What is Interventional Nephrology?
Interventional Nephrology is a new and emerging subspecialty of Nephrology that deals mainly with kidney ultrasonography and ultrasound-guided renal biopsy, insertion of peritoneal dialysis catheters, tunnelled dialysis catheters as vascular access for patients undergoing heamodialysis, and percutaneous endovascular procedures performed to manage dysfunction of arteriovenous fistulas or grafts in patients with end-stage renal disease.
Who is an Interventional Nephrologist?
Interventional nephrology is a nephrology subspecialty that requires practical knowledge of percutaneous endovascular procedures to manage vascular access dysfunctions in ESRD patients. Interventional nephrologists receive special training and perform a wide range of procedures, including the creation and management of dialysis access, which may include angioplasty, stenting, and thrombectomy. Hands-on care allows for a better understanding of dialysis patients' needs and more personalized care.
Interventional nephrology is an exciting and rapidly evolving field. It is critical to address and resolve the critical vascular access issues that arise in haemodialysis patients. The ability to provide timely, efficient, high-quality, and cost-effective service is critical to these patients' care and the operation of our dialysis units and practices.
Early vein preservation, the creation of AV access prior to the need for dialysis, the minimization of venous catheter use, monitoring and screening for access dysfunction, and planning for the creation of secondary native fistulas in anticipation of impending access failure are all opportunities for Interventional nephrologists to improve vascular access. Improved haemodialysis access care and outcomes will result in higher native fistula rates, lower patient morbidity and mortality, fewer inpatient visits, and lower healthcare costs.
Interventional Nephrology Treatments:
Interventional Nephrology (IN) is a new and emerging subspecialty of Nephrology that mainly deals with:
- Ultrasonography of kidneys and ultrasound-guided renal biopsy.
- Insertion of peritoneal dialysis catheters (PDC) in ESRD patients
- Percutaneous endovascular procedures performed to manage dysfunction of arteriovenous fistulas or grafts in ESRD patients
Traditionally, these procedures have been delegated to a variety of specialists, resulting in delays in diagnosis and treatment initiation. Nephrologists have taken the initiative to perform these procedures themselves in order to avoid delays. These specialists are ideally suited to perform this activity due to their unique perspective on dialysis. Indeed, recent research has shown that nephrologists can perform these procedures safely and successfully, with excellent outcomes.
The success of the nephrologist's role in Interventional Nephrology ensures that renal patients are managed optimally, with effectiveness, safety, and at a lower cost to the public health system. As a prerequisite for the concept's success, nephrologists must receive adequate training and develop the necessary skills in the new fields.
Renal Ultrasonography:
When a nephrologist was involved, renal ultrasonography reported that diagnostic information and prompt initiation of therapy were easily established. Recent data show that when performed by the division of nephrology, the time required to perform a renal ultrasound on an outpatient basis is significantly reduced. Nephrologists with adequate training in radiology laboratories equipped with ultrasound imaging technology. Perform ultrasonography of the kidneys or ultrasound-guided renal biopsies. The correlation with the patient's clinical problems is critical for successful renal ultrasonography interpretation. As a result, the nephrologist is best suited to interpret renal ultrasonography findings.
Insertion Of Peritoneal Dialysis Catheters:
Peritoneal Dialysis (PD) has many important advantages as a method of RRT, including the preservation of residual renal function, improved middle molecule clearance, improved fluid and blood pressure control, a lower incidence of left ventricular hypertrophy, a lower risk of severe cardiac arrhythmias, and a higher quality of life. However, only about 10% of ESRD patients eventually chose PD, despite the fact that 50% initially appeared to accept the method. The decreased use of PD is primarily due to surgeons' delayed insertion of peritoneal catheters. For this reason, the insertion of PD by nephrologists is essential.
Insertion Of Tunnelled Dialysis Catheters:
There are three types of vascular accesses.
- A tunnelled cuffed dialysis catheter
- An arteriovenous fistula (AVF)
- An arteriovenous graft (AVG)
TDCs are generally placed temporarily until an AVF or AVG is created. TDCs are only used permanently when other procedures fail. TDCs were traditionally implanted by surgeons and radiologists. Nephrologists have recently begun to perform this procedure safely and successfully. When TDC is occluded due to fibroepithelial sheath, they are also involved in catheter exchange, removal, and repair using angioplasty balloon catheters.
Percutaneous Endovascular Procedures:
Stenosis frequently complicates AVFs and AVGs. AVGs are frequently affected by this issue. Although stenosis can occur anywhere along the dialysis access, venous anastomosis is the most common point of stenosis (60%). The cause of stenosis is multifactorial, but neointimal hyperplasia is the most common. If the stenosis is greater than 50%, a percutaneous angioplasty balloon should be used to treat it. The method is carried out successfully and safely by trained Interventional nephrologists.
A significant number of AVFs (10-25%) do not develop properly and do not survive dialysis. This is known as an early failure. These AVFs were abandoned until recently when Beathard showed that most of the early failing fistulas did not mature because of stenosis in a venous channel or because of a secondary vein which takes blood out of AVF. A nephrology team treated stenosis with a percutaneous angioplasty balloon and obliterated the secondary vein in a multi-centre prospective study with satisfactory results.
Thrombosis of vascular access, which is caused by stenosis in the vast majority of cases, is also successfully treated on an outpatient basis by nephrologists using mechanical or pharmaco-mechanical thrombolysis because stenosis is the leading cause of thrombosis. It is critical to check the vascular access regularly for early detection of stenosis in order to prevent thrombosis.
In conclusion, patients with kidney disease and particularly those undergoing RRT, need frequent interventional procedures. Interventional Nephrology is an emerging subspecialty of nephrology. It allows nephrologists to undergo training in this area to develop the procedural skills to perform interventions to optimize the care of their patients.
Dr. Pranith Ram is The Best Interventional nephrologist in Hyderabad, with experience of 10+ years of clinical expertise in managing conditions like acute kidney injury, haemodialysis, peritoneal dialysis, renal transplantation, glomerular diseases, and interventional nephrology and deals with critical cases of Nephrology. Book your appointment today to get expert to advise from the best nephrologists in Hyderabad on kidney-related diseases.