Nephrology

What is nephrology?

It is the branch of medicine which involves with the diagnosis and treatment of kidney diseases, including electrolyte disturbances and hypertension, caring of patients requiring renal replacement therapy, including dialysis and renal transplant patients.
The specialist physician in this field is called a nephrologist.

Main conditions handled by department of Nephrology

• Acute renal failure, a sudden loss of renal function

• Chronic kidney disease, declining renal function, usually with an inexorable rise in creatinine.

• Hematuria, blood in the urine

• Proteinuria, the loss of protein especially albumin in the urine

• Kidney stones, usually only recurrent stone formers.

• Chronic or recurrent urinary tract infections

• Hypertension that has failed to respond to multiple forms of anti-hypertensive medication or could have a secondary cause

• Electrolyte disorders or acid/base imbalance
  
  

History and the Services provided

The Nephrology, Dialysis and Transplant Unit of National Hospital of Sri Lanka is the forerunner of providing care for renal patients in the region. It consists of the Dialysis Unit with a dedicated nephrology team, and this is the first renal unit to be established under the Ministry of Healthcare and Nutrition.

The current Nephrology team consists of Consultant Nephrologist, two Senior Registrars in Nephrology, 7 Nephrology unit medical officers, 2 Dialysis unit medical officers, one nursing sister with 16 nursing officers and 10 minor staff personnel.

The Nephrology and Transplant Unit is situated in the 2nd medical complex, catering to the renal patients of a wide variety, the services provided includes:

• 24 hour on call for renal service

• 24 hour acute haemodialysis (HD) services for emergencies

• Two Nephrology clinics -Monday and Wednesday at room 34

• One counselling and pre transplant workup clinic- Tuesday at room 36

• One post transplant clinic  - Wednesday at room 34

• Haemo Dialysis clinic- every Tuesday at DU

• Renal biopsy service - 3 days a week at Dialysis unit

• Referral system covering NHSL , DMH, CSHW and peripheral hospitals

• Ward rounds by the renal team involves looking after more than 75 patients scattered in different units all over the NHSL, including all medical and surgical wards, all ICUs, recovery unit, cardiology unit, cardiothoracic unit, neurology wards, neurotrauma unit, orthopaedic units and the accident service.

A Consultant Nephrologist was appointed in 2003  and took over a dialysis unit consisting of 4 dialysis machines which were shared by all medical wards. With the opening of the 2nd medical block in 2004, the dialysis unit was relocated to the ground floor with additional 4 machines.

The number of dialysis sessions carried out has dramatically increased from a little over 3000  in the year of 2003, to more than 11600 in 2013, and more than 6900, up to July 2014 (our average monthly number of HD sessions are around 1000). This is a great example of how the unit has progressed over the years in providing a steady service to renal patients. The dialysis is provided to patients with acute kidney injury and chronic renal failure, and to patients who are awaiting transplants.
In addition to the inward patients at NHSL our services extends to patients in the peripheries as well. These exceed over 20 per day, and the renal team is dedicated to providing maximum assistance to these patients round the clock, which is a unique achievement by us.

Our renal team also conducts 4 clinics a week, catering to a wide variety of renal patients, including the pre-transplant and post transplant clinics, where the patient number is increasing rapidly.

The Renal Transplant program of this unit (under the Ministry of Health) commenced in 2005 with the assistance of two vascular and transplant units of NHSL, despite the absence of an established renal ward. Our team has achieved great success over the years by providing transplant services to a considerably large number of patients in spite of the limited resources, with the number of transplants increasing steadily over the years. Transplants were done on 3 patients back in 2005, which flourished to an astonishing 57 in 2013, and we have done transplants on 46 patients as of July 2014. This is a remarkable indication of the success of the unit as a whole.

The following chart gives a summary of how the unit grew over the few years.

Statistical data of Renal Unit - NHSL

In addition to this a Second Nephrology unit is in operation under the Professorial Medical Unit.

Our future plans are, to:

1. Have a dedicated renal ward which we have been trying to establish since 2003 without much success.

2. Have a dedicated transplant and high dependency unit.

3. Establish a renal registry.

4. Improve the service of Continuous Renal Replacement Therapy (CRRT) for ICU patients.

5. Establish a cadaveric transplant program on par with developed countries.

6. Establish plasma exchange facilities under renal unit for the benefit of transplant patients.

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