Nephrology Treatments & Innovations
Your kidneys remove waste from your body and purify bodily fluids. When they can no longer perform their job, your physician may prescribe dialysis, which is an artificial way of filtering your bodily fluids. There are two types of dialysis: hemodialysis and peritoneal dialysis.
Hemodialysis
Hemodialysis uses a pump and external filter, called a dialyzer, to filter your fluids through your bloodstream. A tube is connected to an access port on your body, and the blood flows through the filter and back into your body.
Peritoneal Dialysis
This type of dialysis uses the lining of your stomach as a filter, with waste removal through a cleansing fluid known as dialysate. There are two types of peritoneal dialysis, and your physician can help you select the best type for your lifestyle. The main difference between Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD) is that CAPD does not use a machine and APD does. APD is often done while you sleep at night.
DMC offers dialysis treatment at multiple facilities, including DMC Sinai-Grace Hospital and our Dialysis Access Center at DMC Harper University Hospital.
The most common treatment for Kidney Stones, Extracorporeal shock wave lithotripsy (ESWL) uses shock waves from outside the body to break down large stones into smaller particles that are more easily passed through urine. Several types of ESWL devices exist, though most devices use either x rays or ultrasound.
In some cases, you may need to have your kidney removed. This kidney may be replaced with a kidney transplant procedure, or you may be able to live healthily with only one kidney.
This treatment is often used when a kidney stone is quite large or in a location that does not allow effective use of ESWL.
In this procedure, the surgeon makes a tiny incision in the back and creates a tunnel directly into the kidney. Using an instrument called a nephroscope, the surgeon locates and removes the stone. For large stones, some type of energy probe - ultrasonic or electrohydraulic - may be needed to break the stone into small pieces.
One advantage of percutaneous nephrolithotomy is that the surgeon can remove some of the stone fragments directly instead of relying solely on their natural passage from the kidney.
A nephrostomy tube is used when the normal path for your urine, through your ureters, bladder, and urethra, is blocked. A percutaneous nephrostomy is the placement of a small, flexible tube through your skin and into your kidney. It allows you to drain your urine directly from your kidney.
Ureteroscopy may be needed for stones located in your mid- and lower-ureter. No incision is made in this procedure. Instead, the surgeon passes a small fiberoptic instrument called a ureteroscope through the urethra and bladder into the ureter. Once the stone is located, it is either removed with a cage-like device or shattered with a special instrument that produces a form of shock wave.
Nephrology Conditions
The adrenal glands are approximately two and half by one inch long yellowish-orange colored glands that are found just above the kidneys. Adrenal glands provide a very important function in protecting the body against stress. This function is carried out by secretion of a number of different types of hormones by the adrenal glands.
Tumors of the adrenal glands may arise from the cortex or the medulla part of the adrenal gland. Adrenal tumors commonly present because symptoms from excess secretion of hormones by the tumor.
Adrenal tumors can be benign (non-cancerous) or malignant (cancer). Often this separation is difficult to make and long term close follow up is necessary after removal to detect recurrences early in patients who have adrenal cancer.
A condition defined by blood in your urine, hematuria can be caused by a variety of health issues. Hematuria may not be visible to the naked eye, which is why your doctor asks for a urine sample. Treatment of hematuria depends on the underlying cause.
Your kidneys remove waste products from the blood and keep the correct balance of fluid and salt in the body. Waste and extra fluid are normally flushed from the body as urine. When the kidneys are damaged waste may build up in the blood, causing symptoms.
Chronic kidney disease usually does not happen suddenly. Small changes may occur to the kidneys over several years as the disease progresses from earliest stages to a point when the kidneys may fail and dialysis may be needed.
Two major causes of kidney disease are:
- Diabetes
- High blood pressure (hypertension)
Other risk factors include:
- Family history of chronic kidney disease
- Senior citizens
- Ethnicity, especially African-Americans, Pacific Islanders, Hispanic-Americans and American Indians.
Symptoms
You may have chronic kidney disease if you are experiencing:
- Fatigue
- High blood pressure
- Blood in urine
- Frequent urination, especially at night
- Difficult or painful urination
- Puffiness around the eyes
- Swelling of hands and feet
Advanced signs of the disease can include:
- Nausea and vomiting
- Loss of appetite and change in taste
- Hiccups
- Weight loss or gain
- Abnormal bleeding
- Trouble sleeping
- Shortness of breath, frequent cough
- Swelling
- Muscle cramps
- Itching
Treatment
It is important to identify and treat kidney problems early to help prevent the progression of kidney disease to kidney failure. If you are diagnosed with chronic kidney disease, learning about the disease can help you keep your kidneys healthy. You may want to ask your doctor the following questions:
- What percent of kidney function do I have now?
- What is the cause of my kidney problem?
- What can I do to keep my kidneys working as long as possible?
- What treatment is available for my symptoms?
- What are the next steps for my treatment?
To keep your disease in check, you should:
- Keep blood pressure within a healthy range
- Control blood sugar levels, especially if you have diabetes
- Limit protein in your diet
- Consult your doctor about an exercise program
- If you smoke, quit
- Visit your doctor for regular checkups
Renal, or kidney, failure can be acute or chronic in nature.
Acute renal failure is a sudden stop in the normal function of your kidneys, and is different than chronic (long term) renal failure. Since your kidneys remove waste from your body, this means waste may buildup in your body, causing problems. It can be caused by a drop in blood flow to our kidneys, a sudden blockage in your urinary tract, or damage from medicine, a poisons, or even an infection (like a UTI).
Chronic renal failure does not happen suddenly and is diagnosed after your kidneys stop functioning normally for an extended period of time. It can be caused by uncontrolled high blood pressure, high blood sugar, vascular problems, kidney disease, and more.
Symptoms
- Little or no urine when you try to go
- Swelling in your legs and/or feet
- Nausea and/or vomiting
- Back pain
- Feeling tired and/or sleepy
- Trouble thinking clearly
Treatment
A doctor may focus on treating the underlying cause of kidney failure, such as high blood pressure or an infection like a UTI. Your doctor may prescribe antibiotics to prevent an infection from spreading, or to prevent you from getting a new infection. Dialysis may be needed in some cases.
Kidney stones, one of the most painful of the urologic disorders, are one of the most common disorders of the urinary tract. Most kidney stones pass out of the body without any intervention by a physician. Stones that cause lasting symptoms or other complications may be treated by various techniques, many of which do not involve major surgery.
A kidney stone is a hard mass developed from crystals that separate from the urine within the urinary tract. Normally, urine contains chemicals that prevent or inhibit the crystals from forming. These inhibitors may not work for everyone, however, so some people form stones. If the crystals remain tiny enough, they will travel through the urinary tract and pass out of the body in the urine without being noticed.
Kidney stones may contain various combinations of chemicals. The most common type of stone contains calcium in combination with either oxalate or phosphate. These chemicals are part of a person's normal diet and make up important parts of the body, such as bones and muscles.
A less common type of stone is caused by infection in the urinary tract. This type of stone is called a struvite or infection stone. Another type of stone, uric acid stones, is a bit less common, and cystine stones are rare.
Urolithiasis is the medical term used to describe stones occurring in the urinary tract. Other frequently used terms are urinary tract stone disease and nephrolithiasis. Doctors also use terms that describe the location of the stone in the urinary tract. For example, a ureteral stone - or ureterolithiasis - is a kidney stone found in the ureter.
Gallstones and kidney stones are not related. They form in different areas of the body. Someone with a gallstone is not necessarily more likely to develop kidney stones.
Doctors do not always know what causes a stone to form. While certain foods may promote stone formation in people who are susceptible, scientists do not believe that eating any specific food causes stones to form in people who are not susceptible.
A person with a family history of kidney stones may be more likely to develop stones. Urinary tract infections, kidney disorders such as cystic kidney diseases, and certain metabolic disorders such as hyperparathyroidism are also linked to stone formation.
Types and Causes of Stones
Cystinuria and hyperoxaluria are two other rare, inherited metabolic disorders that often cause kidney stones. In cystinuria, too much of the amino acid cystine, which does not dissolve in urine, is voided, leading to the formation of stones made of cystine. In patients with hyperoxaluria, the body produces too much oxalate, a salt. When the urine contains more oxalate than can be dissolved, the crystals settle out and form stones.
Hypercalciuria is inherited, and it may be the cause of stones in more than half of patients. Calcium is absorbed from food in excess and is lost into the urine. This high level of calcium in the urine causes crystals of calcium oxalate or calcium phosphate to form in the kidneys or elsewhere in the urinary tract.
Other causes of kidney stones are hyperuricosuria, which is a disorder of uric acid metabolism; gout; excess intake of vitamin D; urinary tract infections; and blockage of the urinary tract. Certain diuretics, commonly called water pills, and calcium-based antacids may increase the risk of forming kidney stones by increasing the amount of calcium in the urine.
Calcium oxalate stones may also form in people who have chronic inflammation of the bowel or who have had an intestinal bypass operation, or ostomy surgery. People who take the protease inhibitor indinavir, a medicine used to treat HIV infection, may also be at increased risk of developing kidney stones.
Symptoms
Kidney stones often do not cause any symptoms. Usually, the first symptom of a kidney stone is extreme pain, which begins suddenly when a stone moves in the urinary tract and blocks the flow of urine. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur. Later, pain may spread to the groin.
If the stone is too large to pass easily, pain continues as the muscles in the wall of the narrow ureter try to squeeze the stone into the bladder. As the stone moves and the body tries to push it out, blood may appear in the urine, making the urine pink. As the stone moves down the ureter, closer to the bladder, a person may feel the need to urinate more often or feel a burning sensation during urination.
If fever and chills accompany any of these symptoms, an infection may be present. In this case, you should contact a doctor immediately.
Treatment
Fortunately, surgery is not usually necessary. Most kidney stones can pass through the urinary system with plenty of water - 2 to 3 quarts a day to help move the stone along. Your doctor may ask you to save the passed stone(s) for testing.
Lifestyle changes, such as drinking more water, are an easy treatment for kidney stones. Staying hydrated can also prevent future stones. Depending on the type of stone you have, your doctor may recommend avoiding certain foods or nutritional supplements.
Medication may be prescribed to treat certain types of kidney stones. Examples of this are allopurinol, which can help with stones from hyperuricosuria.
Surgery may be needed to remove a kidney stone if it:
- does not pass after a reasonable period of time and causes constant pain
- is too large to pass on its own or is caught in a difficult place
- blocks the flow of urine
- causes an ongoing urinary tract infection
- damages kidney tissue or causes constant bleeding
- has grown larger, as seen on follow-up x rays
Kidney Swelling is also known as nephritis, and can be either acute or chronic.
Acute nephritic syndrome is a group of disorders that cause inflammation of the internal kidney structures. It is often caused by an immune response triggered by an infection or other disease, and may be associated with the development of high blood pressure, inflammation of the spaces between the cells of the kidney tissue, and acute kidney failure.
The inflammation disrupts the functioning of the glomerulus, which is the part of the kidney that controls filtering and excretion. This disruption results in blood and protein appearing in the urine, and a buildup of excess fluid in the body. Swelling results when protein is lost from the blood stream. Blood loss from the damaged kidney structures leads to blood in the urine.
Chronic Nephritis is a long term, inflammation of the tissues of the kidney that can be caused by a wide variety of reasons. It is frequently associated with a slow, progressive loss of kidney function. This loss of kidney function is usually discovered accidentally, either by routine urinalysis (tests done to check kidney function) or during a routine physical checkup when anemia, hypertension, or laboratory findings are discovered.
Symptoms
- Blood in the urine (urine appears dark, tea colored, or cloudy)
- Blurred vision
- Decreased urine volume (little or no urine may be produced)
- General aches and pains ( joint pain, muscle aches)
- General ill feeling (malaise)
- Headache
- Slow, sluggish, lethargic movement
- Swelling of the face, eye socket, legs, arms, hands, feet, abdomen, or other areas
Treatment
Treatments for both acute and chronic nephritis depend on the underlying cause of the inflammation.
Protein in your urine almost always comes from an issue with your kidneys. Proteinuria is diagnosed with a laboratory test, so your doctor may ask for a urine sample. Treatment will depend on the cause of the kidney damage and any other medical conditions you may have.
More common in women than men, urinary tract infections (UTI’s) can be quite painful. Fortunately, they are preventable and easy to treat. They are caused by bacteria in your urinary tract. Usually the infection is in your bladder or urethra, though your kidneys can become infected as well.
Symptoms
- Pain and/or burning during urination
- Increased urge to urinate
- Blood in urine
- Pelvic and/or back pain
- Nausea and/or vomiting
- Fever
Treatment
Urinary tract infections are most commonly treated with antibiotics. See a doctor if you think you have a UTI – infections can cause lasting damage, including kidney failure.
