Nephrology and Hypertension

The physicians of UF Health Nephrology in Jacksonville, Florida specialize 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.

For 2019, U.S. News and World Report ranked UF Health Jacksonville among the top 50 hospitals in the nation for nephrology services. Hospitals are evaluated based several key criteria, including patients’ 30-day survival odds after discharge, likeliness to be go home, advanced patient technologies, nurse-to-patient ratios, patient experience and reputation. UF Health Jacksonville is honored to be recognized for its efforts in caring for its complex renal patient populations with diagnoses that include acute kidney failure, hypertensive chronic kidney disease and disorders related to chronic catheters.

UF Health Nephrology offers evaluation of all forms of acute and chronic kidney-related conditions, including:

• Kidney failure

  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 therapy.

• Proteinuria

  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

  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
• Hematuria
• Kidney stones
• Nephrotic syndrome
• Other kidney-related medical conditions

Diagnostic Procedures

Kidney biopsy

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.

Dialysis Treatments

• 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

  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.