Nephrology | Clinical Activities
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 Barnes West County Hospital. 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 CKD Pathophysiology, Calcium Disorders, Renal Transplantation, Acute Kidney Injury, and Inherited Renal Disorders.
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 8-10 kidney transplants/year and has performed almost 300 transplants since inception. As of July 1, 2012, the medical director is Dr. Vikas Dharnidharka.
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. Renal replacement therapies are provided in the Pediatric and Neonatal Intensive Care Units. Available options include acute hemodialysis, peritoneal dialysis, and hemofiltration.
Chronic hemodialysis and home chronic peritoneal dialysis are available for patients with End Stage Renal 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 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.
The division supervises special procedures for the evaluation and therapy of chronic renal diseases. Approximately 40 percutaneous renal biopsies are performed yearly by members of the division, for the diagnosis and staging of renal diseases. Ambulatory blood pressure monitoring and pulse-wave analysis is provided for diagnosis and management of hypertension. The division is also in charge of all pediatric plasmapheresis and cell pheresis services.
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 and participates in long-term follow-up. In addition the division is also an active participant in the Fontan Clinic with other specialists.
Ruth Orschell, RN
Pat Wiltsch, RN
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