Nephrology is the study of your kidneys.
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The Nephrology Department at the Royal is run by a dedicated team of health care professionals who provide the highest standard of care and support to all their patients.
The unit cares for people with Chronic Kidney Disease as inpatients and outpatients. It has the largest dialysis programme in the Mersey region with more than 400 patients.
The Department serves a population of about 1.2 million people throughout Liverpool and its suburbs including North Cheshire. Satellite Haemodialysis units are located at Broadgreen, Warrington, Halton and St Helens.
Nephrology services provide a virtual clinic that triages new patient referrals.
All new referrals are triaged by an experienced Advance Nurse Practitioner. This includes a system for tracking all referrals, organising investigations such as bloods and ultra sound scans, and providing patients with an information welcome pack.
Patients are then filtered to the appropriate clinic. With Satellite outreach services and an extensive clinic stream at the Royal, we are able to offer, depending on urgency, new patient appointments within two to 13 weeks.
The virtual clinic also has a facility to provide advice and guidance for primary and secondary care and this facility sits within the Choose and Book system. This gives clinicians the opportunity to seek advice prior to referral, or advice and guidance about stable chronic kidney disease patients being managed in primary care. This service is nurse led and supported by the on call consultant.
The Nephrology Unit prides itself on the success of its outreach clinics. These clinics are well established and are provided by a multiprofessional team of nephrology experts, who travel from the Royal three times per week to run clinics at St Helens, Warrington and Halton hospitals.
The outreach clinics allow patients to be seen closer to home, provides ease of access and allows patients health care to be under one roof. It also allows flexibility to be seen in several different clinics if a patient's circumstances change.
We run multidisciplinary specialist dialysis clinics once a week at all the satellite units (Warrington, Halton and St Helens) and also at the Royal. In addition, there’s also a weekly Peritoneal Disease clinic run by a specialist multidisciplinary team.
The satellite unit clinics allow patients to be seen closer to their home. These clinics provide specialist services to this complex group of patients, ensuring that renal association standards are achieved, access problems are sorted and timely referral to the Transplant Team is completed.
The outreach obstetrics clinic is held at the Liverpool Women’s Hospital. The clinic aims to see all patients, preconception and in early pregnancy, that are chronic kidney disease stage 3a to 5, hypertensive or proteinuric patients with any chronic kidney disease stage and all dialysis and transplant patients.
The clinic offers one stop renal obstetrics care. All patients are seen by the same consultant obstetrician and nephrologists at each visit. This joint clinic improves communication between patient and multidisciplines, offers expert pre-pregnancy advice, ensures safest drugs used in pregnancy, maps delivery plans and ensures expert pre and post natal follow up care.
Outpatient clinics are provided at the Royal for patients with chronic kidney disease who are not yet on dialysis. These clinics are run by a multiprofessional team for new patients or patients with complex kidney problems and who are unable to be managed by primary care. All patients that are referred are seen within 13 weeks. Urgent referrals are seen within two weeks and often can be seen within a week of referral. Most new referrals are seen within 4-6 weeks of referral.
Diabetic renal clinic
The joint diabetic renal clinic is opened to any complex renal patients, including dialysis or transplant patients with poorly controlled diabetes.
This clinic is multiprofessional, and runs once per month with patients having a 45 minute review by two speciality consultants, with further dietetic or specialist nurse follow up if required.
Nephrology services at the Royal work very closely with paediatric nephrology services in the transfer of adolescents to adult nephrology. Patients are seen in the low urinary clearance clinic by the same consultant nephrologists. This clinic allows the adolescents and their parents to be gently introduced to an adult clinic, and provide them with early education, preparation for renal replacement therapy including pre-emptive kidney transplant.
Anaemia correction is provided to all patients with anaemia associated to chronic kidney disease. Patients are referred from any nephrology clinic to a team of anaemia nurse specialists.
Treatment includes intravenous iron therapies, and erythropoietin stimulating agents. This service is nurse led, and all treatment is monitored by the anaemia specialist nurse team with the support of the consultant nephrologists.
Pre-dialysis education clinics
Patients with advanced kidney failure (CKD5) are referred to the pre-dialysis nurse specialist for advice, education and support. The clinic ensures the nurse specialist provides the patient with the necessary knowledge to be able to make a treatment option choice and thereby enables the patient to have a seamless entry to renal replacement treatment pathways.
Home therapies clinic
Patients are referred to the home therapies clinic once all pre-dialysis education is complete. Patients are assessed by the consultant nephrologists for consideration for home therapies, and patients are then placed on the home therapies pathway prior to commencement of dialysis. This ensures all systems are in place prior to treatment commencing and allows the patient a seamless entry on to the programme.
Conservative management programme
It is important to recognise that conservative management, without dialysis, is not simply defined by the absence of dialysis provision - it entails active disease management, for example active treatment of anaemia, acidosis, or fluid balance, and detailed supportive care, which often becomes increasingly complex. The programme established at the Royal has a multi-disciplinary team approach. In addition to the outpatient clinic, patients are also supported in their own home. This service is the only established such a programme in the Mersey region.
The vasculitis programme is a specialty within renal medicine. It is a multi professional service the covers several specialities within and outside the trust. The service is run by a consultant nephrologist with the support of a clinical nurse specialist.
The service provides day case management for infusion therapies in a purpose built intravenous infusion unit. There is also a designated vasculitis clinic which runs jointly with ear, nose and throat specialists and ophthalmologists. The vasculitis programme is the only programme in the Mersey region. As a relatively new service, it is continuously expanding to meet the needs of the population in the region.
Renal replacement programme
The renal replacement programme at the Royal provides dialysis treatment for about 450 patients. This includes patients having haemodialysis at home, satellite units and the main hub centre - Ward 6B. It also includes patients having peritoneal dialysis at home.
The home dialysis programme under the direction of a Consultant Nephrologist is run by a team of dedicated specialist nurses. The home programme is the largest in the Mersey region and continues to expand as more patients are provided with the necessary skills to become self caring with their treatment.
The satellite units are based at Broadgreen, St Helens, Warrington and Halton. These units are run in joint collaboration with Fresenius, and each unit provides state of the art facilities that enable patients to dialyse closer to home.
The Nephrology Directorate has a designated research nurse, who is committed to facilitating research of the highest standards.
Recent research projects in nephrology have included new treatments for Haemolytic Uraemic Syndrome (HUS), innovative new phosphate binders, novel use of established drugs to improve health and quality of life in dialysis patients, treatments for secondary hyperparathyroidism, and extended dosing of erythropoietin stimulating agents. Future studies include: new treatment regimes for patients with Multiple Myeloma, Vasculitis and nephropathy, and looking at vitamin D levels with view to supplementation.
The Nephrology Unit work very closely with the consultant interventional radiologist. The interventional approach of a thrombosed arteriovenous fistula requires great experience and skill, and the Radiology Department in partnership with the Nephrology Department are able to ensure that haemodialysis patients' vascular access are preserved when complications arise. We have weekly multidisciplinary team meetings to look at the access related problems and they are addressed in a timely manner so loss of access is prevented and also hospital admissions.
Day case Unit
The Nephrology Department boasts a six bedded day unit that is staffed by a team of vastly experienced nephrology nurses. The unit is lead by a nephrology advance nurse practitioner who coordinates the admissions and discharges for day case activity. In addition the advance nurse practitioner also coordinates a rapid access biopsy service that ensures timely diagnoses of complex kidney problems. The department also operates a drop in service that patients can access outside of clinics. This allows patients to be seen and thereby reduces hospital admissions.
The unit has also recently embarked on a large project that has ensured a nephrology specific IT system (CyberRen) has been introduced to enhance the care and improve the outcomes of our Nnephrology patients. This has also lead to us being able to introduce the national Patient View system that allows patients to be more involved in the planning of their care, and allows them access from their own home to all their clinical blood results, recent clinical letters, transplant waiting list status and much more.
Secretaries' phone numbers
Dr R Saxena
Dr H Sammut
Dr J Harper
Dr J Hiremath
Dr M Howse
Dr R Brown
Dr A Rao
Contact Sharon, Maria and Jacqui on 0151 706 3475
Nephrology Ward Numbers
Ward 9B - 0151 7062396/2398
Ward 6A - 0151 7062365/2363
Ward 6B - 0151 7063603/2368
Ward 6PDU - 0151 7063609