THE NEPHROLOGY, HEMODIALYSIS AND RENAL TRANSPLANTATION UNITS
The nephrology, hemodialysis and renal transplantation division consists in 3 functional units:
1/ The consultation unit;
2/ The nephrology and renal transplantation units;
3/ The hemodialysis and peritoneal dialysis unit.
Anatomy of the kidney (cross-sectional view) – Source : www.genie-bio.ac-versailles.fr
The unit is a national reference center for rare diseases: AL amyloidosis and other monoclonal immunoglobulin deposition diseases (MIDD).
For all information : http://www.cr.amylose-al.fr
1/ THE NEPHROLOGY CONSULTATION UNIT
The nephrology consultation unit treats patients in:
- General nephrology consultations;
- Pre-transplant consultations;
- Pre-kidney donation consultations;
- Transplantation aftercare consultations;
- Kidney donation consultations;
- Pre-dialysis consultations.
2/ THE NEPHROLOGY AND RENAL TRANSPLANTATION UNITS
The nephrology and the renal transplantation units provide medical treatment for patients suffering from either kidney disease (acute or chronic renal failure, nephrotic syndrome, proteinuria, etc…) or from general diseases with renal involvement (autoimmune disease, metabolic diseases, malignant hemopathies…).
Organization
- The nephrology unit
- the medical consultation section
The patients referred by general practitioners for a nephrology opinion are admitted to this section for initial treatment. The consultation section is for patients requiring monitoring of their renal disease, pre-dialysis monitoring and pre- as well as post-transplantation monitoring.
- the medical consultation section
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- the hospital treatment section, with 9 individual rooms
Persons are admitted to the hospital treatment section:- following initial treatment in the emergency unit, treatment related to nephrology activities;
- in the context of scheduled hospitalization;
- in response to a medical request, either internal or external to the hospital, in an acute case, with the unit dealing with a majority of emergencies involving patients suffering from renal diseases.
- the hospital treatment section, with 9 individual rooms
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- the day hospital center, with 3 rooms
Patients whose short hospitalization is scheduled to last a few hours are admitted to the day hospital section.
- the day hospital center, with 3 rooms
Short-term care renders it possible:
- to carry out medical, radiological and/or biological investigations in order to make a diagnosis;
- to monitor patients with chronic renal pathology;
- to perform, on an outpatient basis, a number of treatments or therapeutic procedures necessitating surveillance.
- The renal transplantation unit contains 4 individual intensive care rooms with two airlock-like constructions, and it is mainly dedicated to postoperative treatment of transplant récipients and to treatment of renal diseases necessitating intensive care. For all information on renal transplantation:
The pathologies treated
- acute renal failure;
- chronic renal failure;
- nephrotic syndrome;
- glomerulopathies,
- metabolic disorders, diabetes, AHT, hereditary diseases;
- renal transplantation;
- renal damage related to autoimmune diseases and to different pathologies (hematological VIH, cancerous…),
- AL amyloidosis and other monoclonal immunoglobulin deposition diseases.
Questions for Professor Franck Bridoux, nephrologist, from the nationwide reference center for rare diseases: “AL amyloidosis”
What is amyloidosis?
Amyloidosis is a rare and severe disease in which fibrillated protein deposits accumulate and disrupt organ functions. Twenty different proteins can cause amyloidosis. In our reference center, we are specialized in treatment of AL amyloidosis, which has to do with the secretion of a monoclonal immnoglobulin (antibody) by abnormal bone marrow cells (plasmocytes). Extremely stable, the amyloid deposits progressively infiltrate numerous organs, principally the kidney and the heart, a process that may lead to renal and cardiac failure and necessitate transplantation. We also intervene in diagnosis and treatment of certain hereditary amyloidoses connected with mutation of a gene; many of them are renal.
What is a reference center?
A reference center is a unit or a group of hospital units, or a division that has been labeled, certified for work on a rare disease. It is tasked with making this rare disease better known among physicians and the general public, and with improving treatment procedures. It has attained recognized nationwide competence and derives support from a network of centers with regional competence. .
How does the Poitiers CHU reference center function?
In 2006 the reference center of the Poitiers CHU was certified for AL amyloidosis and other immunoglobulin deposition diseases. It consists in the nephrology unit headed by Professor Guy Touchard in the CHU of Poitiers and the hematology unit headed by Professor Jaccard in the CHU of Limoges.
In the CHU of Poitiers, it is reinforced in amyloidosis diagnosis by the units of immunology (Professor Gombert) and pathological anatomy (Professor Goujon); electron microscopy techniques are of key importance. In practice, the reference center serves as a recourse in amyloidosis diagnosis and treatment. It is tasked with defining good practices through implementation of shared care and treatment protocols. It is involved in basic research, clinical research (observational studies, phase 2 and phase 3 trials) and also, using a nationwide data base, in epidemiological monitoring. We regularly collaborate with other reference centers (London, the Mayo Clinic in the United States) in research and diagnosis activities.
How are these amyloidoses diagnosed?
In all cases, diagnosis is based on clinical examination and evidence of amyloid deposits in an organ biopsy. A key step consists in identifying the nature of the deposits, which necessitates the application of sophisticated anatomopathological techniques. In AL amyloidosis, it is necessary to study bone marrow to detect abnormal cells and measure the blood concentration of monoclonal immunoglobulin. In cases of hereditary amyloidosis, identification of the mutate protein necessitates the application, by Dr. Sophie Valleix in the Paris-based Cochin hospital, of molecular biology techniques.
Does there exist a treatment?
As there does not exist a treatment that would make the protein deposits in organs disappear, it is highly important to start treatment at an early stage of the disease. In AL amyloidosis, treatment is aimed at putting an end to protein production by abnormal cells, and that is why chemotherapy is carried out. For some forms of hereditary amyloidosis, a liver transplant may be proposed in order to stop protein production at the source..
Some key figures
– 500 new cases of AL amyloidosis in France a year,
– Nearly 100 patients monitored in the CHU of Poitiers for AL amyloidosis.
A useful link : www.orphanet.fr
Tél : 0810 63 19 20
The main specific treatments performed in the unit are:
- preparation of patients for dialysis,
- preoperative preparation for renal treatment,
- surveillance and postoperative monitoring of kidney transplant,
- information and education for kidney transplant patients, and dialysis or pre-dialysis for renal impairment patients,
- blood tests specific to the specialty,
- renal puncture biopsy, osteomedullar biopsy, myelography; biopsy of the nodes, of the skin, of the accessory salivary glands…,
- administration of cytotoxic products or immunosuppressants.
The unit’s activities present the following characteristics:
- Patients are admitted on a regional, and even an extra-regional scale,
- Average length of stay is 3 days,
- Most of the time, renal transplantation is not programmable inasmuch as it depends on the kidneys retrieved in Poitiers or other hospital centers. Throughout the year, it takes place urgently,
- The number of consultants continues to increase due to growth of the cohort of renal transplantation patients and to the aging of the population, which is responsible for increasing incidence of chronic renal failure,
- Activity is constantly increasing, as is recruitment of patients by the national reference center for rare diseases.
The nephrology, hemodialysis and renal transplantation division also works in close cooperation with :
- the team working in the extrarenal purification technical unit of the medical intensive care department,
- the other care services of the establishment, particularly urology, diabetology and hematology,
- the laboratories,
- the nurses coordinating organ harvesting,
- the pharmacy,
- the dietitian,
- the masseur/physiotherapist,
- the medico-psychological unit for chronic conditions (UCMP),
- the social worker and the town-hospital gerontological network,
- the private health professionals,
- The Poitou-Charentes AURA association (artificial kidney association) : http://www.aurapc.asso.fr
3/ THE HEMODIALYSIS AND PERITONEAL DIALYSIS UNIT
The dialysis unit (hemodialysis and peritoneal dialysis) treats patients suffering from severe or progressive, that is to say “terminal” chronic renal failure.
■ The hemodialysis section
■ The peritoneal dialysis (PD) section
The hemodialysis section
Capacity
The hemodialysis room contains 19 sections, distributed in 5 sub-sections and 2 stations for acute and/or temporary hemodialysis.
Each section is placed under the responsibility of a nurse; in coordination with an assistant nurse, she admits at most 4 patients at the same time.
The tasks assigned to the hemodialysis section
The hemodialysis section admits patients with chronic renal failure, residing in the Vienne department, and whose treatment necessitates admission to a center practicing “heavy” hemodialysis.
Hemodialysis is aimed at eliminating waste products from blood and at rebalancing hydration and ions. “Purification” is carried out through a “dialysis” membrane using a dialysis bath set up with water having itself been purified by double osmosis.
Most of the persons admitted are chronic hemodialysis patients. They come to the center on the average 3 times a week, for 4-hour sessions.
Vacationing dialysis patients sojourning in the Vienne department are welcomed by the Poitou-Charentes AURA (artificial kidney association) for their hemodialysis sessions.
What does hemodialysis consist in?
During this treatment, waste products and excess liquids are extracted from the blood by means of an artificial kidney known as a “dialyzer”, with the assistance of a machine.
In order to fuel the extracorporeal blood circuit, vascular access is required. A surgical procedure is carried so that an arteriovenous fistula can be brought into being, which means that an artery and a vein are joined together. The fistula is generally performed on the forearm, and it strengthens blood flow in the dialyzer.
On principle, this treatment is administered in a hospital, a clinic or an associative structure. A hemodialysis session takes place three times a week, and it lasts approximately four hours.
Organization of the hemodialysis section
The hemodialysis section is open Monday through Saturday, from 6:20 A.M. to 11:50 P.M. It is closed on Sunday, except during the year-end holidays, the objective being to allow patients to spend Christmas and New Year’s Day with their loved ones. At that time of year, dialysis sessions take place on Sunday, but not on the two holidays.
Patients are admitted from 6:45 A.M;, and the first hemodialysis sessions get underway at 7 A.M. The last sessions finish at around 11:15 P.M.
There exist three types of daily dialysis “hook-up” schedules:
- morning session: patients admitted in the room from 6:45 A.M.;
- afternoon session: patients admitted in the room from 12:15 P.M.;
- evening session: patients admitted in the room from 5:45 P.M.
Daily admission capacities are as follows:
- 19 patients in the morning,
- 19 patients in the afternoon,
- 12 patients in the evening.
Patients can come either on Mondays, Wednesdays and Fridays, or on Tuesdays, Thursdays and Saturdays.
Between sessions, the caregiving team disinfects the dialysis generators and cleans up the area, tasks that necessitate a time interval of at least 75 minutes between two sessions.
Since 2008, 200 nurses have been carrying out pre-dialysis support consultations for chronic renal failure patients.
The objectives of the support consultations are as follows:
- for the caregivers:
- to improve the patient’s overall treatment conditions by identifying his resources and his difficulties, getting to know his life circumstances, and assessing his understanding of the different pieces of information conveyed by the doctor;
- to support the patient during the different phases of his treatment and help him to carry on, enabling him to formulate his worries and his questionings;
- to elaborate with the patient – and to subsequently carry out – an individualized therapeutic education program.
- for the patients :
- to benefit from a ready ear, from support following the doctor’s announcement of the need for dialysis;
- to be able to express his feelings, his interrogations, his fears…,
- to have information concerning dialysis techniques and renal transplantation, information that will help him to plan for the future and to reorganize his daily life.
The peritoneal dialysis section (PD)
The tasks of the peritoneal dialysis section (PD)
The peritoneal dialysis section provides treatment for chronic renal failure patients being treated or susceptible to being treated by peritoneal dialysis, and who reside in or near the Vienne department.
PD techniques vary from one patient to the next:
- continuous ambulatory peritoneal dialysis (CAPD)
or - automated peritoneal dialysis (APD), generally in the evening.
In addition to training and monitoring patients, the team also trains private nurses and nephrology nurses, who are tasked with the treatment of hospitalized patients.
Peritoneal dialysis?
How does it function?
This treatment is generally carried out at the patient’s home or with the help of a relative/friend, or else with the help of a private nurse.
Peritoneal dialysis takes place at the level of the peritoneal cavity. .
The dialysis liquid enters this cavity by means of a small catheter, and the peritoneal membrane serves as a filter. The waste products and excess water to be eliminated pass through the peritoneum from the blood into the dialysis solution and are extracted when the peritoneal liquid is drained.
Organization of the peritoneal dialysis sector (PD)
A PD reference nurse is on hand, Monday through Friday from 8 A.M to 4 P.M., to admit patients for both planned or urgently scheduled consultations. The reference nurse: 1) is available to take phone calls; 2) trains patients and caregivers; 3) takes care of different administrative tasks.
According to planned activities, the reference nurse also goes to patients’ homes and to different private nurses’ offices. When he or she is consequently absent, permanent care activities are ensured by the nephrology unit.
From 4 P.M. to 8 P.M. from Monday through Friday, and on Saturdays and Sundays, permanent care activities are likewise maintained by the nephrology unit.
Each month, a coordination meeting on all monitored patients is organized; it is attended by the reference doctor in nephrology, the health care manager for the section and the PD reference nurses.
The peritoneal dialysis unit closely collaborates with the professionals from the Poitou-Charentes AURA association, who are responsible for logistics (delivery of equipment to homes, etc.).