SUMMER TRAINING REPORTONMARKET ANALYSIS OF THE REPIRATORY AND NEPHRO SEGMENTS IN INDIAN PHARMACETICAL INDUSTRY(COMPLETED IN MANKIND PHARMA)(Submitted in Partial Fulfillment of the requirement of Masters of business administration)

Submitted to: Submitted by:Dr. Meghna Sharma Ishneet walia A1802012045 MBA-IB (2nd year, third semester)

Submitted to:AMITY UNIVERSITY,Noida,Uttar Pradesh

ACKNOWLEDGEMENT

ACKNOWLEDGEMENT

No project is done without valuable assistance.It gives me great pleasure in acknowledging the invaluable assistance expended to me by various personalities in the successful completion of this report.My debts are due to many individuals who provided me with valuable guidance,advice and useful comments that helped me in the successful completion of this report.As usual the debts can be only warmly acknowledged but never fully recompensed.

I am thankful to the intire team of MANKIND PHARMA LTD for the support and guidance they have given me and specially to Mr. SANJAY KAUL, P.M.T head(product management team), MANKIND PHARMA LTD., Mr. IRFAN AHMAD, SENIOR PRODUCT MANAGER and also Ms. MEETU MULCHANDANI for their continuous motivation,teachings,encouragement and firm guidance for the successful completion of this project work for giving me this opportunity to work with MANKIND.I would also give my warm acknowledgement to my faculty guide Dr.MEGHNA SHARMA for her support and continous supervision in the completion the summer training report.

ISHNEET WALIAA1802012045SIGNATURE:

_______________________________

DECLARATION CERTIFICATE

TABLE OF CONTENTS

OBJECTIVE OF THE STUDY...6ABSTRACT...7COMPANY PROFILE.........9LITERATURE REVIEW...15INTRODUCTION...18RESPIRATORY SEGMENT........................................19NEPHRO SEGMENT...28RESEARCH METHODOLOGYRESPIRATORY SEGMENT38NEPHRO SEGMENT...49CONCLUSION AND RECOMMENDATIONS..56REFERENCES59

OBJECTIVE OF THE STUDY

Project objective: my objective is to 1. provide mankind company with the information,analysis and suggestions regarding the respiratory and uro segments for market analysis. 2. to launch a product in the coming years in the above segments as there is no product as such of the company in these segments with the help of my information provided.

ABSTRACT

ABSTRACT

This project is mainly based on the market analysis of the respiratory segments and nephrology segments in the Indian pharmaceutical industry. The project report mainly explains the meaning of respiratory and nephrology, their use, the products used under these segments, the molecules which are at good growth in the pharmaceutical industry under these segments and also the new molecules which can be launched by the Indian pharmaceutical company MANKIND PHARMA in the country.For the detailed analysis of these segments the three main softwares were taught in this regard:1. IMS HEALTH 2. PRESCIPTION AUDIT3. AIOCD(All Indian Origin Chemists & Distributors)In the report the data is collected and analysed with the above software to give an authentic analysis. Different data was collected and tables were made to make the conclusion easy and in readable form. The project will further give an idea to the company for launching new product in the Indian pharma market with the new molecules that will be taken out after the analysis.A descriptive pattern of research design has been adopted to make the meaning of the report very clear and authentic. Data description has been made for focused information.

COMPANY PROFILE

COMPANY PROFILE

Mankind Pharma ltd. is the 7thlargest Pharmaceutical Company of India, was established in 1995 with capital of 50 lakhs and only 20 employees. now, they are amongst the top 5 fastest growing Pharmaceutical companies of India with an employee base of more than 10000 and heading towards a turnover of 3000 crores. they aspire to aid the community in leading a healthy life through two parallel objectives: formulating, developing & commercializing medicines and delivering affordable & accessible medication that satisfies urgent medical needs.

Mr. R.C JUNEJA (CEO AND CHAIRMAN)

MANKIND GROUP OF COMPANIESA. PHARMACEUTICAL SEGMENT

DIVISIONLAUNCH YEAR

MANKIND PHARMA1995

DISCOVERY MANKIND2003

LIFESTAR PHARMA2005

FUTURE MANKIND2007

MAGNET2007

LIFESTAR 2 PHARMA2012

Our Mission"To support a healthy & active lifestyle through our broad portfolio of Pharma, OTC & FMCG products."Our Vision"To be amongst the top two pharmaceutical company of India by 2017-18"

B. OTC/FMCG

DIVISIONLAUNCH YEAR

SPECIAL MANKIND2007

C. ANIMAL HEALTHCARE

DIVISIONLAUNCH YEAR

VET MANKIND2007

PET MANKIND2010

With the thrust of making headway, in 2007 Mankind acquired Magnet Labs Pvt. Ltd. and marked its marketing presence in antipsychotic segment. In January 2010, Mankind acquiredLongifene, the former brand of UCB Belgium. We are further expanding the horizon of Serving Lifein Vietnam Philippines, Myanmar and other regulated and semi-regulated markets by 2015.The company has made separate divisions so that it can segregate and equally take control of each segment to achieve its goal of 3000 crores easily.PRESENCE IN OVERSEAS MARKETS

SRILANKAVIETNAMRWANDA

PHILIPPINESNEPAL

KEY SUCCESS FACTORS Disciplined sales force and streamlined marketing practices Brand building with 118 brands in market leadership position Focused doctor-centric approach A low attrition rate at half of industry levels Good presence in OTC market in premium segments like condoms, body spray, pregnancy test kit, toothbrush and artificial sweetener

INFRASTRUCTURE Manufacturing unitsFor proper supply of quality medicines they have fourteen world class manufacturing units, many of which are USDF and GMP compliant.Supply chain To cater to the ever growing market demand, they have operations into the entire length and breadth of the country. They have a wide distribution network of 6000 stockists, 61 C&F agents and field force of 8300 medical representatives and managers.Distribution officesMankind has 4 major distribution offices situated in meerut, Ghaziabad, indore and secundrabad.

R&D They have come up with R&D centre in manesar (ncr delhi). The focus areas being: API development New drug delivery system Formulation development Contract research

MANKIND POPULAR BRANDS

TOP 10 BRANDS FISCAL YEAR 2011-2012, CONSTITUTE 40% OF THE PORTFOLIO.SOURCE- COMPANY ACTUALS

THE TOP TEN BRANDS OF MANKIND PHARMA ARE AS FOLLOWS:

1. NUROKIND2. MAHACEF3. ZENFLOX4. MOXIKIND5. GUDCEF6. AMLOKIND7. GLIMSTAR8. CEFAKIND9. RANIDOM10. NOBEL

MARKET SHARE

PROGRESSION- TOP 10 COMPANIES

COMPANYMar-12Mar-08

RANK% SHARERANK% SHARE

ABBOT17.3%102.3%

CIPLA25.0%25.2%

RANBAXY34.6%35.0%

GLAXOSMITHKLINE44.0%44.7%

SUN54.0%63.3%

ZYDUS CADILA63.7%53.7%

MANKIND73.4%132.2%

ALKEM83.3%73.2%

PFIZER93.2%83.0%

LUPIN LTD.102.7%92.6%

SOURCE- IMS HEALTH MARCH 2012

LITERATURE REVIEW

LITERATURE REVIEW

The softwares used under the project are: I.M.S health Prescription audit AIOCDThese software are used to carry out the analysis for market survey.

IMS Healthis a company that provides information, services and technology for the healthcare industry. IMS Health was founded in 1954 by Bill Frohlich and David Dubow. In 2010, IMS Health was taken private by TPG Capital, CPP Investment Board and Leonard Green & Partners. IMS Healths products and services are used by companies to develop commercialization plansand portfolio strategies,to select patient and physician populationsfor specific therapies, and to measure the effectiveness of pharmaceutical marketing and sales resources.IMS Health uses its own data to produce syndicated reports such as market forecasts and market intelligence. These predict how a market in a country or therapy area will change over time. This works through the production of baseline projections of sales and the application of future events to this baseline to produce a forecast.This software was used to carry out the moving annual turnover of the molecules the brands and the company itself in this project report. It was the major part of the report that was taken into account.PRESCRIPTION AUDIT is used to carry out the total no. of prescriptions written by a doctor each day with reference to the molecules used under there prescriptions.AIOCD Pharmasofttech AWACS Pvt. Ltd. is a pharmaceutical market research company formed by All Indian Origin Chemists & Distributors Ltd. (AIOCD Ltd) in a joint venture with Trikaal Mediinfotech Pvt. Ltd.AIOCD AWACS is a pharmaceutical market research organization that has evolved into an IT infrastructure player in Pharma Distribution & Retail. With 7 different product offerings and several in the offing our aim is to cut time and improve accuracy.

AWACS in military parlance stands for Airborne Warning And Control System where it cuts time and improves accuracy of information. AWACS in AIOCD AWACS stands for Advanced Working, Action & Correction System giving our clients early & accurate information to plan strategies & win over competition. The underlying philosophy behind each of our product is to reduce time to information by 50% or more and to significantly improve on accuracy of information.

INTRODUCTION

INTRODUCTIONRESPIRATORY SYSTEM

DEFINATION OF RESPIRATORY SYSTEMRespiratory system is the set of organs which helps in the take in as well as the exchange of oxygen and carbon dioxide in between the organism and the existing environment, in the human body it includes the nasal cavity, the pharynx, the trachea, the lungs, bronchi and at last the diagraph. It includes two things: A. INHALING B. EXHALINGFUNCTION OF RESPIRATORY SYSTEMThe main function of the respiratory system of the humans is to flow the air into the lungs and to facilitate the diffusion of oxygen into the blood stream. It receives the waste of CO2 from the blood and takes it out.The respiratory system consists of the following parts, divided into the upper and lower respiratory tracts:

LOWER RESOIRATORY TRACTSTRACHEABRONCHIALVEOLIDIAGRAPHUPPER RESPIRATORY TRACTSMOUTH,NOSE,NASAL CAVITYPHARYNXLARYNX

UPPER RESPIRATORY TRACTS:

MOUTH, NASAL & NASAL CAVITY- IT IS THE FIRST PART OF THE RESPIRATORY SYSTEM WHOSE FUNCTION IS TO FILTER THE INCOMING AIR AS WELL AS TO WARM AND MOISTEN IT.

PHARYNX- IN THIS THE THROAT IS DIVIDED INTO THE TRACHEA AND ALSO THE FOOD PIPE. THE EPIGLOTTIS PREVENTS FOOD FROM ENTERING THE TRACHEA.

LARYNX- IT IS THE PART WHERE THE SOUND IS MADE OR GENERATED, IT ALSO PREVENTS THE TRACHEA BY PRODUCING A STRONG COUGH REFLEX IF BY CHANCE ANY FOOD PARTICLE OR SUBSTANCE PASSES THE EPIGLOTTIS.

LOWER RESPIRATORY TRACTS:

TRACHEA- THE OTHER NAME OF TRACHEA IS ALSO WINDPIPE, IT IS THE TUBE WHICH CARRIES THE AIR TO THE LUNGS. IT IS 10-16 CMS IN LENGTH AND 20-25 MM IN DIAMETER.THE INNER PART OF THE TRACHEA IS COVERED IN TINY HAIRS CALLED THE CILIA

BRONCHI- THE TRACHEA IS DIVIDED INTO TWO TUBES, ONE ENTERING THE LEFT LUNG AND THE OTHER ENTERING THE RIGHT LUNG. THE LEFT BRONCHI IS NARROWER, LONGER AND HORIZONTAL A COMPARED TO THE RIGHT.

ALVEOLI- ALVEOLI CONSISTS OF VERY THIN WALLS THAT ALLOWS THE EXCHANGE OF GASES,CO2 & OXYGEN. IN AN AVERAGE IN AN ADULT LUNG THERE ARE APPROXIMATELY 3 MILLION ALVEOLI

DIAPHRAGM - DIAPHRAGM IS A BROAD BAND OF MUSCLE THAT IS LOCATED BENEATH THE LUNGS, ATTACHING THE LOWER RIBS,SPINE AND THE STERUM FORMING THE BASE OF THE THORACIC CAVITY.RESPIRATORY DISEASES

It is the term used for the diseases of the respiratory segment. These include the diseases of the entire respiratory tract and also the nerves and muscles of breathing. Respiratory disease also ranges from mild as cough and cold to life threatening such as bacterial pneumonia. It includes: Inflammatory lung disease- this disease is characterized by a high neutrophil count like asthma, chronic obstructive pulmonary disease, cystic fibrosis, emphysema. Obstructive lung disease- these are the diseases of the lung which takes place when the bronchial tubes become narrow which makes it hard to move the air inside and specially out of the lung. COPD (chronic obstructive pulmonary disease)- it is the disease where the airways become damaged causing them to narrow. It is an example of the obstructive lung disease. Asthma- it is also an example of the obstructive lung disease. Restrictive lung disease- the other name of the restrictive lung disease is interstial lung disease which is characterized by the loss of lung compliance, whose causes are incomplete lung expansion and increased lung stiffness. Eg: respiratory distress syndrome. Upper respiratory tract disease- the most common disease under this segment is the common cold. Most infections of particular organs of upper respiratory tract like sinusits, otis media and laryngitis are also considered upper respiratory tract infections. Lower respirastory tract disease- the most common disease under this segment is pneumonia which is a lung infection. Pneumonia is usually caused by bacteria which is found in western countries. Tuberculosis is an important cause of pneumonia.

Malignant tumours- it is the other name for cancer in respiratory system, specially lung cancer which are a major health problem responsible for 15% of all cancer diagnoses and also 29% of cancer deaths. This tumour is caused through chewing tobacco or smoking tobacco. Benign tumours- these diseases are rare of respiratory disease. Its examples are: pulmonary hamartoma and congenital malformations. Pulmonary vascular disease- these are the diseases that effect the pulmonary circulation which is known by a blood clot in a vein which travels through the heart and lodges in the lungs (thromboembolism).

Asthma fact and fictionFiction:Older adults don't get asthma.Fact:Even though more young people get asthma, it also affects older adults.Fiction:Children outgrow asthma or asthma gets better as you get older.Fact:Children oftendon'toutgrow asthma. A child's asthma can get better or worse over time and some very young children with asthma may get much better as they (and their lungs) grow.Fiction:The steroids used in asthma will stunt growth.Fact:Large medical studies have shown that children using inhaled corticosteroids will eventually reach their normal height, although there may be very small, temporary delays in growth initially.

TREATMENT OPTIONS FOR RESPIRATORY DISEASES

DRUGS USED FOR COUGH (DRY/PRODUCTIVE)

Cough is a protective reflex, its purpose being expulsion of respiratory secretions or foreign particles from air passages. PHARYNGEAL DEMULCENTS: lozenges, cough drops, linctuses containing syrup, glycerine, liquorice.

EXPECTORANTS: a) bronchial secretion enhancers: sodium or potassium citrate, potassium iodide, guaiphenesin, balsum of tolu, vasaka,ammonium chloride.b) mucolytics: bromhexine, ambroxol, acetyl cysteine, carbocisteine

ANTITUSSIVES(COUPGH CENTRE SUPPRESSANTS): a) opioids: codeine, pholcodeine. b)nonopioids: noscapine, dextromethorphan, chlophedianol.c) antihistamines: chlorpheniramine, diphenhydramine, promethazine.

ADJUVANT ANTITUSSIVES: bronchodilators: salbutamol, terbutalin.

DRUGS USED FOR ASTHMA

Asthma is characterized by hyperresponsiveness of tracheobronchial smooth muscle to a variety of stimuli, resulting in narrowing of air tubes, often accompanied by increased secretion, mucosal edena and mucus plugging. Symptoms include dyspnoea, wheezing, cough and may be limitation of activity. BRONCHODILATORS: a) sympathomimetics: salbutamol, terbutaline, bambuterol, salmeterol, formoterol, ephedrine.b)methylxanthines: theophylline, aminophylline, choline theophyllinate, hydroxyethyl theophylline, theophylline ethanolate of piperazine, doxophylline.c)anticholinergics: ipratropium bromide, tiotropium bromide.

LEUKOTRIENE ANTAGONISTS: montelukast, zafirlukast.

MAST CELL STABILIZERS: sidium cromogycate, ketotifen.

CORTICOSTEROIDS: a)systematic: hydrocortisone, prednisolone and others.b) inhalational: beclomethasone dipionate, budesonide, fluticasone propionate, flunisolide, ciclesonide

ANTI-IGE ANTIBODY: omalizuma. LEUKOTRIENE AND CORTICOSTEROIDS ANTAGONISTS: montelukast, zafirlukast.

COMMON RESPIRATORY DISEASE IN INDIA

Most of the disease burden in rural India is due to the respiratory disorders namely asthma, bronchitis & tuberculosis (TB) and pneumonia. In low resource settings these diseases are mainly attributed with exposure to indoor pollution, solid-cooking fuels, poor housing, low nutritional status and sanitary conditions. Leading cause of death between rural male and female was highlighted in the above Table. Bronchitis and asthma recorded as leading cause, pneumonia and tuberculosis of the lungs ranked as one of the five leading causes of deaths in rural India.

FDA APPROVED DRUGS IN THERAPEUTIC AREA FOR RESPIRATORY DISEASES

These are the molecules which are not yet launched in the Indian pharma industry but have been absorbed by the foreign pharma industry.These are written year wise from 2013-2008

1. BEDAQUILINE: This molecule is used in the brand SIRTURO which is owned by janssen therapeutics and is used for the treatment of multi- drug resistant tuberculosis. It was approved in December 2012.2. LUCINACTANT: This molecule is used in the drug SURFAXIN which is owned by discovery laboratories and is used for the treatment of respiratory distress syndrome in pre mature infants. It was approved in March 2012.3. ROFLUMILAST: This molecule is used in the drug DALIRESP which is owned by forest pharmaceuticals and is is used for the treatment of chronic obstructive pulmonary disease. And was approved in February 2011.4. CEFTAROLINE FOSAMIL: This molecule is used in the brand TEFLARO which is owned by cerexa and is used for the treatment of bacterial skin infections and also bacterial pneumonia.it was approved in November 2010.5. TREPROSTINIL: This molecule is used in the product tyvaso which is owned by united therapeutics and is used for the treatment of pulmonary arterial hypertension and was approved in july 20096. CICLESONIDE: This molecule is used in the product ALVESCO which is owned by nycomed and is used in maintenance treatment of asthma as prophylactic therapy in adults and adolescents, it is approved in January 2008.The following page will indicate the molecules that can be taken into consideration by the company in order to adopt and also to grow in those molecules.

NAMEINDICATIONCATEGORYWORTH(in Cr)

2010201120122013

BEDAQUILINEPULMONARY TUBERCULOSISANTI-MICOBACTERIAL--60280

ROFLUMILASTCOPDPDE4 INHIBITOR30364686-

CEFTAROLINE FOSAMILCAP(COMMUNITY ACQUIRED , SSTI (SKIN AND AKIN STRUCTURECEPHALOSPORIN18131263-

TREPROSTINILPULMONARY HYPERTENSIONPROSTACYCLIN ANALOGUE90114321940-

THE ABOVE DATA IS COLLECTED ON THE BASIS OF COMPANY SOURCESOBSERVATION: the above molecules are those which are not yet launched in the Indian pharma industry but are showing good growth in the international market and the company can make use of these molecules in carrying out or launching new respiratory products in the Indian pharma industry.All the above molecules have been briefly explained in the previous page with their company, their brand name, their indication, their category and also their date of approval by F.D.A (Food and Drug Administration).The rest molecules have not been taken into consideration because they are categorized in the other segment that is the Cancer segment.The molecule have only be taken for the year 2013.2012,2011,2010,2009 and 2008.

NEPHRO/URO SYSTEM

Nephro means kidney in Greek. Nephrology is a speciality of medicine that concerns with the study of normal kidney function, problems related to kidney and also the treatment of kidney function. A physician who takes an additional training to become an expert in nephrology are called as NEPHROLOGIST or a RENAL PHYSICIAN.Nephrology is concerned with the treatment of kidney diseases, including hyper tension and electrotype disturbances and also the people who require therapy including dialysis or renal transplant. Most kidneys diseases are systematic disorders not limited to the organ but require special treatment.Function of Nephro system EXCRETION OF WASTES: the kidney excrete waste products through the process of metabolisim, which also includes UREA which is nitrogenous waste. The formation of urine is also a function of the kidney. Exchange by vessels carrying the supply of blood to the nephron is necessary for enabling this function.

REABSORPTION OF VITAL NUTRIENTS: Glucose at the normal plasma rate is completely absorbed in the proximal tubule.the level of plasma will fully saturate the transporters and glucose is lost in the urine.

ACID BASED HOMEOSTASIS: the kidney and the lungs are the two organ systems that maintains the ph level around a relatively stable value. The kidneys have two very important roles in maintaining the acid-base balance: to reabsorb bicarbonate from urine,and to excretehydrogenions into urine. OSMOLALITY REGULATION: an increase in osmolality that causes the glands to secrete ADH, resulting in water reabsorption by kidney and increase in the concentration of urine.

BLOOD PRESSURE REGULATION: the kidney cannot sense the blood directly but the long-term regulation of the pressure of the blood is dependent on the kidney.

HORMONE SECRETION: The kidneys secrete a variety ofhormones, includingerythropoietin, and the enzymerennin.Erythropoietinis released in response tohypoxia(low levels of oxygen at tissue level) in the renal circulation.

Observation: the above graph states that the diabetes share a very huge market of 43.8% in kidney failure diseases and after the diabetes high blood pressure comes second in this regard i.e 26.8%.DISEASES OF NEPHRO SYSTEM Acute and chronic kidney diseases: Most forms of kidney disease damage the nephron ability to filter waste and fluid from the blood. As this unwanted material builds up in the body, symptoms can include ankle swelling, fatigue, poor sleep, shortness of breath and nausea. The final stage of kidney disease is kidney failure, a potentially fatal condition in which the kidneys stop working altogether. Cystic diseases of the kidney: Cystic kidney diseaserefers to a wide range ofhereditary, developmental, andacquired conditions. With the inclusion of neoplasms with cystic changes, over 40 classifications and subtypes have been identified. Depending on the disease classification, the presentation of disease may be from birth, or much later into adult life. Cystic disease may involve one or bothkidneysand may or may not occur in the presence of other anomalies.A higher incidence of cystic kidney disease is found in the male population and prevalence increase with age. Diabetes: Diabetes mellitus, or simplydiabetes, is a group of metabolic diseases in which a person has highblood sugar, either because thepancreasdoes not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms ofpolyuria(frequent urination),polydipsia (increased thirst) andpolyphagia. Fluid and electrolyte disorders: A fluid or electrolyte disorder occurs whenever there is an imbalance in the concentration of salts within the bloodstream. The bloodstream and tissues have a specific concentration of water and natural salts important to normal body function, which include sodium, potassium, calcium, bicarbonate, and phosphate. Glomerulonephritis and glomerular diseases: Glomerular disease reduces the ability of the kidneys to maintain a balance of certain substances in bloodstream.

Hypertension: Hypertension(HTN) orhigh blood pressure, sometimes calledarterial hypertension, is achronicmedical conditionin which theblood pressurein thearteriesis elevated.This requires the heart to work harder than normal to circulate blood through the blood vessels. Kidney-related metabolic disorders: Metabolism is the sum of the chemical processes and interconversions that take place in the cells and the fluids of the body. This includes the absorption ofnutrientsand minerals, the breakdown andbuildupof large molecules, theinterconversionof small molecules, and the production of energy from these chemical reactions. Kidney stones: Akidney stone, also known as arenal calculus is a solidconcretionorcrystalaggregation formed in the kidneys from dietary mineralsin theurine. Glomerular diseases: Glomerular disease reduces the ability of the kidneys to maintain a balance of certain substances in bloodstream. B.P.H (Benign prostatic hyperplasia): it is the increase in the size of the prostate, it results in the formation of large,fairly discrete nodules in the prostate, it also leads to the obstruction of the flow of urine. BPH does not lead to cancer or in any case increase the risk of cancer. It also can be a major disease if it is lead untreated.

HYPERTENSION- A CAUSE FOR NEPHROLOGY

TREATMENT IN NEPHRO DISEASES

Treatment in nephrology are many which includes: Medications as prescribed by the doctor: these include the medications which are needed to cure the disease in case of nephrology diseases.

Surgical interventions: it includes the treatment in terms of surgery by removing or replacing the organ.

Renal replacement therapy: this therapy is a term used which is used to encompass life supporting treatments for renal failure. In context of chronic kidney disease, these treatment does not cure chronic kidney disease. In certain acute conditions or injuries resulting in failure, a person who likewise had a good response to dialysis, who got a kidney relatively quickly if indicated- and whose body did not reject the transplanted compatible kidney and who has no other significant health problems, could very well survive for many years.

Plasma exchange: the other name for plasma exchange is Plasmapheresis is the removal, treatment, and return of (components of)blood plasmafromblood circulation. It is thus anextracorporeal therapy(a medical procedure performed outside the body). The method is also used to collect plasma, which is frozen to preserve it for eventual use in the manufacture of a variety of medications. The procedure is used to treat a variety of disorders, including those of the immune system.

Kidney problems have a huge impact on length of the life, therefore, health education are the key roles in nephrology. Chronic diseases of the kidney are critically managed through the treatment of causative conditions like diabetes, avoidance of substances toxic to the kidney, anti-hyper tensives, diet and weight modification and at last the planning for end stage renal failure.Auto immune and inflammatory kidney disease can also be treated with immune suppression. The commonly used agents under these are pre dnisolone, sirolimus, mycophenolate etc. the new biological drugs are also used in these conditions. Most of the kidney or nephrology disease problemare chronic in nature and they require long-term follow-up with the nephrologist which is necessary.

STATE OF NEPHRO DISEASE IN INDIA The exact prevalence of chronic kidney disease (CKD) is not clear however , the high incidence of diabetes and heart disease in India indicate that CKD could be a silent epidemic.

25-40% of all people with diabetes and heart disease develop chronic kidney disease.Almost 50% of all CKD diseases occur due to diabetes and heart disease.

In an urban population study of 572,000 people ,incidence of End-stage-renal-disease (ESRD) ranged from 151 to 232 cases per million population.

Diabetic nephropathy was the common cause of ESRD44%

One of the key challenges patients face in India is the exorbitant cost of therapy and the availability of renal transplantation centers

It is estimated that India has approximately 100 approved centers, most of them in the private sector.In the absence of health insurance plans ,