Kidney Disease (Nephrology)

Yale New Haven Hospital nephrologists (kidney specialists) offer a complete range of consultative, diagnostic and treatment services for patients with kidney diseases, including chronic, advanced renal insufficiency, end-stage renal disease, renal transplantation and hypertension.

Our approach is multidisciplinary, involving skilled nurses, dietitians, social workers and other physicians.

Our Nephrology Services

YNHH nephrologists are board certified in both internal medicine and nephrology, and are recognized experts in the field. Our close association with Yale School of Medicine, allows us to participate in leading-edge nephrology clinical trials. We oversee primary care to a large group of patients with end-stage renal disease (ESRD). In collaboration with Yale New Haven Transplantation Center, we have the largest kidney transplantation program in New England.

Renal Failure Program

Renal failure refers to temporary or permanent damage to the kidneys that result in loss of normal kidney function. There are different types of renal failure. Acute renal failure has a sudden onset and is sometimes reversible. Chronic renal failure progresses slowly over at least three months and can lead to permanent renal failure. End-stage renal disease (ESRD) is when the kidneys permanently fail to work.

In addition to a physical examination and complete medical history, our diagnostic procedures for renal failure may include blood tests, urine tests, renal ultrasound (also called sonography), kidney biopsy and CT scanning. Specific treatment may include admission to YNHH, intravenous (IV) fluids, diuretic therapy (to increase urine output), medications, dietary restrictions, dialysis and kidney transplantation.

Dialysis is a procedure that our hematology team routinely performs on patients diagnosed with acute or chronic renal failure, or who have ESRD. The process involves removing waste substances and fluid from the blood that are normally eliminated by the kidneys. There are two types of dialysis: peritoneal dialysis, which is performed by surgically inserting a soft, hollow tube into the lower abdomen, near the navel, then running a special solution, called dialysate, through it; and hemodialysis, which involves connecting the patient to a machine that drains the blood, treats it in dialysate, then returns the blood.

Our Renal Failure Program provides a range of treatments aimed at avoiding dialysis and restoring healthy kidney function. When dialysis is required we provide primary care with at-home peritoneal dialysis or hemodialysis at local facilities. Our out-of-hospital dialysis services include home peritoneal dialysis by personalized prescription and in-center hemodialysis with advanced technology.

We also provide evaluation and care for other kidney disorders:

• Glomerulonephritis is a disease in which the kidneys' filters become inflamed and scarred, and slowly lose their ability to remove wastes and excess fluid from the blood to make urine. Care requires a kidney biopsy, which we perform using CT scan guidance and analyze with an expert renal pathologist. Ongoing management of the patient is most often directed by the attending nephrologist usually in collaboration with the referring physician.
• Hypertension, or high blood pressure, can be associated with kidney disorders. We offer evaluation and treatment of severe cases with different medications and surgical procedures.
• Diabetic nephropathy, or deterioration of the kidneys, occurs in five stages. The fifth stage is ESRD. Diabetes is the most common cause of ESRD, accounting for about 44 percent of cases. Progress from one stage to the next can take many years, with 23 years being the average length of time to reach stage five. Treatment may include proper diet, exercise, strict monitoring and controlling of blood glucose levels, often with medication and insulin, and medication to lower blood pressure.
• Polycystic kidney disease (PKD) is a genetic disorder characterized by the growth of numerous cysts filled with fluid in the kidneys. PKD cysts can reduce kidney function, leading to kidney failure. Treatment includes patient and family counseling, tight blood pressure control, prompt treatment of infection and procedures to shrink cysts.
• Renal osteodystrophy, or defective bone development related to kidney function, is determined by bone biopsy. We counsel patients regarding phosphate restriction and often prescribe vitamin D therapies.

All nephrology patients with renal failure are considered potential candidates for renal transplantation. We refer our patients to Yale New Haven Transplantation Center.

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