Nephrology Department

The Department of Nephrology of Tianjin First Central Hospital has a history of nearly 50 years since its establishment. It consists of a chronic kidney disease follow-up management center, a nephrology ward, a blood purification center and a peritoneal dialysis center. The Department of Nephrology carries out integrated management of chronic kidney disease from the aspects of early prevention diagnosis and treatment, differential diagnosis of kidney disease and complications, and diagnosis and treatment of end-stage renal disease. With the help of renal biopsy puncture and rich experience in renal pathological diagnosis, advanced pathological examination equipment and pathological graphic diagnosis and treatment system, multi-disciplinary collaborative integration team and kidney disease information management system, it organically integrates kidney disease clinics, specialized disease clinics, blood purification treatment and basic research. The department has an annual outpatient volume of more than 110,000 and discharges more than 1,400 patients annually, with an annual growth rate of approximately 1.1%. The department conducts weekly renal biopsies and clinical pathology discussions. In addition to diagnosing and treating diseases such as lupus nephritis, purpura nephritis, and small vessel vasculitis, it also diagnoses many difficult and rare diseases, such as renal amyloidosis, monoclonal immunoglobulinosis, and C3 nephropathy. , lipoprotein nephropathy, Fabry disease, collagen III nephropathy, immune tentacle disease, fibroid glomerulopathy, LCAT deficiency renal injury, etc., a renal pathology diagnosis and treatment database has been established, and more than 300 renal biopsy cases are performed every year, involving 17 provinces and cities across the country.In 2014, the department established the first chronic kidney disease prevention and treatment follow-up management center (CKD Management Center for short) in the northern region. In 2021, it was awarded the national "Clinical Multidisciplinary Management and Training Tool Construction-Chronic Kidney Disease Management Model Research Project" training base by the National Health Commission. The management center effectively integrates high-quality medical care, nursing service capabilities, academic research and other resources, and is the first to launch a professional health management team covering chronic kidney disease specialist diagnosis and treatment, lifestyle and medication guidance, psychological nutrition assessment, dietary treatment, etc. For patients with chronic kidney disease who have not received renal replacement therapy, a comprehensive nephrology clinic is set up every week with multi-disciplinary collaboration of nephrologists, nutritionists and health education nurses. At the same time, with the help of remote guidance on the Internet, WeChat official accounts, mini-program diet tools, multi-media and self-media, kidney friends, free clinics and other methods, the management concepts and treatment methods of chronic kidney disease risk screening, acute phase rehabilitation, and comprehensive prevention and treatment have been pushed to nearly 10,000 patients, increasing the outpatient return visit rate, effectively improving patients' quality of life and disease indicators, and thus delaying the time to start dialysis treatment. Patients who have been diagnosed with end-stage renal disease can smoothly and smoothly transition to the stage of renal replacement therapy to reduce acute complications in the early stage of dialysis.Based on the work of the CKD Management Center, in 2019, the "Joint Diabetic Nephrology Clinic" was jointly established with the endocrinology department of our hospital. Nephrologists, endocrinologists, nutritionists, pharmacists, and nephrology health education nurses jointly provide multidisciplinary overall care to improve clinical efficacy and effectively improve the difficulty of treating comprehensive diseases. It has been 45 years since blood purification treatment was launched in 1974. The Fukang Road Blood Purification Center now covers an area of ​​1,580 m2 and has 94 dialysis beds, 94 hemodialysis machines, 13 bedside CRRT machines, 2 MARS artificial livers, and 4 sets of double-stage reverse osmosis water treatment equipment. The new area of ​​the hemodialysis room in Shuixi Campus is approximately 6,000 m2, with 168 new dialysis beds. It also has a dedicated operating training classroom for the blood purification center. The building layout and facilities comply with regulatory requirements, have complete isolation treatment facilities and systems, and have the ability to clinically apply corresponding medical technologies. It is a blood purification medical and nursing technology training base and a blood purification specialist nurse training base in Tianjin. There are currently 18 guiding physicians with clinical application capabilities of hemodialysis technology, including 3 chief physicians and 5 deputy chief physicians. There are 61 blood purification nurses in the nursing staff. Among them, there is 1 deputy chief nurse;There are 22 nurses in charge. Possessing blood purification specialist nurse certificates, including 2 from China and 15 from Tianjin. 3 full-time technicians. Its blood purification scale and treatment types have reached the domestic cutting-edge level. It has developed dialysis technology and is currently the most comprehensive blood purification center in the city involving the most departments. It has rich experience in blood purification treatment. The hepatitis B infection rate has been 0 for 16 consecutive years; the hepatitis C infection rate has been 0 for 6 consecutive years. In addition to conventional hemodialysis, a variety of blood purification modes have been carried out for many years, including hemofiltration, hemodiafiltration, continuous renal replacement therapy, hemoperfusion, plasma exchange, double membrane plasma exchange, immunoadsorption and molecular adsorption recirculation system (MARS), etc., which not only play a major role in the field of kidney disease and organ transplantation, but also cooperate with multiple disciplines in the hospital.Currently, hemodialysis CRRT technology is in charge of full-time doctors and nurses, providing technical support to all departments of the hospital, improving the treatment level of critically ill patients in various disciplines and developing new technologies. It has gradually become an important advanced treatment method among multiple disciplines except kidney disease. It has successfully treated critically ill patients such as acute kidney injury, multiple organ dysfunction syndrome, crush syndrome, sepsis, severe acute pancreatitis, myasthenia gravis, etc., protecting lives and maintaining health. During the follow-up diagnosis and treatment of uremia patients, when other systemic diseases occur, other disciplines can complete various treatments and operations with the support of blood purification treatment in our department. For example, the cardiology department provides vascular interventional treatment for uremia patients, and the cardiac surgery department performs heart transplantation. The Peritoneal Dialysis Center of the Department of Nephrology is the first in Tianjin to carry out single-disease payment for peritoneal dialysis patients to reduce patients’ medical expenses. Physicians at all levels are proficient in peritoneal dialysis catheter placement, including traditional peritoneal dialysis catheter placement, percutaneous peritoneal dialysis catheter placement, laparoscopic peritoneal dialysis catheter placement, etc. Currently, there are 4 full-time peritoneal dialysis outpatient doctors and 4 peritoneal dialysis nurses. They adopt specialized treatment and set up a kidney disease peritoneal dialysis clinic.With the help of informatization and telemedicine management, we provide peritoneal dialysis treatment and long-term follow-up, help newly catheterized patients to survive the perioperative period smoothly, provide training on the application of home automated peritoneal dialysis machines and manual peritoneal dialysis operations, arrange regular outpatient follow-up laboratory examinations, telephone calls, WeChat public accounts, home visits and other diversified health education. Assisted multi-disciplinary peritoneal dialysis treatment, completed APD machine peritoneal dialysis treatment for peritoneal dialysis inpatients in relevant departments, and met the needs of inpatients in other departments for personalized dialysis prescriptions. In addition, the Department of Nephrology actively cooperates with the Department of Surgery to perform parathyroidectomy and autologous transplantation, and provides multidisciplinary collaborative MDT integrated management for patients with end-stage renal disease combined with secondary hyperparathyroidism (SHPT). Full-time surgical doctors perform precise surgeries, provide full perioperative treatment and care, and long-term postoperative follow-up to improve patients' quality of life and increase survival rates.After years of efforts, under the leadership of Director Chang Wenxiu, the academic leader and party branch secretary of the Department of Nephrology, a three-level quality control management echelon and a party-mass scientific affairs management team composed of department directors, ward directors, and treating doctors have been formed to continuously supervise the diagnosis, treatment and management of the ward, and through standardized management, promote the construction of the academic style of the department, the professional quality of professional and technical personnel, and the continuous improvement of medical quality. Strengthen talent training and reserve, and form an academic echelon and medical and nursing technical groups with young and middle-aged academic backbones as the main force, unity and collaboration, reasonable structure, and sustainable development. The general department currently has 109 medical and nursing staff, including 5 chief physicians, 6 deputy chief physicians, 3 attending physicians, and 9 resident physicians, many of whom have doctorate and master's degrees. Doctors at all levels are familiar with the early prevention and treatment of chronic kidney disease, pathological diagnosis and treatment of kidney disease, multidisciplinary diagnosis and treatment of end-stage renal disease, and diagnosis and treatment of perioperative work in kidney transplantation. In addition, he has been teaching at Nankai University School of Medicine and Tianjin Medical University for a long time, and currently has 1 master's student tutor. It undertakes teaching tasks such as clinical teaching, internship and internship for graduate and undergraduate students every year. The blood purification training base has conducted a total of 8 training courses and trained more than 50 blood purification specialist nurses.The undergraduate department accepts 29 trainees per year from the standardized training of hospital residents. Multidisciplinary collaborative diagnosis and treatment model 1. Joint Nutrition Department established the "Chronic Kidney Disease Management Center" to delay the progression of kidney disease. In March 2014, the center effectively integrated high-quality medical resources, diagnosis, treatment and nursing service capabilities, academic research and other resources to launch a comprehensive coverage of chronic kidney disease specialist diagnosis and treatment, specialist nurses' lifestyle and medication guidelines. With a professional health management team such as guidance, psychological assessment, nutritionist nutrition assessment, and dietary treatment, chronic kidney disease screening, risk assessment, health intervention and recovery, health concept promotion and education are pushed into the daily life of every patient who joins the center through the effective combination of high-quality medical service resources and Internet technology. To build a chronic kidney disease management model with patient self-management as the core, doctor-nurse-patient interaction, and social support, a chronic kidney disease clinic composed of nephrologists, specialist nurses, and nutritionists will be opened every Tuesday, Thursday, and Friday morning. For each patient who comes for treatment, the center will establish a health file, formulate a standardized, normalized, individualized and precise diagnosis and treatment plan, and provide them with medication, diet, lifestyle and dialysis guidance as an integrated chronic disease follow-up management service.By dynamically monitoring different stages of disease development, strengthening hierarchical management, formulating different management requirements and goals according to different levels, and conducting daily follow-up and intervention on patients, we can achieve the purpose of reducing medical expenses, lowering medical costs, and delaying disease progression. At the same time, based on the dietary, psychological, medication and other problems of kidney disease patients, experts from the nutrition department, pharmacy department, psychology department and other departments jointly carry out CKD classroom activities every quarter. Currently, the number of patients has reached about 5,000. 2. The "Joint Diabetic Nephrology Clinic" was jointly established with the endocrinology department. A multidisciplinary collaborative team composed of nephrologist Director Chang Wenxiu, endocrinology expert Deputy Director Zhang Fengping, and nephrology health education nurse Song Xinqian visited clinics at the same time every Tuesday afternoon in Clinic Room 12 on the second floor of Area D. We will establish a health file for each patient who comes for treatment and formulate a standardized, normalized, individualized and precise diagnosis and treatment plan, and provide comprehensive management and treatment of chronic diseases integrating medicine, diet and lifestyle. 3. Cooperate with surgical experts to carry out surgical treatment of secondary hyperparathyroidism to reduce the disease burden of post-dialysis patients. Secondary hyperparathyroidism (SHPT) is a common complication in patients with end-stage chronic kidney disease.When drug treatment is ineffective, refractory SHPT develops, which not only leads to metabolic bone disease, but is also associated with severe vascular calcification and cardiovascular and cerebrovascular events, seriously affecting the patient's quality of life and survival rate. At this time, parathyroidectomy is required. At present, there are few hospitals in China that carry out such surgeries. In November 2016, our department, in conjunction with Professor Hua Mingsheng from the Department of Surgery, officially launched the surgical treatment of secondary hyperparathyroidism. Full-time surgical doctors perform precise surgeries, and our department provides full perioperative treatment and care and long-term postoperative follow-up to improve patients' quality of life and increase survival rates. As of May 2018, more than 30 cases of parathyroidectomy have been successfully completed, and various postoperative complications of parathyroidectomy are taken care of in a timely and accurate manner. Through long-term and regular outpatient follow-up management, postoperative medication is further adjusted to improve the quality of surgery and patient prognosis. 4. Multidisciplinary cooperation in different blood purification modesThe blood purification center of the Department of Nephrology consists of one blood purification center room and two blood purification center rooms. Its blood purification scale and treatment types have reached the domestic leading level, and it has rich experience in blood purification treatment. In addition to conventional hemodialysis, it has been developing a variety of blood purification modes for many years, including hemofiltration, hemodiafiltration, continuous renal replacement therapy, hem (plasma) perfusion, plasma exchange, double membrane plasma exchange, immunoadsorption and molecular adsorption recirculation system (MARS). It has also launched extracorporeal membrane oxygenation (ECMO) to treat respiratory failure and a special blood purification mode for children. It not only plays a major role in the field of kidney disease and organ transplantation, but also cooperates with multiple disciplines in the hospital, gradually becoming an important advanced treatment method in multiple disciplines other than kidney disease, protecting lives and maintaining health. The following is a brief introduction to the multidisciplinary application of the blood purification treatment model that our center can carry out: 1. Critical illness such as severe infection and multiple organ dysfunction. Patients with multiple organ dysfunction caused by severe infection or other various reasons are in critical condition and have extremely poor prognosis.With the development of continuous blood purification treatment, early application can remove complex inflammatory mediators and excessive water load in the body, correct severe acidosis and internal environment disorders, and improve the survival rate of patients. In addition, with the emergence of new technologies and new materials, we will gradually introduce endotoxin and various inflammatory factor adsorption columns, and the removal of pathogenic factors will be more refined. 2. Acute drug or poison poisoning When rescuing severe drug or poison poisoning, hemoperfusion can effectively remove toxins in the body during acute drug poisoning, reduce the patient's hospitalization time, and improve the success rate of treatment. When certain poisons cause acute kidney damage or acute poisoning based on original renal insufficiency, the combination of hemoperfusion and hemodialysis can achieve the purpose of removing special poisons. 3. For various immune system diseases, systemic lupus erythematosus (SLE), plasma exchange therapy can remove circulating immune complexes, anti-ds-DNA antibodies, anti-nuclear antibodies, etc. in SLE patients. For rheumatoid arthritis, immunoadsorption therapy is currently recommended for patients who have failed treatment with traditional anti-rheumatoid drugs and new biologic agents, and for patients with refractory active disease. 4. Nervous system diseasesFor myasthenia gravis, plasma exchange therapy can be used in myasthenic crisis, severe myasthenia gravis before thymoma resection, early postoperative period, and when immunosuppressive therapy is started or reduced. In addition, protein A immunoadsorption can also achieve ideal results in the treatment of myasthenia gravis; in Guillain-Barré syndrome, plasma exchange treatment can increase the recovery of motor function and reduce the time of ventilator use compared with simple supportive treatment. The same immunoadsorption method can also be tried to treat Guillain-Barré syndrome. It has been reported in the literature that immunoadsorption can significantly improve neurological deficits. 5. Hematological diseases, thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). TTP patients have vWF cleavage protease defects in their bodies, which reduces vWF clearance and forms vWF multimers with abnormally large relative molecular weights. Plasma exchange can remove abnormal vWF multimers and circulating immune complexes, and supplementing with fresh plasma can supplement vWF-cleaving protease. Before the adoption of plasma transfusion and plasma exchange technology, TTP/HUS progressed rapidly, with a mortality rate of up to 90%. Plasma exchange using fresh frozen plasma as the replacement fluid could reverse the course of the disease.Hyperviscosity syndrome is a disease in which very high plasma concentrations of monoclonal antibody immunoglobulins lead to red blood cell aggregation, ischemia and dysfunction of systemic organs and systems. Plasma exchange halts or reverses the progression of the disease by removing immunoglobulins. Cryoglobulinemia, plasma exchange has been used to treat cryoglobulinemia for 20 years, and almost all literature has confirmed that plasma exchange is effective in patients with obvious symptoms or progressive renal failure. 6. Dual membrane filtration plasma exchange for familial hypercholesterolemia can selectively remove low-density lipoprotein cholesterol without reducing the level of high-density lipoprotein. In our clinical application, the reduction rate every time is ideal. Plasma exchange should be carried out over a long period of time, with the frequency of treatment adjusted according to lipoprotein levels, generally once every 2-3 weeks. 7. Transplantation of highly sensitized recipients of organ transplants. Due to exposure to exogenous HLA antigens due to previous kidney transplant history, blood transfusions and pregnancy, group reactive antibodies appear in the kidney transplant recipients. Such patients are highly sensitized recipients and will face a higher risk of hyperacute or acute rejection during transplantation, increasing the risk of transplanted kidney failure. For the treatment of highly sensitized recipients.The current more mature solution is to perform plasma exchange combined with intravenous immunoglobulin (IVIG) or immunoadsorption before and after kidney transplantation to reduce the level of cytotoxic antibodies in the body. Our center has rich experience in this area of ​​treatment, allowing many patients who were originally unable to undergo kidney transplantation due to high allergy to have the opportunity to undergo kidney transplantation and achieve good healing. ABO blood type incompatibility transplantation, ABO blood type incompatibility was once considered to be an exclusion condition for kidney transplantation, but due to the shortage of donors, kidney transplant recipients have to consider donors with incompatible blood types. Plasma exchange is widely used in living donor transplants from ABO-incompatible blood groups to remove anti-A or anti-B blood group antibodies against non-host native antigens and avoid the occurrence of acute humoral rejection. Plasma exchange uses albumin as the replacement fluid. Acute humoral rejection Acute humoral rejection is characterized by the presence of circulating donor-specific antibodies and severe graft loss. The prognosis is poor, and hormone shock and anti-lymphocyte therapy are often ineffective. The application of plasma exchange combined with IVIG can inhibit more than 80% of acute antibody-mediated rejection. 8. Liver diseaseLiver insufficiency and liver failure. In hepatic insufficiency, the detoxification and synthesis functions of the liver are impaired. Plasma exchange uses fresh plasma as the replacement fluid. On the one hand, it can remove a large number of large, medium, and small toxic substances in the body, and remove blood ammonia, bilirubin, etc. It can also supplement bioactive substances such as coagulation factors, albumin, stabilize the internal environment, reduce the risk of bleeding, and buy time for liver regeneration or liver transplantation. For hyperbilirubinemia and hepatic encephalopathy, the plasma bilirubin adsorption column has a strong adsorption effect on bilirubin and bile acids in plasma, and it is necessary to separate the plasma for plasma adsorption. For the pathogenic mediators that cause hepatic encephalopathy, hemoperfusion can remove blood ammonia, free fatty acids, phenols, etc., and can be used to treat hepatic coma. In our center, there are many perioperative patients waiting for liver transplantation due to liver failure. Therefore, the bilirubin adsorption column BS-330 and the hemoperfusion device HA330-Ⅱ are often combined to treat hyperbilirubinemia and hepatic encephalopathy in liver failure after plasma separation. It can also be used alone to treat hyperbilirubinemia and hepatic encephalopathy respectively.Molecular circulation re-adsorption system (MARS). The principle of the MARS system is that the patient's blood is in indirect contact with the albumin dialysate. The albumin dialysate and bicarbonate dialysate carry out solute dispersion and are regenerated through activated carbon and anionic resin tanks to remove toxins bound to albumin. Our center has introduced the MARS system for perioperative treatment of acute and chronic liver failure since 2003, and has successfully treated hundreds of patients with critical liver failure.