Kidney Disease & Hypertension

Treatment for Kidney Disorders in Washington, DC

The Division of Kidney Disease & Hypertension at The GW Medical Faculty Associates offers comprehensive care for patients with acute and chronic disorders of the kidney and urinary tract; fluid, electrolyte and acid base imbalances; and hypertension.

Clinical services have expanded over the past several months to include inpatient as well as outpatient care, hemodialysis, continuous renal replacement therapies, peritoneal dialysis, renal transplantation options, renal biopsy and interventional nephrology.

Brochures:

• Nocturnal Dialysis
• Diabetic Trifold

Outpatient Care

Kidney & Hypertension Clinics in Washington, DC

General Nephrology clinic: Because Kidney Disease rarely begins or ends with concern about the kidneys alone, patients are treated here by a team of doctors trained to evaluate their diet and metabolism, digestive system, heart and circulatory system, and more. A state-of-the-art electronic medical record system permits real-time access to lab test results, imaging studies like X-rays, MRIs, and CT scans, plus consult notes from the team of treating specialists.

Kidney Protection clinic: This unique clinic is devoted to the prevention of Kidney Disease in patients with Diabetes and other conditions which put them at higher risk of developing kidney problems. Patients receive not only recommended care; they have access to novel therapies through participation in ongoing research projects.

Pre-ESRD clinic: Patients approaching end-stage renal disease are offered dietary and psychosocial support to equip them to live with kidney failure. The program is geared to equip patients for informed decisions about pre-dialysis vascular surgery treatment options and kidney transplant.

Hypertension Clinic: This program is dedicated to the management of difficult to treat hypertension, secondary hypertension, and hypertension with no obvious underlying cause. Specialists in kidney, heart and metabolic disorders work alongside radiologists to care for the patient. Here, patients can be helped with daily, out-patient blood pressure monitoring to help confirm a diagnosis or hone care.

Stone Clinic: Urologists and radiologists work collaboratively in this clinic to identify and manage patients at elevated risk of kidney stone disease.

Transplant clinic: This program follows and supports patients through kidney transplantation and beyond.

Intervention Nephrology: Currently delivered through GW Radiology Services.

Glomerular Diseases

Preventing End Stage Renal Disease in DC

The Division of Kidney Disease & Hypertension is pleased to announce the Center for Glomerular Diseases at The GW Medical Faculty Associates, the only center of its kind in the Washington, DC area.

Glomerular diseases are the third leading cause of end stage renal disease; however, if treated early, progression can potentially be prevented.

This multidisciplinary center works in close collaboration with Nephro-pathology, Radiology and Rheumatology to deliver a comprehensive care plan for patients with glomerulonephritis.

The center offers the following services:

• Initial consultation
• Second opinion
• Kidney biopsy
• Immunomodulatory therapies
• Plasmapheresis

In addition to the established therapies for glomerular diseases, the center offers patients unique opportunities to participate in novel therapies as part of the ongoing research in the division and in collaboration with other centers throughout the world.

The center offers special care for:

• Lupus nephritis
• Vasculitis
• Nephrotic syndrome

For an appointment in the Center for Glomerular Diseases:

• Call 202-741-2283

Kidney Stone Disease

Preventing & Treating Kidney Stones

The Division of Kidney Disease and Hypertension and the Department of Urology at The GW Medical Faculty Associates are pleased to announce the creation of a comprehensive, multidisciplinary clinic to care for patients with kidney stones.

Kidney stones are one of the most common disorders of the urinary tract. In the United States, it accounts for more than a million outpatient consultations and 300,000 emergency room visits each year.

Complications of kidney stone disease include:

• Obstruction to urine flow
• Acute kidney failure
• Chronic kidney disease requiring dialysis
• Recurrent urinary tract infections
• Infection of the kidney (Pyelonephritis)
• Whole body infection (sepsis)
• High blood pressure
• Heart disease

The kidney stone clinic offers seamless personalized care that includes prevention strategies, and medical management as well as prompt surgical removal of kidney stones by a highly experienced team of experts. The clinic provides quick and easy access to patients with newly diagnosed kidney stones. Patients are seen by a nephrologist and urologist during the same clinic visit and is well suited for the management of complex stone diseases such as

• Inherited and genetic diseases
• Metabolic disorders
• Structural abnormalities of the urogenital system
• Urinary tract infection

The stone clinic offers the following services:

• Metabolic evaluation
• Stone analysis
• Kidney imaging
• Urodynamic studies
• Dietary counseling
• Medical management
• Surgical management
• Endo-urologic procedures

The clinic offers the unique opportunity to be evaluated simultaneously by a team of experts including a nephrologist, urologist, and other support personal, thereby reducing the number of visits to the outpatient clinic.

The clinic is led by Yoosif Abdalla, MD.

PLEASE NOTE THAT PATIENTS WILL BE REQUIRED TO MAKE TWO CO-PAYS AT THEIR VISIT SINCE THEY WILL BE SEEN BY BOTH A NEPHROLOGIST AND UROLOGIST.

Outpatient Dialysis

Attentive Care for Patients with Kidney Failure

The dialysis programs draw from the expertise of a multi-disciplinary team of physicians, nurses, social workers and dieticians, who collaborate each care plans. Treatment options for patients with kidney failure include:

Hemodialysis: Patients receive hemodialysis treatment at on K Street, NW. These centers consistently rate highly in clinical care.

Nocturnal Hemodialysis: Traditional hemodialysis requires four hours of treatment at a time, three days per week. By contrast, nocturnal hemodialysis is performed overnight while the patient sleeps -- a therapy shown to improve heart function and nutritional health.

Home Hemodialysis: The GW Medical Faculty Associates is establishing a Center for Excellence in home dialysis. It will allow patients to receive regular hemodialysis and peritoneal dialysis and is working to establish a telemonitoring unit to enhance safety.

Peritoneal Dialysis: The GW Medical Faculty Associates provides care for the largest PD population in the area. It has excellent results and superior outcomes.

Nocturnal Dialysis

Dialysis Treatment You Can Sleep Through

The Division of Kidney Disease & Hypertension at The GW Medical Faculty Associates is pleased to announce that it now offers Nocturnal Dialysis at its K Street DaVita Dialysis unit. This new modality was integrated into the MFA’s care system after partnering with DaVita®, a leading provider of kidney care in the United States.

Nocturnal dialysis is gentler than conventional dialysis, as it is extended over more hours per session than conventional in-center treatment. In-center hemodialysis is generally done during the day, three days a week, for a three-to-five hour period. By contrast, Nocturnal dialysis, permits patients to sleep at the clinic three nights a week while they are undergoing hemodialysis.

Benefits of Nocturnal Dialysis

The slower treatment time allows for a reduced flow rate, which can be helpful for patients who have complications from the higher blood flow and larger fluid removal rates of conventional hemodialysis. Because fluid is removed from the body at a slower rate, the prospect of cramping or drops in blood pressure can diminish for some patients. Nocturnal Dialysis has been shown to have a beneficial effect on:

• Cardiac function
• Blood pressure control
• Sleep
• Appetite
• Patient well-being
• Better rehabilitation

About Our Team

Dr. Dominic Raj, professor of Medicine and Director of Kidney Disease & Hypertension at The GW Medical Faculty Associates will lead the program at the K Street facility as the Medical Director. He has extensive experience in this innovative technique. The launch of Nocturnal Dialysis leaves the MFA poised to become a Center for Excellence in Home Dialysis.

In order to accommodate this new modality, the DaVita Dialysis facility underwent a complete renovation and now offers a quiet and comfortable space, as well as modified personal work stations. This novel dialysis is modality is especially suitable for:

• People with day time employment
• Large patients
• Patients with significant inter-dialytic weight gain

For patients or family members who are interested in more information, please contact:

PHONE: (202) 741-2283
FAX: (202) 741-2285

Inpatient Services

Dedicated Care for Patients with Kidney Disease

The division of Kidney Disease & Hypertension at The GW Medical Faculty Associates provides inpatient care at GW Hospital for patients with diagnoses ranging from acute kidney injury, uncontrolled hypertension, fluid electrolyte disorders and chronic kidney disease. GW Hospital is equipped to support both stable and acutely ill patients. The hospital's Acute Dialysis Unit offers several kidney replacement therapies, including:

• Conventional hemodialysis for stable patients
• Slow extended daily dialysis (SLEDD)
• Continuous Renal Replacement Therapy (CVVH)
• Peritoneal dialysis
• Therapeutic Plasmapheresis
• Kidney Biopsy, real-time ultrasound-guided and CT-guided percutaneous needle biopsy

Therapeutic Apheresis

Treatment for Chronic Kidney Conditions

The Division of Kidney Diseases and Hypertension offers therapeutic plasmapheresis and cytopheresis using state of art techniques, in both the inpatient and outpatient setting, through The George Washington University Hospital. The physicians are well-trained in all modalities of extra-corporeal therapy including plasmapheresis and cytopheresis. We endeavor to deliver the therapy tailored to the patient and the clinical condition.

Besides treating well recognized renal indications such as Goodpastures/anti-GBM disease, ANCA related vasculitis, and Thrombotic Thrombocytopenic Purpura, therapy is available for conditions such as myasthenia gravis, chronic inflammatory demyelinating polyneuropathy, Waldenstrom macroglobulinemia, Guillain-Barré syndrome and intractable pruritus from cholestatic disease.

The physicians will work with the referring specialists in delivering optimal care for the patients. The Apheresis team will organize the vascular access and will monitor the necessary biochemical and serological parameters, which will be shared with the referring physician.

To arrange for treatment please contact (202) 741-2283 and ask to be connected to the fellow or the attending physician on the inpatient service.

Hypertension

Managing High Blood Pressure in Washington, DC

The Division of Kidney Disease & Hypertension is pleased to announce the establishment of The Center for Hypertension at The GW Medical Faculty Associates.

The division participates in Systolic Blood Pressure Intervention Trial (SPRINT), Thrombolysis in Myocardial Infarction (TIMI) Study and number of other clinical and clinical translational studies. The research team in the division is examining the mechanism of salt sensitivity and role of dopamine receptors in mediating high blood pressure.

These are some statistics about hypertension:

• There are 70 million (1 in 3 adult in the US) people with a high blood pressure
• High blood pressure accounts for 1 in 6 deaths annually
• About 1,000 deaths each day in the US are attributed to uncontrolled blood pressure
• Only about half of people with high blood pressure have controlled hypertension
• Blood pressure is an important cause for chronic kidney disease

The division has a long tradition of serving as a tertiary referral clinic for the management of uncontrolled blood pressure. The center offers the following services:

• Initial consultation for diagnostic confirmation of hypertension
• Second opinion for difficult to treat blood pressure
• 24 hour blood pressure monitoring
• Non-invasive pulse wave analysis and central blood pressure monitoring
• Optimization of blood pressure medications through chronotherapy
• Work-up and management of secondary hypertension

Clinical Research

In addition to offering state-of-the art care and therapies for patients with hypertensive diseases, the center offers patients opportunities to participate in novel therapies as part of the ongoing clinical research projects in the division. Funded by the National Institute of Health, the division is examining the mechanism and genetic basis for hypertension, salt sensitivity and vascular damage. We are exploring methods to personalize blood pressure control for patients.

The team of experts in the center for hypertension are trained to identify and treat secondary causes of hypertension such as:

• Renal Artery Stenosis
• Adrenal Adenoma and Hyperplasia
• Pheochromocytoma
• Genetic Hypertension

The center personalizes treatment by:

• Detection of White Coat Hypertension
• Identification of Masked Hypertension
• Offering Chronotherapy

The collaborative center is specifically equipped to:

• Identify high risk individuals for more intensive therapy
• Personalize blood pressure medication and blood pressure targets
• Prevent end-organ damage through collaboration with other specialties

For an appointment in The Center for Hypertension, call 202-741-2283.

Kidney Precision Medicine Clinic

Welcome to our kidney precision medicine clinic. The goal of our kidney precision medicine clinic is to deliver personalized kidney care to patients afflicted with kidney disease that may have an underlying genetic component. This individualized care starts with identifying patients who will benefit from genetic evaluation, performing the appropriate genetic testing, pre-test and post-test counseling patients and family and providing them with a management plan tailored according to the diagnosis.

How do your genes influence your kidneys?

It is becoming evident that many kidney diseases have a hereditable component, with significant diagnostic, prognostic, and therapeutic implications.

• About 10% of unselected patients with chronic kidney disease (CKD) have underlying genetic component.
• APOL1 gene variant is a strong risk factor for developing CKD and progressive loss of kidney function. About 13% of African Americans have APOL1 high risk gene variant.
• Autosomal dominant polycystic kidney disease affects 1 in 500 to 1,000 people.
• Many glomerular diseases have underlying genetic component, which influences the response to treatment. Some diseases may recur even after kidney transplantation.
• The nature of gene variation can affect the outcomes if one wants to donate a kidney to their loved ones.

Who should be seen in kidney precision medicine clinic?

You may benefit from a genetic testing if you have a strong family history of a kidney disease or any of the following:

• Early age of onset of kidney disease of unknown cause
• Cystic kidney diseases
• Alport syndrome
• Fabry’s disease
• Familial proteinuria (protein in urine)
• Familial hematuria (blood in urine)
• Anyone with family history of kidney disease of unknown cause
• Nephrotic syndrome resistant to treatment
• Those with family history of protein in urine or blood in urine
• Inherited kidney stone disease (Cystinosis)

Why should you be seen in kidney precision medicine clinic?

Our goal is to provide preventative and treatment plans for individuals who have a genetic cause of kidney disease.

• Some genetic disease affects more than one organ in our body. It is also known that certain genetic abnormalities increase the risk for specific cancers. Such individuals with specific gene variant need to be seen by other specialists to screen for involvement of other organs, screen for cancers and need long term follow up.
• African American kidney donors and kidney donor with a family history of kidney disease will benefit from genetic testing to evaluate their risk of developing kidney disease in the future after kidney donation.
• Some kidney disease can also recur after a kidney transplant. Transplant candidates with an unknown cause of end stage kidney disease with benefit from pre- transplant genetic testing to evaluate if their kidney disease can recur.
• Identify individuals who will benefit from implementing gene-based treatment.

What do we do in the kidney precision medicine clinic?

• After your initial evaluation in the clinic, we will test you for specific gene variation. The platform used for testing will depend on the underlying clinical presentation.
• Based on the results of the genetic testing, if any variation of clinical significance is detected, the results will be discussed with you and you will be provided with genetic counselling.
• Based on the gene variations, your treatment will be altered and individualized.
• You will be referred to appropriate dedicated specialists (cardiology, neurology, endocrinology, ophthalmologist, ear nose throat specialists, cancer specialist, kidney transplant team and urologist) for further investigation as warranted.

How do I get appointment in this clinic?

The kidney precision medicine clinic is led by Divya Shankaranarayanan, MD, an Assistant Professor of Medicine in the Division of Kidney Diseases and Hypertension. She is board certified in Internal Medicine and Nephrology. She also received additional clinical and research training in Transplantation Medicine and molecular biology from Cornel University.

To make an appointment call 202-741-2283 and ask for an appointment in the Nephrogenetic clinic.

Kidney Wellness Education

Preventing and Treating Kidney Disease Naturally

There is a global epidemic of chronic kidney disease (CKD) which if untreated, progress to end-stage kidney disease which may require dialysis as a life-saving measure. The Division of Kidney Disease & Hypertension at The GW Medical Faculty Associates is now offering an Kidney Wellness Education; one of the only kind in the Washington, DC area. The class is designed for patients interested in natural methods for slowing the progression of kidney disease. Lifestyle modification provides added health benefit for heart disease, hypertension, diabetes and obesity. You may continue to be managed by your regular physicians.

Our Introduction to Kidney Wellness Class offers options beyond traditional treatment through lifestyle modification with the goal of reversing chronic illnesses naturally. This course is led by Patricia Centron Vinales, MD in conjunction with Nancy Uhland, NP (Lifestyle educator) and Granetta Coleman ( Food For Life Instructor).

About the Course:

• Group Medical visits with lifestyle coaching in which participants learn from each other under physician guidance
• Nutrition education including (but not limited to) adopting a plant-based diet
• Cooking demonstrations

Am I A Good Candidate for this Course?

Our Kidney Wellness Class is designed for new and existing patients interested in preventing or learning tactical and simple ways of nutritional management of Chronic Kidney Disease. This class is also ideal for patients suffering from preexisting conditions such as:

• Diabetes
• Obesity
• Metabolic syndrome
• Hypertension
• Kidney stone disease

Join the Class!

The Introduction to Kidney Wellness Class is held the 4th Friday of each month at our 2300 M Street, NW location. To make an appointment:

• Call 202-741-2283