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Deaconess Clinic

Conditions & Services

Deaconess Clinic Nephrology provides specialized care for patients with a variety of kidney disorders and diseases. Our physicians and staff will work with you to find the best treatment and resources. Below are some of the procedures and services we offer as well as descriptions of some of the conditions we treat. Our physicians also see dialysis patients as well as educate patients on potential kidney replacement therapies is at the end stage of renal failure.


Management of Procedures and Services 

  • Continuous renal replacement therapy
  • Erythropoiesis-stimulating agent (ESA) injections
  • Hemodialysis
  • Home hemodialysis
  • Iron infusion
  • Kidney biopsy
  • Peritoneal Dialysis
  • Plasmapheresis
  • Ultrafiltration

 
Conditions We Treat

Acute Kidney Injury:
Acute Kidney Injury (AKI), the sudden loss of kidney function, is a common complication of medical illness and surgical procedures.  It frequently affects patients with chronic kidney disease, elderly, diabetes, heart diseases (like heart failure, blocked arteries.) The occurrence of AKI in patients with CKD often lead to progressive worsening of kidney function while there is a temporary and/or permanent loss of kidney function in patients with previously normal kidney function.  AKI is significant risk factor for chronic kidney disease later in life.

Resource: Mayo Clinic on Acute Kidney Failure
 
 
Anemia of Kidney Disease:
Kidneys Anemia is one of the complications of kidney failure in which the body has below normal level of red blood cells (RBCs.)  The RBC contains hemoglobin which is a protein that carries oxygen to tissues and organs throughout the body. The ability of the RBCs to deliver needed oxygen to vital organs, such as brain, heart, and the kidneys, is reduced in the setting of anemia.  The functions of these organs may be compromised as a result of anemia. Anemia worsens as the kidney failure progresses. Diseased kidneys may not produce enough of the main hormone (called erythropoietin, EPO) that regulates RBCs production. Iron and vitamin deficiencies along with inflammation and poor nutritional status are other problems that are common in patients with kidney failure that worsen anemia.

Resource: National Kidney and Urologic Diseases Information Clearinghouse on Anemia
  
Chronic Kidney Disease:
Chronic kidney disease (CKD) is the gradual loss of kidney function. The kidneys are two bean-shaped organs located below the rib cage in the back of the abdomen, on both sides of the spine. They are as big as a clenched fist in adult, contain about a million nephrons (“filtering, functional units”) that filter out unused water and wastes from the body. The kidneys also make hormones for healthy bones and good blood count. CKD is a gradual loss of kidney function in the setting of conditions such as diabetes, high blood pressure (hypertension,) inflammation (in systemic lupus, glomerulonephritis), chronic kidney/bladder obstruction (with kidney stones and enlarged prostate,) and kidney infection. This progressive loss of kidney function occurs over months to years and it might also be due to inheritable conditions (polycystic kidney disease, nephrotic syndrome) as well.

With gradual loss of kidney function, patients may develop anemia (low blood count), poor nutritional health, nerve problem, high blood pressure, bone disease, and heart diseases. The detection of kidney disease is done by simple tests such as blood test for creatinine to calculate the estimated glomerular filtration rate, urine test to check for blood and protein, and blood pressure measurement.

The SYMPTOMS of CKD usually occur late in the disease stage which underlies the importance of early diagnosis and management. The common symptoms include:
  • Loss of appetite
  • Nausea and/or vomiting
  • Swelling of the face, legs
  • Decrease energy level
  • Itchy skin
  • Loss of concentrating ability
  • Restless leg during sleep
  • Waking up several time at night to urinate
  • Abnormal taste or unpleasant taste that will not go away

The increased risk of developing kidney disease is often seen among individual with the following characteristic:
  • Ethnicity with high prevalence of diabetes, hypertension such as Hispanic Americans, American Indians, Asian and Pacific Islanders, and African Americans.
  • Family history of CKD
  • Hypertension
  • Diabetes
 
Chronic Kidney Disease -Mineral and Bone Disorder (CKD-MBD):

CKD-MBD is also known as Renal Osteodystrophy, renal bone disease. CKD-MBD is one of the complications associated with kidney failure. It occurs as the kidney failure progresses and fails to maintain proper levels of calcium, phosphorus, and vitamin D.  The resultant effects are abnormal hormone levels, thin and weak bones, bone and joint pain, and risk of bone fracture.

Resource: The National Kidney and Urologic Diseases Information on Mineral and Bone Disorder

Diabetic Nephropathy:
Diabetes is the most common cause of kidney failure. Poor control of diabetes along with hypertension are particularly worrisome combination that often lead to kidney failure.  Hispanic American, Native American, and African American are at a higher risk of developing worsening diabetic nephropathy. It may take an average of 10 years of diabetes before the kidney problems ensue, but there are likely preceding problems such as diabetic retinopathy (diabetes affecting the eyes) that occur before the onset of diabetic kidney problems. The earliest sign of diabetic nephropathy is proteinuria (protein in the urine.)  Optimal blood sugar control, lowering BP and control of proteinuria are mainstay of therapy.

Resource: WebMD on Diabetic Nephropathy
 
Electrolyte and Acid/Base Disorders:
Electrolytes
Electrolytes, such as sodium, potassium and calcium are minerals in the blood.  Electrolytes along with acid and the base in the blood help to maintain fluid balance, appropriate chemical and cell function. The imbalance of acid/base as well as electrolytes can cause mild symptoms such as irritability, fatigue and nausea. Severe symptoms due to uncorrected and worsened imbalance may include muscle spasm, drop in blood pressure, seizure, irregular heartbeat, muscle breakdown, and paralysis.   

End Stage Renal Failure:
End Stage Renal Failure (ESRF) is the complete loss of kidney function requiring replacement therapies and is the last stage of the chronic kidney disease. This is when the kidneys are no longer removing excess fluid and waste from the body. Patients with CKD who have been seeing nephrologists regularly should have been educated on available options for kidney replacement therapy such as kidney transplant, hemodialysis, and or peritoneal dialysis. More than 400,000 adult Americans are on dialysis and about 180,000 have functioning kidney transplants. 
 
The common symptoms include the following:
  • Loss of appetite
  • Nausea and/or vomiting
  • Swelling of the face, legs
  • Decrease energy level
  • Itchy skin
  • Loss of concentrating ability
  • Restless leg during sleep
  • Waking up several time at night to urinate
  • Abnormal taste or unpleasant taste that will not go away
 
Our doctors, as a part of a multi-disciplinary team that includes nurse practitioners, registered nurses, dietician, and office personnel, will provide specialized medical care to manage associated complications such as bone disease, hypertension, and anemia, fluid overload.  We also educate our patients and families on available options that are available for kidney replacement therapies (hemodialysis, peritoneal dialysis, and kidney transplant.)

Resource: National Kidney Disease Education Program on End Stage Renal Failure


Glomerulonephritis:
Glomerulonephritis is a selective inflammation of the kidney “filtering, functional units.”  It can develop suddenly or its cause may be chronic (slow) in nature. It may be an isolated disease entity where the inflammation is limited only to the kidney. Or it could be part of a systemic disease where the kidneys are affected along with multiple organs in the body as in systemic lupus and vasculitis. Proteinuria (protein in urine,) hematuria (blood in urine) and edema (swelling) are the hallmarks of the symptoms. Progressive decline in kidney function along with hypertension are associated complications. Patient may need kidney biopsy for informed decision making on diagnosis, therapy, and prognosis.

Resource: National Kidney Foundation on Glomerulonephritis
 
 
Hematuria:
Hematuria is the presence of blood in the urine. The blood can get into the urine from any site (kidney, ureter, bladder, prostate and urethra) along the urinary tract. Visible blood in the urine usually prompts medical attention.  Invisible (to the naked eye) blood in the urine (but visible under microscope) is often found incidentally during routine medical evaluation.

Resource: National Kidney and Urologic Diseases Information Clearinghouse on Hematuria
 
 
Hypertension:
Hypertension Hypertension means high blood pressure. Blood pressure is a measurement of the force of the blood that pushes against the wall of the blood vessels. Hypertension may be due to inherited genes and/or secondary to other systemic diseases. In some instances, hypertension occurs due to too much fluid in the blood vessels and/or as result of stiff, narrow or clogged blood vessels. Overtime, uncontrolled hypertension makes the heart to work too hard to pump blood to vital organs in the body. This process subsequently leads to damage of the blood vessels, decreased blood flow or too high blood pressure in the vital organs which can lead to organ failure such as kidney failure, stroke and heart attack. Damaged blood vessels in the kidney and hence kidney failure often lead to inefficient excess fluid and wastes removal by the kidney. The resultant accumulated fluid in the body lead to worsening high blood pressure.

Resource: National Kidney and Urologic Diseases Information Clearinghouse on Hypertension
 
Kidney Disease During Pregnancy:
During pregnancy, women may be at an elevated risk for kidney disease. Talk to your OB/GYN and consult a nephrologist if you are at risk or exhibiting signs.


Kidney Stone:
A kidney stone is formed when the substances that are normally found in the urine become too highly concentrated.  Kidney stones are one of the most common disorders of the urinary tract. More than a million visits to health care providers and hundreds of thousands of visits to the emergency room per year had been reported to be due to kidney stones.  A kidney stone may stay in the kidney while other small stones may travel down the urinary tract without causing pain. Larger stone may obstruct the urinary tract causing infection, blood in the urine, abdominal and back pain.  

Resource: National Kidney and Urologic Diseases Information Clearinghouse on Kidney Stones
 
Kidney Transplant:
Kidney transplant is the process of removing healthy kidney from a healthy volunteer and surgically placing it into the body of a patient with kidney failure. The donated kidney can come from anyone—someone who recently died (deceased donor,) or from a living person (spouse, family member, friend, relative, stranger.)  Kidney transplant is not for everyone. Some patients may have conditions that are not suitable for successful surgery. Kidney transplant is one of the many ways to treat kidney failure, but it is not a cure.  Patients still need to take life-long anti-rejection medications and regularly see their nephrologists.

Resource: National Kidney Disease Education Program on Kidney Transplants

 
Polycystic Kidney Disease:
PCKDPolycystic Kidney Disease (PKD) is a genetic abnormality which is often characterized by the development of numerous pouches (cysts) in the kidneys.  It is a common disorder that leads to profound enlargement of both kidneys due to the presence of cysts replacing normal kidney tissues. Patient may suffer from back pain, urinary tract infection, hematuria, and uncontrolled hypertension. The cystic enlargement of the kidneys lead to progressive kidney failure in about 60% patients with PKD. More than 500,000 people in the United States have PKD, which is the fourth leading cause of kidney failure.  Patients with PKD may also have cysts and problems in other organs such as liver, colons, pancreas, heart, and blood vessels in the brain.

Resource: National Kidney and Urologic Diseases Information Clearinghouse on Polycystic Kidney Disease


Proteinuria/Edema:
Proteinuria is leakage of blood protein into the urine due to damage to the kidney.  The reduced levels of blood protein often lead to passage of fluid from the blood to the surrounding tissues. Edema is swelling that is caused by the trapping of excess leaked fluid from the blood into the surrounding tissues. Swelling that is due to proteinuria is usually seen in the face (around the eyes) and legs but can occur anywhere in the body.

Resource: National Kidney and Urologic Diseases Information Clearinghouse on Proteinuria
 
 
Urinary Tract Infections and Obstructions:
Urinary Tract infections and obstructions can be painful and potentially dangerous. The urinary tract is a tube connecting the kidney to the bladder. If infected, bacteria can spread into the bladder and/or kidneys. Infection should be treated as soon as possible so as to stop potential spreading. An obstruction blocks the flow of urine from the kidneys to the bladder. This also should be treated immediately.