Nephrology and Hypertension
UF Health Nephrology and Hypertension at Jacksonville specializes
in the diagnosis and therapy of kidney diseases. These specialists are experts in
preventing and delaying the onset of kidney failure, and provide a wide range of
expertise for patients who require dialysis therapy. Staffed by the faculty nephrologists
of the University
of Florida Division of Nephrology and Hypertension in Jacksonville, UF Health
Nephrology offers evaluation of all forms of acute and chronic kidney-related conditions,
The evaluation of kidney failure is typically based on how long the condition has
been present. The evaluation of longstanding or chronic kidney failure is performed
in the outpatient nephrology clinic and involves blood and urine tests. Some patients
require further testing in radiology and/or follow-up blood or urine testing based
on the results of the initial evaluation.
Unexplained or rapid loss of kidney function (acute kidney failure) is a more urgent
problem and requires admission to the hospital to define the cause and appropriate
Proteinuria results when protein normally found in the bloodstream appears in the
urine. This is typically due to a leak through the small filters that make up the
kidney. Many diseases can cause protein to leak into the urine, including diabetes.
The evaluation of proteinuria is performed in the outpatient nephrology clinic and
involves blood and urine tests. Some patients require further testing in radiology
and/or follow-up blood or urine testing based on the results of the initial evaluation.
When the cause of proteinuria and/or the proper therapy cannot be determined in
the clinic, a kidney biopsy is generally recommended.
Complex hypertension is elevated blood pressure that requires four or more medications
for control, or elevated blood pressure found in the presence of kidney failure.
The evaluation for complex hypertension is performed in the outpatient nephrology
clinic and involves blood and urine tests. Most patients require further testing
in radiology. Follow-up blood or urine testing may be required. Some patients may
need a kidney biopsy to help determine the cause of the condition.
Additionally, the division offers outpatient evaluations of the following:
- Anemia requiring erythropoietin therapy
- Difficult-to-control hypertension
- Kidney stones
- Nephrotic syndrome
- Other kidney-related medical conditions
During a diagnostic kidney biopsy, a small piece of the kidney-approximately one-half
of an inch in length and the diameter of a pencil lead-is obtained using a specially
designed needle guided by ultrasound. It takes about 25 minutes to set up for the
biopsy and less than five minutes to do the procedure. The set up involves visually
locating the kidney under ultrasound, cleaning the skin with antiseptic and numbing
the skin with a local anesthetic. A kidney biopsy is then obtained with a biopsy
needle. A bandage is placed on the biopsy site, which is typically a small cut less
than one-quarter of an inch in size. To minimize bleeding, the patient is asked
to lie flat in the bed for six hours and remain on strict bed rest overnight. Normal
walking can be resumed in the morning, but no heavy lifting or exertion is permitted
for at least five days.
A kidney biopsy can be performed as an outpatient procedure or during a hospital
admission. Blood tests are necessary prior to an outpatient biopsy to confirm that
blood clotting is normal. If blood clotting is abnormal, the biopsy is postponed
until all clotting is normal.
Acute and chronic hemodialysis
Hemodialysis is used when waste products, salt and water build up in the kidneys
and the patient has symptoms of kidney failure (weakness, persistent nausea, vomiting
or confusion) or problems with too much fluid (severe swelling, difficulty breathing
when laying flat, severe high blood pressure or heart failure). Hemodialysis requires
a three- to four-hour treatment with a kidney machine three times a week. The kidney
machine slowly removes the toxins and excess salt and water by filtering blood through
an artificial kidney.
Hemodialysis using a kidney machine requires the placement of intravenous lines
similar to having blood drawn. Line placement may damage the small veins in the
arm, so patients need to have a venous shunt surgically placed before regular dialysis
can be performed. In some situations, like emergencies, dialysis can be performed
through a large IV line, but this is usually for temporary situations.
Chronic hemodialysis is performed in an outpatient dialysis center. When needed,
emergency dialysis can be performed in the hospital. In addition, if a hemodialysis
patient requires hospitalization for other medical problems, dialysis treatments
are provided in the hospital dialysis unit and supervised by a nephrologist from
UF Health Nephrology.
Peritoneal dialysis is a form of dialysis that uses the abdominal cavity as an artificial
kidney. A soft plastic tube is surgically placed in the abdominal cavity. After
the site heals, the catheter is used to run fluid (dialysate) into the abdominal
cavity, where it draws out toxins and extra fluid. When the dialysate is drained
from the abdomen, it carries the waste products with it.
Peritoneal dialysis can be performed during the day, changing a bag of dialysate
every four to six hours, or at night with an automatic cycler. In both cases, the
patient performs the dialysis at home. Patients with active lifestyles tend to prefer
peritoneal dialysis since it helps to maintain independence.
Continuous renal replacement therapy
Continuous renal replacement therapy (CRRT) is a form of gentle bedside dialysis
that is used in the intensive care setting. CRRT is reserved for critically ill
patients requiring dialysis and is typically used in the medical and surgical intensive
care units. The nephrology division offers an inpatient consult service that provides
this therapy to patients.