Nephrology | Clinical Activities

The general nephrology clinic currently meets three times a week, conducting 1800 patient visits for initial evaluation and follow-up each year. 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 renal disorders secondary to systemic diseases. Special interests of our faculty include Polycystic Kidney Disease, Calcium Disorders, Renal Transplantation, and Inherited Renal Disorders.

A separate Transplant clinic meets weekly for long-term management of pediatric kidney transplant recipients. A twice monthly Hypertension clinic is conducted jointly with the Division of Pediatric Cardiology.

The division maintains an active consultation service for hospitalized patients, including the management of acute fluid and electrolyte disorders, hypertension, renal manifestations of systemic diseases, and therapy for acute and chronic renal failure. St. Louis Children's Hospital has active programs in Pediatric Cardio-Thoracic, General, and Urologic Surgery, as well as Heart, Lung, Liver, and Bone Marrow Transplant, and the Renal Division provides active support when needed. Renal replacement therapies are provided in the Pediatric and Neonatal Intensive Care Units. Available options include acute hemodialysis, peritoneal dialysis, hemoperfusion and hemofiltration.

Chronic hemodialysis and home chronic peritoneal dialysis are available for patients with End Stage Renal Disease. Hemodialysis is performed three times a week 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 home peritoneal dialysis therapy undergo intensive training in center, with monthly visits for on-going care. The care of chronic dialysis patients is based on a team approach, with participation by the dialysis nurses, nephrologists, social workers, and dieticians to individualize each patient's care.

Specialized Services

The division supervises special procedures for the evaluation and therapy of chronic renal diseases. These include: measurement of glomerular filtration rate (GFR) as an indicator of kidney function, using either inulin or isotopic techniques; Calcium loading tests for the evaluation of kidney stone disease; and furosemide challenge for the diagnosis of renal acidification disorders. Approximately 40 percutaneous renal biopsies are performed yearly by members of the division, for the diagnosis and staging of renal diseases.