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Interventional Nephrology

Interventional nephrology groups together, under the skills of a single specialist, a variety of procedures and steps needed to treat kidney patients. With the great strides in recent years in vascular access, imaging techniques and minimally invasive catheter-based procedures, nephrologists can now intervene more effectively to take care of a greater portion of the needs of kidney patients under their care. This includes interventions that in the past or otherwise might require surgery, have required appointment or consultation with a different specialists, or might not be treatable at all.

Given the volume of patients treated with dialysis, the field focuses first and foremost on managing and maintaining vascular access for dialysis – and as a newer and emerging subspecialty of nephrology, it also involves placing and replacing these catheters (which give access to the circulatory system for dialysis). In addition, interventional nephrology involves a range of care using specialized imaging and other diagnostic techniques to evaluate the blood flow, urinary function and overall status of the kidney, as well as interventions to open blood flow to arteries and veins that are critical to renal circulation.

This area of training for kidney doctors can make immediate care available and better. This area of concentration collects under the practice of one specially trained nephrologist interventions that until recently were always delegated to a variety of different healthcare staff members involved in other areas of care. (Interventional nephrologists may still, however, collaborate with the interventional radiologist, general surgeon, vascular surgeon or other clinicians for these care needs.)

Interventional nephrologists offer procedures necessary to test kidneys and to establish the access to veins and arteries that makes dialysis possible-providing patients all of this care from a single specialist committed to care of renal conditions.

Procedures provided by interventional nephrologists include:

  • insertion and removal of hemodialysis catheters, including tunneled catheters;
  • insertion, removal, manipulation of peritoneal dialysis catheters;
  • fibrin sheath removal from chronically indwelling central catheters;
  • mechanical thrombectomies (blood clot removal) of clotted hemodialysis catheters, and clotted AVFs (arteriovenous fistulas) and AVGs (arteriovenous grafts);
  • venograms and angiograms, for vascular mapping;
  • angioplasties to open blocked blood vessels;
  • placement of endovascular stents;
  • diagnostic sonography (ultrasound of the kidneys);
  • renal biopsies (fine-needle sampling of kidney tissue with ultrasound guidance);
  • and accessory vein ligation.

Because nephrologists have the closest perspective on dialysis and kidney conditions of any medical specialists, they are ideally suited to take charge of these interventions that don’t involve complex surgery or radiology and to interpret and follow-up their results. At the nephrology office, dialysis center and associated outpatient-procedure facilities, they can provide these services to patients in a timely, practiced and skilled manner, leading to better care, safety and cost effectiveness. As a result, patients gain better access to these interventions, reducing referral for procedures standard or essential to their care. As a medical center advanced in the care of kidney conditions, Lourdes offers and supports the interventional nephrology role.

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