Renal Diseases Service

Clinical Services:

Renal Replacement Therapy

Renal Replacement Therapy is the major form of treatment for patients with end-stage renal disease (ESRD). It is either artificial and intermittent (hemodialysis and peritoneal dialysis) or biologic and continuous (kidney transplantation), both of which aim to replace some of the functions of the diseased kidneys such as removing excess wastes and fluids, and keeping the balance of electrolytes appropriate.

Hemodialysis (HD) is a process where "unclean" blood is machine-pumped out from the patient and circulated through plastic tubings connected to his vascular access (arteriovenous fistula or AVF, or graft) for "cleaning" by an artificial kidney (dialyzer) over 4-5 hours each day, 2-3 times a week. Fluid retained during the interval between treatments is also removed during the process. HD is the predominant technique for treating ESRD worldwide.

Peritoneal dialysis (PD), is another form of renal replacement therapy. In this form of dialysis, a plastic tube is placed through surgery into the abdomen to make an access. PD works by using the body’s peritoneal membrane, which is inside the abdomen, as semi-permeable membrane. Special solution is infused in through the catheter, remains in the abdomen for a time and is drained out. The number of exchanges may range from 3 to 5 times the whole day or more frequently, depending on the needs of patient.

Kidney Transplantation
In kidney transplantation, a new kidney is harvested from a healthy living donor or cadaveric donor and implanted into the lower abdomen of the patient with end-stage kidney disease. This serves to replace the lost kidney function of the patient. For the new kidney to maintain good function, anti-rejection medications are taken by the recipient indefinitely.

Overall, kidney transplantation is the best treatment option for most patients with end-stage kidney disease because it produces the best results in terms of survival and quality of life.

Kidney Biopsy
A percutaneous kidney biopsy may be obtained for establishment of the exact diagnosis as an aide to determine the nature of recommended therapy. The degree of active or chronic changes helps determine prognosis and likelihood of response to treatment. Other indications for obtaining biopsy may include presence of significant protein in urine, microscopic blood in urine, unexplained increase in serum creatinine (native or transplanted kidney), or kidney manifestation of systemic disease.

The routine evaluation of a percutaneous renal core biopsy involves examination of the tissue under light, immunofluorescence and electron microscopy. Each component of the evaluation can provide important diagnostic information.