Kidney Disorders

Treatments for Kidney Disease / Kidney Cancer / Kidney Stones

Nephrology

The George Washington University Hospital is equipped to support both stable and acutely ill patients who have uncontrolled hypertension, fluid electrolyte disorders, chronic kidney disease or an acute kidney injury. The multidisciplinary team provides care ranging from traditional therapies to emerging experimental treatments for those participating in clinical trials.

Acute Dialysis Unit:
The George Washington University Hospital has eight Fresenius K series machines capable of delivering conventional dialysis as well as slow extended dialysis. The acute dialysis unit also has two Cobe-Spectra Plasmapheresis machines.

The following therapies are offered through the Nephrology Service:

  • Conventional Hemodialysis for stable patients with acute and chronic kidney failure
  • Continuous Renal Replacement Therapy (CVVH) is provided for acute and critically ill patients who cannot tolerate regular hemodialysis.
  • Slow Extended Daily Dialysis (SLEDD) is offered as a bridge between CVVH and regular hemodialysis as well as to selected patients who are critically ill and unstable.
    Peritoneal dialysis
  • Therapeutic Plasmapheresis is offered for renal and non-renal disease by well-trained clinicians, nurses and technicians.

Kidney Biopsy is performed percutaneously under real-time guided by ultrasound or computerized tomography as indicated for diagnostic purposes.

Renal Imaging services are provided through the department of radiology.

Interventional Nephrology services are provided in collaboration with the division of interventional radiology, which includes placement of hemodialysis catheters, imaging of vascular access, declotting of clotted access.

Vascular Access Surgery: Highly trained vascular surgeons perform access mapping and vascular access surgery.

Urological Services: The nephrologists work with experienced urologists to deliver care to patients with problems related to urogenital system including medical management of obstructive uropathy, nephrology care and post-nephrectemy care.

Nephrectomy

Because of their vital functions such as filtering wastes and fluids from the bloodstream, kidneys are essential for human survival. Yet more than 30,000 Americans suffer from kidney cancer each year and many more have suspicious growths on their kidneys requiring surgical removal or biopsy, known as nephrectomy. Kidney cancer, kidney disease or infection can result in kidney failure. If one or both kidneys fail to operate properly, a patient may need to undergo chronic dialysis treatment or the surgical transplantation of a healthy kidney in order to sustain life. In most cases, surgery is the appropriate choice.

Nephrectomy may involve eradicating a small portion of the kidney or removing the entire organ as well as surrounding tissues. In a partial nephrectomy, only the diseased or infected portion of the kidney is extracted. A radical nephrectomy involves the removal of the entire kidney, a section of the tube leading to the bladder (ureter), the adrenal gland and the fatty tissue surrounding the kidney. A simple nephrectomy requires the removal of the kidney and a section of the attached ureter.

Hand-Assisted Laparoscopic Nephrectomy

A technique using minimally invasive surgical procedures, hand-assisted laparoscopic nephrectomy has recently enhanced kidney removal procedures. Removing a kidney because of infection, obstruction or cancer historically meant making a 10- to 12-inch incision in the patient's side and sometimes removing a rib. Today the innovative hand-access procedure allows surgeons to view, cut and remove the kidney or infected area—through a significantly smaller incision.

The physician makes four small ¼- to ½- inch incisions in the abdomen. A flexible videoscope is inserted in one of the incisions providing the surgeon with a magnified view of the kidney and surrounding tissue. Other surgical instruments on long, narrow rods are placed through the other incisions. A fifth incision of about 3 inches provides access for the surgeon's hand. Once the kidney is freed, it is secured in a bag and channeled out of the body through this same incision.

This procedure takes about the same amount of time as a conventional nephrectomy, it results in enormous postoperative benefits to the patient. The decreased size of incision results in less pain, shorter hospital stays, fewer infections and faster recovery. With hand-assisted nephrectomy, patients generally stay in the hospital for two days and return to their normal activities within one to three weeks. Traditional surgery usually requires patients to stay in the hospital for five days and return to normal activities at four to six weeks. Another benefit of the minimally invasive technique is an improved cosmetic result—the three inch incision is often hidden in one's belt line.

Advances in Treating Kidney Stones

In the past, patients with kidney stones too large to pass faced a major surgery to remove the stones. Even when stones were smaller, passing kidney stones was painful and not always possible.

Urologists at GW use several minimally invasive techniques when stones are large or the patient cannot pass them easily.

Extracorporeal shockwave lithotripsy (ESWL) uses high-frequency ultrasound delivered from outside the body to smash the stones into a passable dust-like material. ESWL is a major advance in the ability to deal with kidney stones.

Even if smashed, larger stones create too much debris to pass through the ureter. In this case, urologic surgeons at GW Hospital use a procedure called percutaneous nephrostolithotomy to access the kidneys with endoscopic instruments inserted through the patient’s back. The stones are then broken up with a laser or other tools and removed.

Open surgery for kidney stones is almost obsolete. Now, there are a lot of different ways to deal with stones.

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Additional Minimally Invasive
Kidney Procedures

Over the past few years, GW Hospital has invested significantly in expanding minimally invasive surgical approaches for kidney-related diseases such as tumors, cysts, kidney stones, reconstruction of urinary tract anomalies, stricture disease and removal of poorly functioning kidneys (noncancerous).
Learn about options >

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The George Washington University Hospital is owned and operated by a subsidiary of Universal Health Services, Inc.(UHS), a King of Prussia, PA-based company, that is one of the largest healthcare management companies in the nation.          

The George Washington University Hospital

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