What is renal medicine?
Renal medicine is the area of medicine that deals with problems related to the kidneys. The kidneys are bean-shaped organs, approximately 10 cm in size, found in the abdomen. The right kidney is often slightly larger than the left.
The kidneys have many different functions within the body. They produce urine and remove toxins from the body, but they also help control blood pressure and blood cells. They are also important in regulating the health of bones and vitamin D.
What are the most common conditions seen in renal medicine?
There are many conditions that may affect the kidney. They can be divided into those that damage the kidney over a short period of time (hours-days), known as ‘acute kidney injury’, or those that cause damage over a long period of time (months-years), known as ‘chronic kidney disease’ (CKD).
Acute kidney injury
A wide range of things can cause acute kidney injury. The most common is not having enough blood supply to the kidney. This is caused by conditions such as dehydration, severe infection (sepsis), blood loss or very low blood pressure. There are also medicines that may damage the kidney, such as ibuprofen or other anti-inflammatories, certain antibiotics like gentamicin, and even some blood pressure medications. These are more likely to cause damage if there is already an underlying kidney problem.
The kidney may also be damaged if there is something blocking the urine from leaving the kidney, such as a kidney stone. It is also possible for the kidney itself to become infected – this is known as pyelonephritis.
In some cases, other medical conditions such as heart problems can cause a problem with the kidneys, and there is sometimes a risk to the kidneys after major surgery.
Symptoms of an acute kidney injury can include nausea, diarrhoea, producing less urine than usual and confusion. It is possible for acute kidney injuries to develop into chronic kidney problems.
Chronic Kidney Disease – CKD
CKD often affects people as they get older; it is estimated that 1 in 5 men and 1 in 4 women between 65-75 years old have some kind of CKD. It tends to be more common in people of South Asian or Afro-Caribbean ethnic origin.
Conditions that cause kidney damage over longer periods of time include uncontrolled high blood pressure and uncontrolled diabetes. In fact, diabetes is the most common cause of CKD. The best way to reduce the risk of developing CKD is to manage existing health conditions such as these. Treatment depends on the cause of the CKD, but it is often focused on preventing progression and managing symptoms, as well as stopping other complications such as heart problems developing. In addition, having a healthy diet, regularly exercising and stopping smoking can reduce the risk.
Symptoms of CKD often will only be noticed when it becomes advanced. As a result, it is often only picked up on urine or blood tests. If symptoms do occur, they include tiredness, nausea, swollen ankles or feet, or occasionally blood in the urine. Additionally, people may feel the need to urinate more often, and may have some difficulty sleeping.
CKD has different stages, which are determined based on a combination of kidney function blood tests. Stage 1 is kidney disease with normal kidney function, while Stage 2 has mildly impaired kidney function. Both Stage 1 and 2 are usually managed by GPs; this mainly involves annual monitoring of blood and urine tests, and ensuring good blood pressure control. There are a small proportion of patients who will need further tests to check the risk of more serious kidney problems.
In Stage 3, there is further impairment of kidney function, and the GP may consider referral to a specialist kidney doctor. Only a small percentage of patients with CKD will progress to Stage 4 and 5, in which kidney function is severely impaired. This very severe damage is often called kidney failure or renal failure. For some people, the only permanent way to treat this is with a transplant. As waiting lists for transplant are often long, alternative methods such as dialysis can be suitable for some people as a way of replacing the function of the kidney.
What is dialysis?
When the kidneys are not functioning properly, dialysis does the job of filtering toxins and harmful waste products from the blood instead. Dialysis does not make the kidneys work again. It usually involves being connected to a machine that cleans the blood before returning it to the body. Dialysis is necessary until a transplant can be performed. For some people who are not suitable for transplants, dialysis remains the long-term treatment option for them.
There are two main methods of dialysis known as’ haemodialysis’ and ‘peritoneal dialysis’:
This is the most common type of dialysis. A tube is attached to a needle in the arm. Blood flows out from the body through the tube into a machine where it is filtered before being returned to the body. This takes about 4 hours and is usually required 3 times a week. Before the first dialysis treatment starts, a minor surgery is required to join together two types of blood vessel – this is known as an arteriovenous fistula. This is done to strengthen the vessel and make the dialysis easier to perform.
This method does not use an external machine, but instead uses the lining of the abdomen (the peritoneum) to filter waste from the thousands of tiny blood vessels around it. Before this treatment starts, a minor surgery is needed to insert a small tube called a catheter into the abdomen, near the belly button. Dialysis fluid is then pumped into the body through the catheter. As blood flows through the vessels in the peritoneum, waste products and toxins are drawn out of the blood into this fluid. The used fluid is collected in a bag and replaced with fresh fluid. This can be done overnight while the patient sleeps, or can be repeated 4 times during the day.
What we offer
Here at the Royal Free Hospital Private Patients Unit (PPU), we are proud to offer access to leading specialists in renal medicine who work within an experienced multidisciplinary team. We are dedicated to delivering the highest standards of care to our patients. We offer access to a wide range of expertise for the management of CKD and related conditions. We also have a fully-equipped, 6-chair dialysis unit.
Our dedicated renal medicine team are experts in their field and have many years of experience treating kidney failure at the leading kidney units within the UK. Our consultant team have a range of specialist interests, including kidney transplantation, managing critical illness, chronic renal failure and kidney problems in pregnancy.
We are committed to reinvesting all the profits from our private services directly back into NHS services. We deliver the professional excellence you would expect from a top London NHS teaching hospital with the convenience, comfort and personalised attention of a private hospital.