Nephrology 

Definition:

Nephrology is a branch of internal medicine that deals with the study of the function and diseases of the kidneys.

Patient Services:

• The Renal Unit provides a full range of services for adult patients with renal diseases, including the diagnosis and management of acute renal failure, chronic renal disease and nephritic/nephrotic syndrome.
• The unit cares for all renal transplant patients starting from as early as 10 days after the transplant.
• Provides regular dialysis therapy in the form of haemodialysis or peritoneal dialysis.
• Provides extra-corporeal blood purification to patients with intoxication or autoimmune disease.

Who sees a nephrologist?

Patients are referred to nephrology specialists for various different reasons, such as:

• Acute renal failure (a sudden loss of renal function).
• Chronic renal failure.
• Haematuria (blood loss in the urine).
• Proteinuria (the loss of protein, especially albumin, in the urine).
• Kidney stones.
• Cancer of the kidney, mostly renal cell carcinoma, but this is usually the domain of the urologist.
• Chronic or recurrent urinary tract infections.
• Hypertension that has failed to respond to multiple forms of anti-hypertensive medication or that could have a secondary cause.
• Electrolyte disorders or acid/based imbalances.
• Diseases of the bladder and the prostate such as malignancy, stones or obstructions in the urinary tract.

Diagnosis:

Laboratory tests are almost always aimed at urea, creatinine, electrolytes, and urinalysis, which are frequently the key tests when searching for a diagnosis. More specialised tests can be ordered to discover or link certain systemic diseases to kidney failure such as hepatitis b or hepatitis c, lupus serologies, paraproteinemias (amyloidosis or multiple myeloma) or various other systemic diseases that lead to kidney failure. Collection of a 24-hour sample of urine can give valuable information on the filtering capacity of the kidney and the amount of protein loss in some forms of kidney disease. However, 24-hour urine samples have recently, with regard to chronic renal disease, been replaced with spot urine ratios of protein and creatinine.

Other tests often performed by nephrologists are:

• Renal biopsy - to obtain a tissue diagnosis of a disorder when the exact nature or stage remains uncertain.
• Ultrasound scanning of the urinary tract and occasional examinations of the renal blood vessels.
• CT scanning when mass lesions are suspected. CT scans also help diagnose nephrolithiasis.

Therapy:

• Insertion of temporary peritoneal dialysis catheters.
• Insertion of temporary internal jugular/subclavian/femoral catheters for haemodialysis.
• Conducting slow dialysis therapy CAVHD/CVVHD.
• Plasmapheresis.
• Charcoal haemoperfusion to remove toxins.
• Renal biopsy under ultrasound guidance.
• Other general medical procedures (ascitic/pleural fluid aspirate, lumbar puncture, bone marrow aspirate, etc.).

Location of Service:

The Renal Unit is located on the 9th Level of the East and Central wings and holds 42 beds plus an additional 4 beds in the West wing.

The unit holds daily ward rounds dedicated to providing inpatient care.