Dr. E. Ravi

Critical care nephrology

Management of acute kidney injury (AKI) in ICU and high-dependency settings — identifying AKI aetiology (prerenal, intrinsic, obstructive), fluid resuscitation and avoidance of fluid overload, nephrotoxin avoidance, and renal replacement therapy initiation in critically ill patients.

• AKI aetiology workup — sepsis-AKI, contrast nephropathy, post-surgical AKI, cardiorenal and hepatorenal syndrome
• CRRT initiation and prescription in haemodynamically unstable patients — CVVH, CVVHD, CVVHDF
• Emergency management of hyperkalaemia, severe metabolic acidosis and pulmonary oedema
• Collaboration with the KIMS ICU and critical care team for multi-organ failure cases with AKI

Interventional nephrology

Dr. Ravi's specific subspecialty interest within nephrology. Interventional nephrology covers the range of invasive nephrology procedures:

• Tunnelled dialysis catheter (permacath) placement — right and left internal jugular approach, for long-term dialysis access in patients without a functional AV fistula
• Native kidney biopsy — percutaneous ultrasound-guided renal biopsy for glomerular disease diagnosis, optimising biopsy approach, sample adequacy and complication management
• Transplant kidney biopsy — for surveillance, rejection evaluation and calcineurin inhibitor nephrotoxicity assessment
• Non-tunnelled temporary dialysis catheter placement — for acute haemodialysis initiation

Kidney transplant

Transplant physician care — from pre-transplant recipient workup through long-term post-transplant follow-up, including ABO-incompatible transplant recipients.

• Pre-transplant recipient workup and medical clearance
• Post-transplant immunosuppression management and drug level monitoring
• Surveillance biopsy interpretation
• Rejection management — acute cellular and antibody-mediated rejection
• Long-term post-transplant complications — infection (CMV, BK virus, tuberculosis), post-transplant hypertension, and calcineurin inhibitor nephrotoxicity

Dialysis modalities

• Haemodialysis (HD) — acute and maintenance, with dialysis adequacy assessment and prescription modification
• Continuous renal replacement therapy (CRRT) for critically ill patients
• Sustained low-efficiency dialysis (SLED)
• Peritoneal dialysis — CAPD and CCPD

Glomerular diseases

Diagnosis and management of the glomerulonephritides, with kidney biopsy correlation and immunosuppressive protocol management. He presented a paper on C4d staining in allograft biopsies at ISOT (Indian Society of Organ Transplantation) — reflecting a specific academic interest in the immunological basis of transplant rejection.

• IgA nephropathy, FSGS, membranous nephropathy and minimal change disease — including nephrotic syndrome presentations
• Lupus nephritis and ANCA-associated vasculitis
• Kidney biopsy correlation and immunosuppressive protocol management
• Post-transplant glomerulonephritis recurrence management