Nephrology – Patient Care and Treatment
Nephrology provides services in dialysis, renal transplantation, hypertension, and inpatient and consultation services. Our outpatient clinic offers care for renal stones, renal tubular acidosis, glomerular diseases, hematuria/proteinuria, chronic renal insufficiency, and complicated hypertension.
Acute and chronic kidney care
Find out more about our nephrology services.
Dialysis is a treatment for people in the later stage of chronic renal insufficiency (kidney failure). This treatment cleans the blood and removes wastes and excess water from the body. Normally, this work is done by healthy kidneys. The only other treatment for kidney failure is a kidney transplant.
There are two primary types of dialysis: hemodialysis and peritoneal dialysis. In hemodialysis, your blood is passed through an artificial kidney machine to clean it. Peritoneal dialysis uses a filtration process similar to hemodialysis, but the blood is cleaned inside your body rather than in a machine.
The treatment normally takes three to five hours, and usually three treatments a week are needed. Only a small amount of your blood is out of the body at one time. Your blood must circulate through the machine many times before it is cleaned.
You can be attached to the dialysis machine in different ways. The most common method of providing permanent access to the bloodstream for hemodialysis is an internal fistula in your arm. This involves having an artery and a vein connected surgically. When they are joined, the stronger blood flow from the artery causes the vein to become larger. Needles can be inserted in the enlarged vein to connect you to the dialysis machine.
Another way to provide access to the bloodstream is to insert an internal graft. In this procedure an artery is surgically connected to a vein with a short piece of special tubing placed under the skin. Needles can be inserted in this graft.
Sometimes, when it is necessary to gain access to the bloodstream quickly, or when the veins in the arms are too small to provide enough blood for hemodialysis, a central venous catheter is used. A soft tube is surgically inserted into a large vein in the neck or near the collarbone. This method is usually temporary until a permanent access site is ready.
Hemodialysis may be done in a hospital dialysis unit, in a self-care center, or at home with the help of a partner or nurse. In home hemodialysis, patients and their designated partners are trained to perform the entire dialysis treatment independently at home. Home hemodialysis offers freedom, independence and convenience—often improving quality of life, by giving patients control of their own treatments.
Peritoneal dialysis filters toxins and other excess materials from the blood using the lining of the abdomen (peritoneum). A catheter is implanted surgically and the abdominal cavity is filled with a solution of water and chemicals (dialysate). The peritoneum draws toxins out of the blood back into the abdominal cavity where it sits for a set period of time before being removed and replaced with another dialysate by the patient. This may be performed several times during the day and night to completely clean the blood.
In chronic cyclic peritoneal dialysis (CCPD), a machine called a cycler performs the dialysate exchange. This is done several times during the night and one or two times during the day
Continuous veno-venous hemofiltration dialysis
Continuous veno-venous hemofiltration (CVVH) was designed as a renal replacement therapy for patients with acute renal failure. It’s often chosen over intermittent hemodialysis when blood pressure instability is a problem, and CVVH is generally more efficient than peritoneal dialysis.
Hemofiltration is a continuous dialysis therapy where blood is forced through a semi-permeable membrane and water and small molecules are filtered out of the blood. Hemofiltration is slower and less physiologically disturbing than hemodialysis and is used in intensive care units on very sick patients.
Diabetic renal disease
Kidney failure is the final stage of a slow deterioration of the renal system. Diabetes is the most common cause of kidney failure. Dialysis allows those with serious kidney problems to maintain a productive life, by assisting the kidneys in cleaning the blood and avoiding the buildup of toxins in the body.
Acute glomerulonephritis is an inflammation of the glomeruli, bundles of tiny vessels inside the kidneys. Usually affecting children 2 to 12 years of age, the damaged glomeruli lose the ability to effectively filter out waste and excess water from the blood. This backup makes the kidneys appear congested. Diagnosis is made with laboratory studies of the urine and blood. Treatment aims to decrease the damage to the glomeruli, decrease the metabolic demands on the kidneys, and improve kidney function.
Hypertension is a condition in which blood pressure is persistently elevated (it stays high for a long period of time). Blood pressure is a measure of the pressure of the blood against the blood vessel walls. Persistent high blood pressure puts undue stress on the heart, blood vessels, and other organs because the heart must work much harder to maintain adequate blood flow to the body.
Penn State Health supports an active program in kidney and pancreas transplantation. Since diabetes is the most common cause of the need for renal replacement therapy, the availability of both kidney and pancreas transplants allows patients to be cured of renal failure and diabetes at the same time.
Patients with progressive renal disease should be referred early for transplantation evaluation as the work-up requires several months and there is a waiting list. Patients may qualify to be placed on the waiting list before their actual need for dialysis. Contact the Transplant Coordinators office at 717-531-3716 .
Nephrolithiasis is another name for kidney stones. Kidney stones are also called renal calculi. They are rock-like pieces that are about the size of a grain of sand. They form most often in the kidneys and get stuck in the ureter, which blocks the flow of urine and causes pain. If the stone does not pass on its own surgery may be required to remove it.
Children who have kidney diseases or high blood pressure get expert care at Penn State Children’s Hospital Division of Pediatric Nephrology and Hypertension.
Early kidney disease
Kidney diseases tend to be progressive and ultimately result in kidney failure and the need for dialysis therapy or a kidney transplant. While there are effective treatments to slow or arrest the progression, only a few kidney diseases can be reversed with treatment. Many of the complications, however, are amenable to treatment, which is more effective if started early.
The Division of Nephrology has special clinics in which patients with early renal failure are followed. This has the added advantage of preparing the patient for dialysis before the actual need. Patients can also be referred early in their disease for a kidney transplant, and lessen the need for dialysis and shorten the waiting period.
Our social worker, Gail Flannery, MSW LSW, assists patients with kidney disease with their non-medical problems.
- Counseling to help you and your family cope with kidney disease and the changes it may bring about in the family, home, workplace, and community
- Planning for treatment to fit your lifestyle
- Identifying services provided by federal, state, and community agencies to meet your needs, including funding for dialysis and medications (no one is denied dialysis due to a lack of funding).
- Help through the maze of policies, regulations, and paperwork so you receive the maximum benefits available.