Medical Specialties
Nephrology
Our main interest is to prevent, diagnose and treat symptoms and diseases that can affect renal function:
Urinary tract infection
“In recent days I have to go to the bathroom very often. When I urinate, my urine stings and itchies and it is blood stained”.
What are urinary tract infections?
It is an infection usually caused by bacteria in urine.
Where is the infection located?
When the infection is in the bladder, it can cause cystitis. The patient reports urinary frequency constant feeling of desire to urinate and a feeling of incomplete emptying of the bladder. It is associated with pain or burning while urinating. Sometimes, you may see blood in the urine (hematuria).
If the patient has fever, an organ may be affected by the infection.
- In men, the infection can affect prostate and cause prostatitis.
- Kidney can alos be affected, presenting with fever, chills, back pain and malaise. The infection is called acute pyelonephritis).
How do I get the infection?
Usually the most common way of infection is the ascending one, by germs that ascend from the urethra, reaching bladder, prostate or kidneys. This explains why women present more urinary infections than men, since the urethra is shorter. Another way of infection is through the blood stream from a distant area of infection.
Sexual activity, constipation and urinary retention are also associated with the recurrence of infections.
What factors may predispose to have infection?
The use of urinary catheters, the presence of renal stones, immunosuppression or diabetes mellitus are some factors that predispose to urinary infections.
How can be detected?
By testing the urine for infection, and doing urine cultures to isolate and identify germs in urine.
What treatments are indicated?
Antibiotics are used to treat infections, They should be initiated early and selecting the most optimal one according to the result of the urine culture. It is, therefore, very important to perform a urine culture before starting treatment.
How the treatment varies?
Depending on the location of the infection, the patient’s age and clinical situation and the type of germ, the treatment and the duration of the treatment can be different. It is very important to decide the right antibiotic with the right dose and the right duration of the treatment.
What treatment is advised in women with recurrent uncomplicated urinary infections?
If 2 or more infections in six-month period occur, treatment may include: suppressive treatment with rinary antiseptics (cranberry juice) or antibiotics, postcoital prophylaxis and intermittent treatment with several antibiotics.
What is prophylaxis?
It is the administration of a low dose, long duration of antibiotic treatment to keep the patient free of infection.
It is advisable to seek medical advice in the event of urinary symptoms suggestive of infection.
Prostatitis
“I had high fever,lower abdominal pain and my sex life has changed. And yes, I have to get up at night to urinate as well.”
What is prostatitis?
It is a localized infection in the prostate characterized by the onset of high fever and urinary disorders such as difficulty in urination or pain in the pelvic floor (perineum). It is identified by inflammation of the prostate and PSA elevation in blood (prostate specific antigen).
Depending on the type of infection, prostatitis can be:
- Acute bacterial infection: acute prostatitis.
- Recurrent bacterial infection with frequent prostate infection.
- Chronic non bacterial pain: it is not an infection but generates pelvic pain for more than three months and it can cause symptoms during urination or sexual intercourse.
What are the symptoms of prostatitis?
- Increased urinary frequency and pain.
- Fever, general malaise and perineal pain that usually ascend to the pubis, inner thighs, lower back, scrotum and penis.
- Decreased sexual desire, total or partial loss of erection, premature or painful ejaculation, infertility, or blood in the semen.
It is advisable to seek medical advice if these symptoms occur.
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How is the diagnosis made?
Clinical history, physical examination and diagnostic tests (urine culture, semen culture, PSA and ultrasound scan of kidneys, bladder and prostate. Occasionally, a prostate biopsy is recommended.
What is the treatment?
- Acute prostatitis: specific antibiotics directed against bacteria can be identify through urine cultures. In severe cases, the antibiotic needs to be administered intravenously or intramuscularly. The treatment usually lasts between 4 and 6 weeks.
- Chronic Prostatitis needs to be treated with powerful antibiotics that penetrate the prostate tissue. The treatment usually lasts between 6 and 12 weeks.
Renal colic and kidney stones
“This morning, I had a sudden and severe pain in the kidneys reflected toward the groin, together with by dizziness and vomiting. The pain is so intense that I cannot stand still.”
What are kidney stones?
Kidney stones are caused by the appearance of “solid material” in the urinary tract known as kidney stones. They are formed by precipitating “salts of the urine”.
How are the kidney stones produced?
The causes are many and varied. The low water intake, infections, genetic disorders, stress, anatomic abnormalities of the kidney, factors related to food can be associated.with the kidney stone formation.
Therefore it is recommended to drink plenty of water and avoid salty diet, as well as restricting certain foods in some cases, depending on the type of stones.
Are there different types of stones?
Urinary stones can be grouped into different types. The most common, calcium oxalate. Other, calcium phosphate, uric acid, cystine, infectious and medication.
To determine the exact type of calculation and to establish the most appropriate treatment, it is recommended to carry out a specific study of stones (crystallographic examination) or to perform a metabolic study of the urine.
What are the most common symptoms?
The most frequent symptom in renal colic is pain in the loin area. It happens when the stone blocks the ureter. It is a very intense pain and it is usually accompanied by dizziness, nausea and vomiting.
What are the consequences of a renal colic?
The stone, down the ureter, can cause an obstruction in the urine flow. This can lead to serious infections, alter renal anatomy, reduce renal filtration and harm the kidney irreversibly.
Always seek advice in the event of symptoms suggestive of renal colic.
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What treatments are currently used?
In most cases, the use of anti-inflammatory drugs and pain killers are needed.
In some cases the stone is expelled naturally. In others, it is necessary to use specific medication to help with the stone expulsion.
When the stone is large and cannot be removed, the use of shockwaves that the fragment the stone(lithotripsy) may be helpful.
In exceptional cases, open surgery, or the use of laparoscopic or endoscopic devices may be required.
What preventive measures are available?
It is important to have a low-salt diet drink two liters of water per day. It is also advisable to reduce stress in life, avoid smoking, reduce alcohol consumption and have a good daily rest.
In some cases, depending on the specific type of stones, it is recommended to avoid foods high in oxalates (spinach, beets, etc.), uric acid and calcium, as well as to have a low protein diet.
What do patients who have had renal stones must know?
It is advisable to analyze the stones ejected and to perform a metabolic study to help to establish the best treatment option.
Renal failure
“In the last blood test I was foun to have an abnormal rebal function test. Is it serious? Will it end in dyalisis?”.
What is kidney failure?
It is the loss of kidney function leading to a decreased ability to eliminate toxic substances in the blood.
There are lots and different factors that will lead to this situation: diabetes, hypertension, elderly patient, immune disorders, kidney and / or liver diseases, chronic infections, low water intake, chronic use of anti-inflammatory drugs, etc.
What can be the causes?
- Pre-renal: this is produced by a reduction of blood supply to the kidneys, like bleeding, dehydration due to gastrointestinal losses as vomiting or diarrhea, or heart failure.
- Vasculitis: causing immune glomerulonephritis or acute/chronic inflammation of the renal glomeruli.
- Malignant hypertension.
- Hereditary: polycystic kidney disease.
- Nephrotoxic: use of drugs that cause renal toxicity in their elimination through the urine.
- Post-renal: caused by obstruction of the urinary tract (prostatic hypertrophy, stones, prostate cancer).
What are the most common symptoms?
The accumulation of toxic substances in the blood can cause different symptoms in different organs or body systems.
- Gastrointestinal symptoms like nausea, loss of appetite and vomiting.
- Abnormal blood blood count, with anemia, high white cell counts and abnormal clotting tests.
- Cardiovascular abnormalities, like: hypertension, arrhythmias and heart failure.
- Neurological symptoms: progressive cognitive dysfunction, restless leg syndrome and impaired sensation or pain in extremity.
- Hormonal abnormalities: bone pain and fractures caused by abnormal formation and destruction of bone.
- Musculoskeletal symptoms: dolor óseo y fracturas por alteración en la formación y destrucción del hueso.
- Electrolyte: alterations in potassium, sodium, phosphorus and calcium.
- Dermatologic symptoms: straw-colored skin.
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How is it diagnosed?
It is diagnosed by blood and urine tests, renal ultrasound and, sometimes, ultrasound-guided renal biopsy for definitive diagnosis.
How is it treated?
Acute renal failure is sometimes reversible and should be treated aiming the specific underlying condition. When there is a long standing renal abnormality, full renal function may not be recovered, leading towards chronic renal failure.
The use of intravenous rehydration and withdrawing renal toxic drugs are used in the treatment of this condition.
Salt intake must be reduced as well as a reductions in certain fruits and vegetables.
What drug treatments are best?
- Diuretics can help to eliminate potassium and water.
- Active vitamin D, to help control levels of calcium and parathyroid hormone and promotes bone mineralization and calcium reabsorption.
- Erythropoietin and iron treatment, to help with red cell production of red blood cells and control of anemia.
What renal replacement therapies are currently available?
If you do not respond to conventional treatment, invasive measures should consider:
Hemodialysis : removes toxins and fluid by an arteriovenous through an artificial filter. It is done in regular sessions, lasting between 3 to 4 hours each, three times a week.
Peritoneal dialysis dialysis is characterized by using the peritoneal membrane that surrounds the abdominal organs to eliminate toxins and fluid. It requires implantation of a catheter in the peritoneum to provide access to the dialysis fluid in the abdomen. It is done at home. It should be performed three or four times daily.
Kidney transplantation: it can be done from a living donor or from a deceased donor.
Diabetic nephropathy
“I have had diabetes for many years and it has always been very difficult to control. I have been advised to seek advice by a kidney specialist. Why?”
What is diabetic nephropathy?
It is a kidney disorder secondary to long-standing diabetes. Diabetes is usually associated with other cardiovascular risk factors such as hypertension, hypercholesterolemia and genetic predisposition.
Why diabetic nephropathy occurs?
The kidney is responsible for filtering the blood to remove toxic products. These wastes will be eliminated through the urine.
Diabetes damages the small arteries of the kidney which are responsible for filtering blood, leading to a loss of protein in the urine that favors the onset of renal dysfunction.
There are several nephropathy predisposing factors:
- Long duration of diabetes.
- Hypertension.
- Poorly controlled diabetes.
- Obesity.
- Lack of exercise.
Which are the initial symptoms?
Severe symptoms may appear when renal function is severely damaged. The initial symptoms are polyuria (urinating large amount) or foam in urine, which is indicative of presence of protein in the urine. Therefore, regular blood and urine tests should be performed in all patients, especially those with diabetes.
It is advisable to ask for medical advice if urinary symptoms appear.
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How is it identified?
Urine tests can identify protein loss, suggesting diabetic nephropathy. Eye evaluation can detect signs of retinal involvement of diabetes, which is called diabetic retinopathy.
When the damage is serious, the kidneys may stop working and can lead to chronic renal failure with increased levels of creatinine and urea, and decrease of the renal filtration rate in the blood tests.
What is the treatment?
It is very difficult to reverse chronic renal failure, so early detection is very important. Thus, it is important to control cardiovascular risk factors, keep on to a low salt and low protein diet, exercise regularly and control blood pressure, diabetes and cholesterol with the appropriate medication.