Let's delve into the journey of Dr. Janak Giridhar an esteemed Nephrologist whose dedication to the field is transforming the lives of countless individuals. He completed his MBBS (2006–2012) as well as M.D. in General Medicine from Amrita Institute of Medical Sciences (2013–2016), and DM in Nephrology from Government Medical College, Trivandrum (2018–2021). He is presently practicing as a Consultant nephrologist at PRS Hospital, Trivandrum, Kerala, India. Here, Dr. R Janaki engages in an enlightening conversation with Dr. Janak Giridhar.
Dr. R Janaki: Welcome to a DocScopy session with MedBound Times. Before starting the interview, can you please introduce yourself to our readers?
Dr. Janak Giridhar: Hello everyone, I’m Dr Janak Giridhar, a consultant nephrologist, working in a private hospital in Trivandrum, Kerala.
Dr. R Janaki: Can you guide us through your journey into becoming a nephrologist? What inspired you?
Dr. Janak Giridhar: Right from my MBBS days, I was drawn to the way the kidney functions, and how it manages to support the body with the removal of toxins, balancing the body’s pH, electrolyte, and fluid status. It was my favorite subject and I used to take a lot of pain to go through these topics in depth. I felt that to be able to prescribe and manage disturbances concerning these aspects of a patient's ailment would be cool. Through my post-graduate training in Internal Medicine, I found Nephrology to be more challenging as well as appealing. So, I continued to aspire to pursue this. Notably, this area is often taken care of by other specialists, especially Intensivists in the Intensive care unit as well. One of the few organs that may be transplanted are the kidneys, and in doing so a person who has been a victim of a longstanding morbid disease, requiring frequent dialysis, may even be cured from the otherwise irreversible debilitating state.
Dr. R Janaki: What are the key responsibilities and duties of a nephrologist in your daily practice?
Dr. Janak Giridhar: There are mainly three key responsibilities of a nephrologist firstly, to prevent the progression of disease and treat the acute conditions, secondly, to continue the care of patients having end-stage kidney disease with medicines, dialysis, and/or transplant and thirdly, the most attractive aspect would be to provide cure to those possible. A definitive cure in the form of a transplant can only be offered to a fraction of patients who have a good functional status, relatively preserved health, and are not very advanced in age. Care of any dialysis-requiring patient would mean, placing and maintaining the catheter with which dialysis is done, depending on the type of dialysis; further, deciding the dose, and requirement and maintaining the frequency as assessed to achieve optimal results.
Dr. R Janaki: What does a typical day look like for a Nephrologist?
Dr. Janak Giridhar: A typical day in the life of a nephrologist would consist of dialysis rounds, in-patient rounds, and out patient practice. We start our day by seeing patients undergoing dialysis in the dialysis unit, addressing key issues that may arise. Patients who suffer from immediate damage to normally functioning kidneys, or to those with already diseased kidneys, even those kidney patients with other medical issues, and those requiring emergency intervention are admitted to the wards or Intensive care unit as per requirement. Rarely, some patients post-transplant may also get admitted. These comprise of patients who need to be seen during In-patient rounds. In my out-patient practice, patients with kidney disease across stages 2-5 come. Our main aim is to focus on those with stage 2-3 that may still respond to treatment medically, the rest may require other supportive therapy in the form of dialysis or even transplant, in addition to medications.
Dr. R Janaki: What are some common kidney-related conditions that you encounter in your practice, and how do you approach their diagnosis and treatment?
Dr. Janak Giridhar: When we look into a patient suffering from a disease, we try to find out for how long the patient has been suffering from the said ailment, whether is it reversible or not, and will the patient benefit from any treatment. Among the various kidney diseases, the ones afflicted by uncontrolled sugars or high blood pressure are the ones that are common. However, these do not have any particular therapies for cure, only those supportive treatment modalities that can slow down the disease progression. Some disease conditions which occur as a result of autoimmune conditions, for instance, systemic lupus erythematosus or “lupus”, we can prescribe certain medicines to curb the self-destructive activity of the immune system, thereby reducing the kidney damage and even partially correcting the damage incurred. Alternatively, there are situations when patients develop a relapse or may not respond effectively and continue to progress, but with suitable treatment measures, we can achieve the feat of putting a brake. So, the treatment varies as per the disease.
Dr. R Janaki: How do you stay updated with the latest advancements and research in the field of nephrology?
Dr. Janak Giridhar: It is imperative that a doctor should be well-informed about the latest developments. Conventionally, we attend a number of conferences and webinars focused on continuing medical education across the globe, in a particular specialty, in a given year, in addition to going through various articles, journals, etc. These days, with advancements in digital technology, even social media, particularly, Twitter; following relevant Twitter accounts of esteemed specialists helps us in keeping updated regarding landmark studies and trials.
Dr. R Janaki: What are some of the challenges that nephrologists face in their profession, and how do you overcome them?
Dr. Janak Giridhar: Nephrology is also termed as an objective specialty, which means that we rely on laboratory parameters, for instance, urine analysis, blood urea, creatinine levels, and ultrasound of kidneys to diagnose a patient with kidney disease.
The symptoms and signs that you see in other conditions do not appear in the early stages. eGFR can be expanded to the estimated glomerular filtration rate, which is taken as a representation of kidney function.
Most patients who come to us with swelling of their feet or high blood pressure have creatinine levels of 3 or 4, which reflects an eGFR of 20-30, by which time its quite irreversible, and at this point, we can only try to slow down the progress. It’s very rare for patients to come to us at stage 2 or 3 when the eGFR is higher, and some of them who lose proteins in urine can actually reverse the damage to an extent at this stage with medicines. This is the biggest challenge that nephrologists face.
Dr. Janak Giridhar: Nephrology is also termed as an objective speciality, which means that we rely on laboratory parameters, for instance, urine analysis, blood urea, creatinine levels, ultrasound of kidneys to diagnose a patient with kidney disease. The symptoms and signs that you see in other conditions do not appear in early stages. eGFR can be expand to estimated glomerular filtration rate, which is taken as a representation of kidney function. Most patients who come to us with swelling of their feet or high blood pressure, have a creatinine levels of 3 or 4, which reflects an eGFR of 20-30, by which time its quite irreversible and at this point we can only try to slow down the progress. It’s very rare for patients to come to us at stage 2 or 3 when the eGFR is higher, and some of them who lose proteins in urine can actually reverse the damage to an extent at this stage with medicines. This is the biggest challenge that nephrologist face.
Dr. R Janaki: Can you discuss the importance of early detection and prevention of kidney diseases? What advice would you give to individuals to maintain kidney health?
Dr. Janak Giridhar: As mentioned earlier, early detection through mere symptoms is mostly unlikely, hence, we focus on those with major risk factors that can make them prone to kidney diseases. Especially those with high sugars, high blood pressure, kidney stones, recurrent infections, autoimmune like lupus, heart diseases especially coronary disease, and significant family history.
Diabetes is the leading cause of across the world, about 80%, therefore, any patient with high sugars should be checked for kidney dysfunction. Those with type 1 Diabetes can wait for up to 5 years to be checked from the time of diagnosis. Some common tests that are done to evaluate are blood urea, creatinine followed by urine protein, red and white blood cells, and subsequently, ultrasound to detect any abnormality, infection, size, stones in kidneys, urinary tract, or bladder, or any obstruction in the tract. If all three are normal then most nephrologists with 90-95% certainty can say that the kidneys are normal.
Majority of the kidney diseases are due to lifestyle problems, hence, having a healthy diet, a good workout routine lasting for 120-150 minutes per week, as well as some lifestyle adjustments to stop smoking, avoiding alcohol as much as possible, to reduce unchecked rampant intake of over the counter pain medicines to name a few. It is essential for people of all age groups to adhere to these. Those who suffer from high blood sugar or blood pressure, should be compliant with their medicines and maintain the numbers within limits. Especially those with kidney disease to retard progression. Those at risk, with normal kidneys, may need only a yearly check-up, depending on person to person.
Dr. R Janaki: What advice would you give to medical students and residents aspiring to specialize in nephrology?
Dr. Janak Giridhar: Nephrology is basically an extension of internal medicine along with dialysis and kidney transplants. I consider it much easier compared to other branches of medicine, as an in-depth knowledge of internal medicine itself goes a long way in practice. We do deal with patients, a lot of whom require long-term dialysis, a few who may get cured with a transplant, and some who may even be easily treated. Each of these patients goes through a lot of hardships and we do, sometimes, find it difficult to navigate through these challenges.
MedBound Times expresses sincere gratitude to Dr. Janak Giridhar for sharing his valuable insights on our platform.