Nephrology, Hypertension & Renal Transplantation
Nephrology, Hypertension & Renal Transplantation
Clinical Activities
The division is active in a wide variety of clinical activities. These include inpatient acute dialysis, evaluation and management of fluid and electrolyte disorders, renal transplantation, outpatient clinics and the management of patients with end-stage renal disease.
There is considerable exposure of the house staff to the nephrology program. The intern is responsible for the daily care of all patients admitted to the inpatient services by nephrology faculty and those patients for whom the division is providing consultation to other attending physicians. The intern has the opportunity to learn patient management and critical decision making from the division's faculty and fellows. The PGY-2 and PGY-3 residents have the opportunity to select an elective rotation on the nephrology service during which time they receive intensive training in the diagnosis and management of kidney disease, hypertension, fluid and electrolyte disorders, dialysis, and renal transplantation in both the inpatient and outpatient setting. The residents work side by side with the renal fellow to provide consultations during which time they participate in work rounds, attending rounds, division conferences, student teaching, and outpatient activities.
For more information on Clinic Locations and Services Offered please click here.
Inpatient consultation
Three inpatient consult teams serve patients at Shands Hospital and the Gainesville Veterans Affairs Medical Center. Each team includes an attending physician, a fellow, a first (PGY-2) or second (PGY-3) year medical resident and two to four medical students.
The consult service at Shands Hospital maintains a daily census of 15 to 20 patients. The consult team evaluates patients with a wide variety of acute and chronic renal, hypertensive, and electrolyte disorders, performs percutaneous kidney biopsies, and manages patients requiring either acute or chronic dialysis.
The inpatient transplant service at Shands Hospital has a daily census of 10 to 15 patients. The team performs pretransplant and living related donor evaluations and follows all transplant patients post-operatively on a separate transplant ward. Currently, approximately 125 kidney transplants are performed each year and more than 1,000 kidney transplant recipients are managed as outpatients.
The consult service at the VAMC carries an average census of 10 to 15 patients, and provides inpatient consultations for all nephrologic and hypertensive disorders. This service also staffs an active acute and chronic hemodialysis facility.
Outpatient clinics
Extensive outpatient activities are carried out by the division faculty and fellows. They are conducted in two renal transplant clinics, one hypertension clinic, and two general nephrology clinics at Shands Hospital. We evaluate and manage patients with a wide variety of conditions, including glomerulonephritis, renal artery stenosis, hyperaldosteronism, chronic renal insufficiency, and hypertension. A large number of patients with renal artery stenosis and chronic renal insufficiency are seen in these clinics because of the availability of CO2 angiography at Shands Hospital and the Gainesville VAMC. CO2 angiography enables renal artery angiography utilizing CO2 as the contrast agent; since this agent is physiologic and has essentially no nephrotoxicity, it allows renal angiography to be performed with less risk of acute renal failure than conventional radiocontrast agents.
In the transplant clinic we follow approximately 1000 patients, including patients immediately following their renal transplant, and patients with functioning renal transplants who may be several years out from their transplant. For additional information regarding being seen in or referring patients to this clinic, please call (352) 265-0139.
At the Gainesville VAMC the faculty and fellows see patients in a combined nephrology and hypertension clinic. For additional information regarding being seen in or referring patients to this clinic, please call (352) 374-6102.
Acute dialysis
The Division provides a wide variety of acute dialysis for patients with renal failure. We provide conventional acute hemodialysis, and continuous renal replacement therapy with either acute peritoneal dialysis,continuous venovenous hemofiltration (CVVH), CVVH with dialysis (CVVH-D) and CVVH with hemofiltration and dialysis (CVVH-HD). Renal biopsies are performed under ultrasound and/or CT guidance.
Renal transplantation
Providing renal transplantation is an important function of the Division of Nephrology. Each year approximately 150 patients receive either living-related or cadaveric renal renal transplants under the supervision of the Division. We evaluate patients before transplant, assist in their management during the admission for transplantation, and follow patients once discharged. In the outpatient renal transplant clinics we manage immunosuppression, hypertension, hyperkalemia, polycythemia and other complications of renal transplantation. Should acute or chronic rejection occur, we evaluate patients extensively, including transplant biopsy, if needed, and then implement necessary anti-rejection therapy. All renal transplant patients admitted to either Shands Hospital or the Gainesville VAMC are seen and cared for by members of the Division. For additional information, including referral for transplantation or follow-up in the renal transplant clinics, please call (352) 392-4008.
End-stage renal disease
The Division believes that providing high-quality renal replacement therapy to patients with end-stage renal disease is critical to our mission. Under the supervision of Dr. Edward Ross, Director of the End-Stage Renal Disease Program, the division provides in-center hemodialysis, home CAPD and home CCPD therapy. In-center hemodialysis is provided at the Shands Dialysis Center. Full training and management in CAPD and CCPD is also available at the Shands Dialysis Center. For additional information regarding Dialysis Treatment, please call (352) 265-6890.