Nephrology is the speciality that is devoted to the study and treatment of kidney diseases and the many systemic diseases that affect the kidneys, including Arterial Hypertension and Diabetes Mellitus. It also develops treatments involving techniques for replacing renal function (different types of dialysis) and also for renal transplantation.
At the Hospital Ruber Internacional, we provide clinical nephrology both through consultations and on an in-patient basis..
What diseases do we treat?
Among the many diseases we attend to are:
- Chronic Renal Disease in its various stages, with a specific section for older patients, which constitutes Geriatric Nephrology.
- Acute kidney failure
- Primary inflammatory diseases of the kidney (Glomerulonephritis).
- Kidney diseases secondary to systemic diseases (Disseminated Lupus Erythematosus, Myeloma, Amyloidosis, Diabetes Mellitus, etc.)
- Arterial hypertension in collaboration with other hospital services.
- Urinary tract infections.
- Hereditary and family diseases of the kidney, such as polycystic kidney disease.
- Water-electrolytic disorders (sodium, potassium, water disorders)
- Calcium-phosphorus metabolism disorders.
- Metabolic study of the formation of kidney stones.
Chronic Kidney Disease (CKD)
The kidneys perform vital functions for the correct operation of the body, such as:
- Filtering functions: Removal of end products resulting from normal metabolism (urea, uric acid, etc.).
- Metabolic functions: Regulating the balance between water and electrolytes (control of bodily fluids) and acids and bases. Control of calcium-phosphorus metabolism.
- Endocrine functions: control of the hormones that regulate blood pressure and the hormone that stimulates erythropoiesis.
When any of these functions deteriorate over time, the result is CKD.
It has five stages, determined by its effects, as measured by the glomerular filtration rate, and it may be asymptomatic early on. Hence the importance of diagnosing it early to keep it from advancing.
Glomerular Filtration Rate
>90 + Proteinuria
Kidney damage with normal or high GFR
89 - 60
Mild kidney damage with decreased GFR
Medium to moderate damage
Moderate to severe damage
Severe kidney damage
Advanced chronic kidney disease
The treatment in stage 5 requires including alternative kidney therapy in any form (hemodialysis, peritoneal dialysis, kidney transplant)
This stage can result from multiple diseases that affect the kidneys, the most important being, in order of frequency, arterial hypertension and diabetes mellitus.
The typical symptoms of kidney failure are: fatigue, paleness, dry skin and generalized itching, bitter smell or taste, swelling of the eyelids or lower limbs, lack of appetite, nausea, changes in the characteristics of the urine or a sustained decrease in the amount of urine, weakness and muscle cramps.
We work in concert with other services (Endocrinology, Cardiology, Internal Medicine, Radiology, Urology and Pathological Anatomy) to properly diagnose and measure kidney function, in order to establish a medical and dietary treatment programme that keeps the CKD from advancing to stage 5 and avoids the need for dialysis.
In Spain, there are over 3.5 million people who are in some stage of kidney failure, as shown by the OSERCE study conducted by the Spanish Society of Nephrology in 2005. The International Society of Nephrology recommends that patients with chronic kidney failure, starting with stage III, should be under the care of kidney specialists in a nephrology unit in order to keep the disease from progressing to the point where dialysis is required. This is the main function of nephrologists: avoid dialysis whenever possible.
In addition, kidney failure is considered an important cardiovascular risk factor that also requires treatment.
Elderly patients often experience a deterioration in kidney function, not only due to the ageing of the organ, but also to the increased incidence of systemic diseases at these ages (hypertension, diabetes)
It is essential to diagnose and evaluate renal function in these patients, given the fragility and sensitivity they have to conditions that would be normal in younger patients, such as imaging examinations with contrast materials, and preparing for endoscopies and surgeries.
To avoid the many complications resulting from the acute deterioration of kidney function during routine medical practices, it is essential to determine the degree of kidney function beforehand and, if necessary, to use the measures required to avoid them.
It is also necessary to determine the kidney function of elderly patients in order to adjust the dose of any medications they may need.
Assessing the clinical situation of a geriatric patient is fundamental to applying renal replacement therapy, when conservative treatments do not provide sufficient quality of life.
Acute kidney failure
Acute kidney failure is a serious alteration of the functions performed by the kidneys and occurs suddenly, jeopardising the life of the patient.
It can be the result of:
- General diseases that alter the hemodynamic status, such as sepsis, dehydration, shock, post-surgical situations, multiple trauma.
- Sudden onset primary kidney disease, such as acute or rapidly progressive glomerulonephritis.
- Lastly, blockage of the urinary tract (obstructive uropathy) of any type and at any stage.
A correct diagnosis will be key to the choice of treatment, which ranges from conservative medical treatment to renal replacement therapy with extrarenal filtration techniques.
At the Hospital Ruber Internacional, we have continuous hemodiafiltration techniques for treating acute renal failure.
Glomerulonephritis: Inflammation diseases of the kidneys
The term Glomerulonephritis encompasses a large number of inflammatory diseases affecting the kidneys.
The functioning units of the kidney are called nephrons, of which there are approximately one million in each kidney. Each nephron has a glomerulus and a tubule.A nephron has clusters of vessels contained in a structure called the insterstitium.As a result, kidney diseases are classified as glomerular, tubular, interstitial and vascular.
The glomerulus is a structure that forms part of the nephron. It has a "vascular pole" through which the blood flows. Substances diluted in plasma are filtered out through the basal glomerular membrane, which prevents the passage of large cells or proteins
Glomerular diseases are inflammatory diseases of the kidneys that can have multiple causes (immune, inflammatory, metabolic, infectious) and can be classified as:
Based on presentation:
- Quickly progressing
Based on cause:
- Primary (kidney disease)
- Secondary to systemic diseases
The most common clinical form of presentation is Nephrotic Syndrome, which is characterised by the presence of severe proteinuria (loss of proteins through the urine), with low levels of protein in the blood and oedemas.
The diagnostic study entails laboratory and imaging tests, including, where necessary, "percutaneous renal biopsy", which can provide an anatomical-pathological diagnosis, identifying the kidney injury and allowing us to adjust the specific treatment and assess the prognosis.
Arterial Hypertension is defined as blood pressure higher than 140/90. It is one of the most important cardiovascular risk factors and its consequences, if not controlled, are very serious, affecting the central nervous system (strokes, dementia), the heart (ventricular hypertrophy, arrhythmias, ischaemic heart disease) and the kidney (renal insufficiency).
The most common cause is what is called Essential Hypertension, which has a genetic, hereditary origin in which the mechanisms for regulating blood pressure are altered, resulting in hypertension. It is present in 80% of patients with Arterial Hypertension. The remaining 20% involve secondary hypertension, such as that due to hormonal disorders (e.g., adrenal gland disorders), vascular causes (severe arteriosclerosis, renal artery stenosis), renal causes (situations involving renal insufficiency), etc.
A proper diagnosis is essential for targeted treatment and to avoid serious complications.
We conduct multidisciplinary studies in concert with other services (radiology, laboratory, cardiology, nuclear medicine) to identify the origin, assess the damage produced (visceral impact) and establish the best treatment.
We place special emphasis on resistant hypertension, which is high blood pressure that cannot be treated using three drugs, including diuretics. It is usually associated with renal pathology and ends up having serious consequences. Currently, techniques are being developed to improve its treatment and the patient's quality of life.
Urinary tract infections
Urinary tract infections are a very common disease, especially in women. They often present abruptly and require emergency treatment. In other cases, they are recurrent and a study is necessary to rule out possible causes and to establish prophylactic treatments and care.
The symptoms can vary greatly, though frequently the infection starts with a high fever, considerable general discomfort and shivering. Later, the patient will have trouble urinating, with a burning sensation and pain. The urine may be cloudy and even contain some blood, giving it a reddish colour. It may even have a bad smell. In these cases, the patient should go to the emergency room and start treatment as soon as possible to avoid complications.
The most common form causes discomfort when urinating, with burning, pain and changes in the colour of the urine.
Then there are asymptomatic infections or urine contamination, only detectable with urine cultures, but they have to be evaluated individually due the possible complications that may arise.
The most common bacteria in urinary tract infections are the so-called "Enterobacteria", i.e. those that are usually in the digestive tract and are necessary for intestinal functions by helping to break down food waste. The most frequent of these bacteria include: Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, etc.
As a general rule, to avoid urinary tract infections, you should drink plenty of fluids, avoid holding in urine for many hours, treat constipation or diarrhoea and maintain adequate hygiene, avoiding prolonged contact with wet compresses.
An isolated episode of urinary tract infection is not a cause for concern, but when they are "recurrent", a detailed analysis should be carried out to rule out organic and structural causes that must be corrected (incontinence, obstructive uropathy due to hypertrophy of the prostate or lithiasis, bladder disorders, etc.).
Once the study has been carried out, a suitable treatment can be determined to treat the recurrent urinary infection.
Polycystic kidney disease
It is the most common hereditary kidney disease that we deal with. It is the cause in 6.5% of patients who need to be treated with replacement renal therapy.
Diagnosing and monitoring this disease, which exhibits a dominant pattern of inheritance, is essential to slow its progression to advanced kidney failure.
Adult polycystic kidney disease is usually asymptomatic in the first three decades of life, and should be monitored if there is a clear family history, through blood pressure measurements, renal function tests and renal ultrasound.
We are currently taking part in very promising clinical trials with medication that can slow the growth of cysts.
Disorders involving the metabolism of water and ions are frequent in daily life and often result in symptoms such as fluid retention and oedemas. Using objective data to study kidney function, urine concentration capacity and the management of ions such as sodium, potassium and chlorine is essential to achieve a correct diagnosis and to propose a treatment.
Potassium imbalances or diuresis (excessive urination) are less frequent, but they should be studied and corrected, since they can have serious long-term consequences.
Sodium or potassium imbalances can occur as a result of drug interactions or uncontrolled treatments, especially in older people.
Calcium metabolism and renal lithiasis
We study disorders involving calcium, which is controlled primarily in the kidneys. Kidney failure leads to severe alterations, but disorders of calcium metabolism can also occur with normal renal function, such as alterations of the renal tubule, which can lead to the formation of kidney stones or cause calcium to be deposited in soft tissues, with arteries throughout the body being most affected.
Nowadays, with the growing obsession with calcium intake in women, studying and controlling this element is increasingly important to avoid vascular calcifications, with can have serious future consequences as the calcium is deposited in the coronary arteries, producing ischaemic heart disease, as many studies have already shown.
There are renal metabolic and dietary disorders associated with lithiasis that must be identified and treated to prevent the re-emergence of stones. This study should not coincide with renal colic episodes or procedures to remove the stones, which correspond to the field of urology. The metabolic study should be done when no procedures to treat or remove kidney stones are in progress, as these can interfere with the results.