The general nephrology clinic currently sees 3500 patient visits for initial evaluation and follow-up each year at locations in St. Louis Children’s Hospital and its outreach clinics. Emphasis is on the management of congenital and hereditary kidney disorders, urinary tract infections, kidney stones and related conditions, acute and chronic glomerular and tubular diseases, hypertension, and kidney disease secondary to systemic disorders. Special interests of our faculty include chronic kidney disease, bone and mineral disorders, kidney transplantation, renovascular hypertension, and hereditary kidney diseases.
A separate transplant clinic meets weekly at St. Louis Children’s Hospital for long-term management of pediatric kidney transplant recipients. Our service performs an average of eight to ten kidney transplants per year and has performed almost 300 transplants since inception. As of July 1, 2012, the medical director is Paul Hmiel, MD, PhD.
The division maintains an active consultation service for hospitalized patients, including the management of fluid, acid-base, and electrolyte disorders, hypertension, acute kidney injury, and treatment of primary kidney diseases and systemic diseases with secondary kidney involvement. Kidney replacement therapies are provided in the pediatric and neonatal intensive care units. Available options include hemodialysis, continuous renal replacement therapy, peritoneal dialysis, and aquapheresis.
Chronic hemodialysis and peritoneal dialysis are available for patients with end-stage kidney disease. Hemodialysis is performed in the St. Louis Children’s Hospital Dialysis and Infusion Unit (virtual tour available), which was designed to reflect the special needs of pediatric patients. Patients who elect peritoneal dialysis, which is performed at home, undergo intensive training with monthly visits for on-going care. The care of chronic dialysis patients is based on a team approach, with participation by dialysis nurses, nephrologists, social workers, psychologists, and dietitians to individualize each patient’s care.
The division supervises special procedures for the evaluation and therapy of chronic kidney diseases. Approximately 40 percutaneous kidney biopsies are performed annually by members of the division for the diagnosis and staging of kidney diseases. Ambulatory blood pressure monitoring and pulse-wave analysis is used to assist in the diagnosis and management of hypertension. The division also provides all pediatric apheresis services for St. Louis Children’s Hospital, including plasmapheresis, red blood cell exchange, leukapheresis, and extracorporeal photopheresis.
In addition to these services, the Division actively supports and participates in long-term follow-up of patients in the Cardiothoracic Surgery, General Surgery, Urology, Bone Marrow Transplant, and several solid organ transplant programs. We have multidisciplinary clinics with other specialists, including a combined Nephrology/Urology clinic, Fontan clinic, and the newly formed Aortic & Renovascular Center for Hypertension (ARCH) program.
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