Nephrology

Overview of the department

Chairman Prof. Masayuki Iwano

Chairman
Prof. Masayuki Iwano

We are responsible for the prevention of chronic kidney disease (CKD) and dialysis/transplantation based on urine abnormalities on health checkups. With respect to underlying diseases, major diseases, such as diabetic nephropathy, chronic nephritis, nephrotic syndrome, hypertensive nephrosclerosis, and lupus nephritis, are treated from nephrologists’ viewpoints in cooperation with relevant departments in our hospital and relevant hospitals, contributing to regional medical practice.

Consultation system/therapeutic strategies

Outpatient medical care is conducted in a specialized outpatient clinic in the morning from Monday to Friday. Skilled physicians, as instructors, and residents are responsible for admission care. Clinical conferences and the professor’s rounds are carried out every week for accurate diagnosis and treatment. Terminal renal failure is managed from the start of dialysis until outpatient dialysis in the Department of Blood Purification Therapy.

Field of expertise

Concerning urinalysis abnormalities on health checkups, patients are admitted for 1 week, and kidney biopsy is performed. Early diagnosis-based treatment is provided. If necessary, an inulin clearance test is conducted to precisely evaluate the kidney function.
With respect to diabetic nephropathy, of which the incidence has been increasing, angiotensin II-suppressing hypotensive drugs are positively administered from the microalbuminuria phase or early phase of overt nephropathy in addition to diabetes treatment, such as diet therapy and blood glucose/pressure control, and hyperlipidemia treatment. To treat renal failure, uremic toxin adsorbents are combined in the early stage. To patients with renal anemia, erythropoietin preparations are administered before the introduction of dialysis to prevent progression and improve the quality of life. For dialysis care, maintenance dialysis is conducted in the outpatient clinic.

Advanced medical practice

To treat IgA nephropathy, steroid pulse therapy is performed, as a rule, when kidney biopsy findings suggest a relatively poor or poor prognosis.
Concerning diabetic nephropathy, multidisciplinary treatment is conducted in cooperation with physicians specializing in other fields, administrative dietitians, and nurses. Basically, angiotensin II-suppressing hypotensive drugs are administered to prevent progression by reducing hypertension, hyperlipidemia, anemia, and edema.
In the Department of Blood PurificationTherapy, 9 beds for dialysis are available. Two of these beds are equipped with hemodiafiltration (HDF) devices, which facilitate the management of severe-status patients. Information on dialysis is managed using a computer. Accurate, safe dialysis is conducted.
Kidney transplantation is performed in cooperation with surgeons belonging to the Department of Urology. Acute/chronic rejection is also controlled.

Symptoms/diseases treated in our department

In the Department of Nephrology, edema, hematuria, proteinuria, and hypertension are treated. Glomerulonephritis and nephrotic syndrome are primary kidney diseases. They are treated in our department. Consultations before and after surgery in patients with kidney hypofunction are possible. Furthermore, we are responsible for the treatment of kidney diseases that concomitantly develop with disorders in the field of internal medicine, such as diabetes, hypertension, heart failure, and lupus nephritis. Chronic renal failure is controlled in patients before the introduction of dialysis, outpatients undergoing dialysis, and patients after kidney transplantation. In the Department of Blood PurificationTherapy, treatment for acute renal failure is performed.

Primary examinations and explanations

Kidney biopsy is a basic, essential examination to make a diagnosis of persistent proteinuria (0.5 g/day or more), chronic nephritis, or nephrotic syndrome and select therapeutic strategies. In our department, kidney biopsy-based diagnoses are made in approximately 50 patients per year. This is the highest number in Fukui Prefecture. This procedure is completed in approximately 30 minutes under local anesthesia, while confirming the kidney position using ultrasonography.