay proper treatment which might lead to progression of your disease 
There are many ways to treat cancer. These include:
(1) Surgery
(2) Chemotherapy
(3) Radiation Therapy
(4) Hormone Therapy
(5) Targeted therapies
(6) Transplantation
Not all cancers can be effectively treated by surgery. However, surgery is an effective cure for many types of cancers, especially those that have not spread to other parts of the body. Cancer surgery may be the only treatment, or it may be supplemented with other treatments such as radiation, chemotherapy, hormone therapy or biological therapy 
The use of drugs or chemicals to treat cancer is called chemotherapy. These drugs target and destroy dividing cells. Because chemotherapy drugs kill dividing cells, these drugs can cause side effects, since they affect healthy body tissues where the cells are constantly growing and dividing (such as the skin, bone marrow, hair follicles and lining of the digestive system) 
Radiotherapy is the use of high-energy rays, usually x-rays and similar rays (such as electrons) to treat disease. It works by destroying cancer cells in the area that’s treated. Although normal cells can also be damaged by radiotherapy, they can usually repair themselves, but cancer cells can’t. Radiotherapy is always carefully planned so that it avoids as much healthy tissue as possible. However, there will always be some healthy tissue that’s affected by the treatment and this is responsible for the side effects associated with radiotherapy treatment  
Hormones are substances that function as chemical messengers in the body. Certain hormones such as estrogen and progesterone can stimulate the growth of some cancers (like breast cancers). Hormone therapy is used to stop or reduce the growth of these tumors by blocking the body’s ability to produce hormones or by interfering with action of hormones. Hormone therapy is used in treatment of cancers of breast, prostate and endometrium  
Immunotherapy is the process of treating cancer by enhancing the immune system of the body. A major advantage of this method is that it has no significant adverse effects  
Yes, early detection and treatment can lead to the complete cure of some cancers. Many cancer patients can return to their normal life activities during the treatment also   
The cure rate of cancers in children is usually better than adults   
Although, chemotherapy is an effective treatment for many types of cancers, it often causes side-effects as these drugs damage the healthy cells of our body. Common side-effects include:
(1) Nausea, vomiting
(2) Pain/headache, muscular aches, stomach pain, tingling and numbness of fingers and toes
(3) Sores in mouth and throat
(4) Diarrhoea or constipation
(5) Loss of appetite
(6) Fever
(7) Hair loss 
The type and intensity of side-effects vary from person to person and depends upon the location of cancer, dose of the drugs and person’s overall health. Researchers are working to identify new drugs, methods of administering the drugs and combination of existing treatments that have fewer side- effects and are better tolerated 
Hair loss related to cancer treatment is usually temporary. In most cases, hair will grow back over a period of time (usually 6-12 months). Talk to your doctor/health care team member if you are concerned about hair loss related to cancer treatment. He/she will be able to guide you regarding better management of this side effect 

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