DRG Treatments

Kidney stone REMOVAL

Kidney stones may vary in size and shape. A small kidney stone may pass through the urinary tract on its own, causing little or no pain. A larger kidney stone may get stuck along the way. A kidney stone that gets stuck can block the flow of urine, causing severe pain or bleeding. Here are three different kidney stone removal methods.

  • Shock wave lithotripsy blasts the kidney stone into small pieces. The smaller pieces of the kidney stone then pass through the urinary tract. A doctor can administer anesthesia during this outpatient procedure.
  • Cystoscopy and ureteroscopy. During cystoscopy, the doctor uses a cystoscope to look inside the urethra and bladder to find a stone in the urethra or bladder. During ureteroscopy, the doctor uses a ureteroscope, which is longer and thinner than a cystoscope, to see detailed images of the lining of the ureters and kidneys. The doctor inserts the cystoscope or ureteroscope through the urethra to see the rest of the urinary tract. Once the stone is found, the doctor can remove it or break it into smaller pieces. The doctor performs these procedures in the hospital with anesthesia. Patients typically go home the same day.
  • Percutaneous nephrolithotomy is a procedure in which the doctor uses a thin viewing tool, called a nephroscope, to locate and remove the kidney stone. The doctor inserts the tool directly into the kidney through a small cut made in the patient’s back. For larger kidney stones, the doctor also may use a laser to break the kidney stones into smaller pieces. The doctor performs percutaneous nephrolithotomy in a hospital with anesthesia. Patients may have to stay in the hospital for several days after the procedure.

(Source: https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-stones/definition-facts)

Dialysis

Hemodialysis is a treatment for kidney failure that uses a machine to filter blood outside the body. At the start of a hemodialysis treatment, a dialysis nurse places two needles into the arm. A pump on the hemodialysis machine draws the blood through one of the needles into a tube, a few ounces at a time. The blood travels through the tube to the filter, called a dialyzer. Inside the dialyzer, blood flows through thin fibers that filter out wastes, extra salt, and extra fluid. After the dialyzer filters the blood, a different tube carries blood back to the body through the second needle.

Staff-Assisted Home Dialysis

Many people choose to have dialysis at home, which can be much more convenient. Liberty Home Dialysis will provide a nurse who will go to the patient’s home and deliver treatment in the privacy and comfort of their home, at a time that works for them. We recognize that it’s not convenient for everyone to come to a dialysis facility three times per week, so we do our best to remove all barriers to receiving dialysis by bringing the treatment directly to the patient.

Not only does the patient have a nurse assigned to them that comes to their home three times per week, we also provide a complete care team which includes a nephrologist, dietitian, and social worker. The care team will come to the patient’s home to meet with them each month, or more frequently if necessary, to talk with the patient about their dialysis treatments and health concerns.

We believe that patients that receive dialysis at home should receive the same high level of care and attention as those who come to our dialysis centers. Our entire team goes directly to the patient to ensure that they receive the best care possible.

In-Clinic Dialysis

We have several dialysis clinic locations around the Dallas-Fort Worth area. Each and every facility we partner with is state-of-the-art and staffed with caring, licensed renal nurses.

Preparing for Dialysis

Preparations for hemodialysis should be made at least several weeks in advance. Patients will need to have a procedure to create an “access” several weeks or months before treatment begins, as it needs time to heal or “mature.” The Dallas Renal Group works with the Dallas Vascular Center, a state of the art, Joint Commission Gold Seal-Approved facility.

Vascular access creates a way for blood to be removed from the body, circulate through the dialysis machine, and then return to the body at a rate that is higher than can be achieved through a normal vein. There are three major types of access. A nephrologist will recommend which option is best for you.

  • Primary AV Fistula: This is the preferred type of vascular access. It requires a surgical procedure that creates a direct connection between an artery and a vein. This is often done in the lower arm but can be done in the upper arm as well. A primary AV fistula is usually created two to four months before it will be used for dialysis. During this time, the area can heal and fully develop.
  • Synthetic AV Bridge Graft: The graft sits under the skin and is used in much the same way as the fistula, except that the needles used for hemodialysis are placed into the graft material rather than the patient’s own vein. Grafts heal more quickly than fistulas and can often be used about two weeks after they are created. However, complications such as narrowing of the blood vessels and infection are more common with grafts than with AV fistulas.
  • Central Venous Catheter: This method uses a thin flexible tube that is placed into a large vein, usually in the neck. Catheters have the highest risk of infection and the poorest function compared to other access types. They should be used only if a primary AV fistula or synthetic bridge graft cannot be maintained.

PERITONEAL DIALYSIS

Peritoneal dialysis is an alternative to hemodialysis that utilizes the membrane that lines the peritoneal cavity within the abdomen. With this method, the patient will have a catheter placed in the abdominal cavity which is used to fill the abdomen with dialysis solution. Once the dialysis solution fills the abdominal cavity, the membrane lining, called the peritoneum, allows wastes and excess fluid to pass from the blood into the dialysis solution. The wastes and excess fluid then leaves the body when the dialysis solution is drained.

There are two methods of peritoneal dialysis. One can be done manually, in a method called Continuous Ambulatory Peritoneal Dialysis (CAPD). The other uses a machine while the patient sleeps, called Continuous Cycling Peritoneal Dialysis (CCPD). Both methods are done 7 days per week, and are performed by the patient following a several week training program. Peritoneal dialysis has comparable risks and benefits. A nephrologist will review the treatment options with the patient to determine the best solution.

Transplantation

Transplantation is the only treatment for chronic kidney diseases and end-stage renal failure. Since kidney function cannot be restored, patients with the disease can only maintain health through dialysis treatments. That’s why we encourage all of our patients who qualify to join the transplant waiting list. Some of our patients who have received a transplant were only on the waiting list for a matter of months. While that varies from patient to patient, we see great success in transplantation. Our physicians and care team have excellent resources for those who are interested in and qualify for a kidney transplant. Learn more about transplantation here:

https://www.kidney.org/transplantation

https://www.unos.org