Department of Nephrology

Introduction of department

As the phrase cardiorenal interaction indicates, nephrology is an area of internal medicine that examines and treats not only the kidneys but also the body as a whole.

We are often consulted by other departments because of our degree of specialization.
As few medical institutions treat nephrology as a specialty, many patients are referred to us by physicians from various other medical institutions. We have the highest number of outpatients and inpatients in the prefecture. Furthermore, the number of patients with kidney disease will increase in the future, and we believe that early detection and appropriate management of kidney disease are important, as was also shown in last year’s chronic kidney disease (CKD) educational activities.

Nephrology health professionals are involved in the long-term treatment of patients. Starting with the diagnosis of proteinuria/hematuria, our department manages everything from the initial stages of kidney disease to the terminal phase, including treatment of kidney disease and the introduction of dialysis and post-dialysis management. In addition, we are often consulted by other departments regarding aging patients and advanced medical treatment options. We use the phrase cardiorenal interaction to describe the correlation between kidney and cardiovascular diseases. As the kidneys deteriorate, patients often develop cardiovascular diseases such as arteriosclerosis. In other patients, the kidneys deteriorate in association with the condition of the body as a whole, and their physicians refer them to the nephrology department if their conditions worsen.

The cohesiveness of our group is strong, and the spirit of mutual cooperation is our motto.
Our team of 21 individuals, including staff, practicing physicians, and graduate students, conducts research, imparts education, and administers treatment.
Cohesiveness is our best characteristic since the establishment of the team. We have mutual respect for each other, and everybody recognizes the spirit of mutual cooperation as our motto.

In our weekly ward conferences and renal biopsy conferences, we share our observations of pathologies and treatment details while expressing our various opinions. Our working environment in the ward (ninth floor of the east building) is improved each year, with the cooperation of health-care professionals and system improvements, including electronic medical records. We manage inpatients using a team system so that somebody is available to respond at all times.

Our work also incorporates many factors related to general internal medicine, not just the kidneys.
Nephrology is an area of internal medicine that implements the three core pillars of urinalysis, blood tests, and renal pathological diagnosis to examine and treat the whole body, not just the kidneys.

Furthermore, the relationship between patients and staff is close, as we must handle the initial response to various diseases and dialysis treatment. Thus, in addition to a high degree of specialization, nephrology also incorporates many factors related to general internal medicine. It is never a department exclusively for the kidneys. For this reason alone, I consider working in the nephrology department to be worthwhile.

Details of medical treatment.
We are responsible for a wide range of treatments for the so-called renal diseases, including systemic renal diseases such as primary glomerular disease/tubulointerstitial disorder, hypertension, diabetes, connective tissue disease, and blood disorders, as well as acute and chronic renal failures. We perform diagnoses centered on renal biopsies for nephritis and multidisciplinary treatment based on the results of the diagnoses. We use conservative treatment methods such as diet and drug therapy, as well as dialysis for renal failure. We are characterized by our positive promotion of the introduction of peritoneal dialysis and have 20–30 peritoneal dialysis patients currently attending our hospital for treatment.

Furthermore, in the Department of Dialysis, aside from hemodialysis, we are also skilled in conducting apheresis treatment of various diseases.

Research content

Our research emphasizes clarification of the mechanisms of disease progression and the establishment of preventive measures against this progression.

Clinical research
We conduct various types of clinical research; advice sodium restriction for CKD treatment; administer renin-angiotensin system inhibitors for CKD treatment; perform tonsillectomy and steroid pulse therapy for IgA nephropathy treatment; and prescribe immunosuppressants for refractory nephrotic syndrome treatment.

CKD patients are at risk of heart and cardiovascular diseases, which are the leading causes of death for those with end-stage kidney disease on dialysis. Owing to their correlation with severity of heart failure, N-terminal pro-brain natriuretic peptide (NT-proBNP) levels have been recently used as a clinical marker for the diagnosis of heart failure. However, CKD induces increases in NT-proBNP levels, and the normal range of the levels in hemodialysis patients is unknown. We are conducting a multicenter clinical research to clarify the utility of NT-proBNP levels in hemodialysis patients as a marker of heart failure.

Basic research
Regardless of disease origin, fibrosis is a final common pathway in CKD that leads to disease progression and ultimately to organ failure. We are conducting in vitro research using cell culture and various types of nephritis models to clarify the mechanisms of renal fibrosis. We are also conducting research to clarify the mechanisms underlying tissue disorders in nephritis using human renal biopsy tissues.

One severe problem in peritoneal dialysis patients is peritoneal fibrosis. We are conducting in vitro research using human peritoneal mesothelial cells and in vivo research using rat models of peritoneal fibrosis to clarify the mechanisms underlying peritoneal fibrosis and to identify potential preventive strategies.

Mesenchymal stem cells (MSCs) therapy for preventing the progression of renal fibrosis.
In addition to the ability of MSCs to directly suppress the progression of fibrosis by inhibiting TGF-β1 signaling, MSCs can suppress the infiltration of inflammatory cells. So, the administration of ex vivo expanded MSCs to patients with chronic kidney disease has the potential to be a useful therapy for preventing the progression of renal fibrosis. We are conducting the experiments that are indispensable for future clinical trials of MSCs therapies.
Branch laboratory: Department of Stem Cell Biology and Medicine, Graduate School of Biomedical & Health Sciences Hiroshima University.

Treatment achievements

In 2017, the annual number of inpatients was 220; the number of pathological diagnoses made based on renal biopsy findings was 68; and the number of patients to whom dialysis was newly introduced was 36 (hemodialysis, 32 and peritoneal dialysis, 4).