Our general and specialized services include:
Consultative General Nephrology
Consultations for: kidney complications of diabetes mellitus, hypertension and/or inflammatory diseases of the kidney, such as systemic lupus erythematosus (SLE) and management of fluid and electrolyte disorders (abnormal blood levels of sodium, potassium and calcium).Referrals for acute and chronic kidney disease or failure and their associated complications: volume overload and other edematous states, anemia, hypertension and/or electrolyte imbalances.Referrals for second opinions
Chronic Kidney Disease (CKD) Management
Monitoring kidney function and treatment of chronic kidney disease to reduce complications and slow the progression to kidney failure.Manage disease states associated with CKD, including anemia,bone disease, hypertension and diabetes. Adjust treatments, medications, diet and monitoring as changes in kidney function occur.
End Stage Renal Disease (ESRD) Requiring Dialysis Treatment
Selection, monitoring and management of the best dialysis method, including: in-center hemodialysis, home hemodialysis, nocturnal hemodialysis and peritoneal dialysis. Early evaluation and timely referral for kidney transplantation.
Long-Term Care After Kidney or Kidney-Pancreas Transplant
Closely monitor the function of your kidney transplant to improve long-term outcomes and reduce complications by coordinating with transplant centers, adjusting anti-rejection medications, monitoring kidney function and treating complications and associated medical problems.
Comprehensive Evaluation and Treatment of Hypertension
Achieving optimum blood pressure control reduces the risk of kidney diseases, and death from strokes and heart disease. Treatment of hypertension requires a multifaceted approach: Medications, dietary modification, and an exercise program.
Evaluation and Treatment of Kidney Stones
Patients who form stones are at risk of developing stones in the future. Although lithotripsy or surgical removal of stones provides immediate relief, the fundamental treatment requires careful medical evaluation and risk abatement to prevent new stone formation.
We Provide Treatment For Following Conditions:
- Diabetic Nephropathy
- Hypertensive Kidney Disease
- IgA Nephropathy
- Nephrotic Syndrome
- Polycystic Kidney Disease
- Systemic Lupus Erythematosus (SLE) with Nephritis
- Cardiorenal Syndrome
- Hepatorenal Syndrome
- Primary Hypertension (formerly known as essential hypertension)
- Secondary Hypertension
- Resistant Hypertension
- Renovascular Hypertension
To learn more about the services we provide, please call us today at 909-542-2777 to schedule an appointment.
Home Dialysis Program
California Kidney Specialists run and operate our own state of the art home hemodialysis program in both Los Angeles and San Bernardino counties. We offer both Home dialysis modalities- Peritoneal dialysis and Home hemodialysis (NxStage machine) to our patients. Our board certified Nephrologists are multi-lingual and are well trained in all the current technologies and medical therapies to provide the best standard of care.
Acute Renal Failure
Acute renal failure (ARF) occurs when the kidneys suddenly stop filtering waste products from the blood. This sudden loss of function can result from injury, trauma or infection, or from complications during surgery. It usually affects people who have additional health-related conditions.
Causes of Acute Renal Failure
Acute renal failure can be caused by a loss of blood flow to the kidneys, or when blocked or damaged kidneys prevent urine from flowing. Although ARF can affect anyone, it is more common in older people, and those who suffer from underlying conditions that include the following:
- Kidney disease
- Liver disease
- High blood pressure
Acute renal failure is also more common in people who are obese.
Symptoms of Acute Renal Failure
Unlike chronic renal failure, in which symptoms develop slowly and over time, acute renal failure causes sudden symptoms that include the following:
- Fluid retention
- Internal bleeding
If a person lapses unexpectedly into a coma, ARF may be the reason.
Diagnosis of Acute Renal Failure
Acute renal failure is diagnosed through a complete review of symptoms and a physical examination by a doctor. Additional tests include the following:
- Blood tests
- X-rays or other imaging tests
A kidney biopsy may also be performed to further determine the cause of ARF.
Treatment of Acute Renal Failure
Treatment for ARF aims to restore kidney function, and prevent waste from building up in the body. Treating the underlying cause or illness can help the kidneys to regain function. Other methods of treatment include dialysis, which is often administered for a few days or weeks before the kidneys again function on their own, or medication. In severe cases, a kidney transplant may be necessary.
After treatment, patients need to make dietary adjustments, and may also be prescribed antibiotics to prevent or treat infection. Left untreated, acute renal failure can be fatal.
Edema (water retention) is swelling caused by an excessive accumulation of fluid in the body. It typically affects the hands, feet, arms, ankles and legs, but can develop in any part of the body. The lower legs are particularly susceptible to edema due to the force of gravity.
Normally, the kidneys filter the blood and help to maintain a proper metabolic balance. However, under certain conditions, too much fluid is retained and swelling results. Mild edema may be inconsequential but, because fluid buildup can result from a serious medical condition and have grave consequences if left untreated, a physician should be consulted when symptoms are severe or prolonged.
Causes of Edema
Edema has many causes, some much more serious than others. It can result from standing or walking in excessive heat; sitting for prolonged periods; eating too much salt; getting sunburned; or being premenstrual or pregnant. More serious causes of edema include the following:
- Lymph-node problems (particularly after a mastectomy)
- Certain medications
- Venous insufficiency
- Congestive heart failure
- Kidney disease
- Chronic bronchitis or emphysema
- Infection, injury or allergic reaction
A lack of protein in the diet can also cause edema.
Symptoms of Edema
Edema is not difficult to diagnose because most of its symptoms are apparent upon examination. Symptoms include the following:
- Puffiness under the skin
- Skin that appears taut or shiny
- Increased size of the affected area
- Abdominal swelling
- Loss of elasticity in the skin
- Bloating, tightness or pain at the affected site
- Decrease in urine production
When edema is left untreated, it can cause much more serious symptoms, including shortness of breath and chest pain.
Treatment of Edema
Treatment for edema focuses on reducing the buildup of fluid. The simplest methods of reducing fluid are restricting salt intake and exercising. When edema is present in the legs, elevating them as frequently as possible is also helpful.
If further treatment is required, diuretics to promote urine production may be prescribed. When a patient has edema with hypertension, medications to lower blood pressure may be prescribed. When edema is caused by disease in the lungs, heart, kidneys or liver, the underlying conditions must be addressed.
Electrolytes are ionized materials found naturally in the body that help to regulate nerve and muscle function, fluid levels and help maintain proper acid or pH levels in the body. Common electrolytes include sodium, potassium, calcium, magnesium and chloride, which also help to regulate the function of many bodily systems. Imbalanced electrolyte levels may develop as a result of impaired kidney function and causing troubling symptoms.
Causes of Electrolyte Imbalance
Healthy kidneys regulate the electrolytes within the body by filtering them from the blood, keeping the necessary substances and excreting any excess through the urine. However, when the kidneys do not function properly, an imbalance may occur. Electrolyte imbalance may be the result of:
- Poor diet
- Chronic diarrhea or vomiting
- Kidney or liver disorders
- Certain medication
- Excessive amounts of fluids
- Anorexia or bulimia
Symptoms of Electrolyte Imbalance
Symptoms of electrolyte imbalance may vary depending on the type and severity of the disorder, but often include:
- Weight loss
Treatment of Electrolyte Imbalance
Treatment for electrolyte imbalance may vary depending on the type and underlying cause of the condition. It may include identifying and providing specific electrolyte replacement through:
- Dietary changes
- Stopping certain medications
- Electrolyte replacement therapy
Electrolyte replacement therapy can be administered either orally or intravenously. Hemodialysis may also be used to treat the condition and reduce potassium levels in patients with impaired kidney function. A doctor will determine which type of treatment is most appropriate for each individual condition.
End-Stage Renal Disease
The final stage of chronic kidney disease (CKD), end-stage renal disease occurs when the kidneys are functioning at less than 15 percent of their normal capabilities, and are no longer able to filter waste from the blood. The kidneys experience complete or near-complete failure, and cannot function on their own.
Causes of End-Stage Renal Disease
End-stage renal disease is usually caused by diabetes, but can also be a result of the following:
- High blood pressure
- Vascular disease
- Injury or trauma to the kidneys
- Autoimmune disease
Certain genetic disorders can also cause end-stage renal disease.
Symptoms of End-Stage Renal Disease
As kidney failure progresses, patients experience many symptoms, which can include the following:
- Loss of appetite
- Weight loss
- Difficulty breathing
End-stage renal disease also results in seizures.
Treatment of End-Stage Renal Disease
Because of the severity of the damage to the kidneys, the only treatments for end-stage renal disease are dialysis and kidney transplants.
Dialysis is the blood-cleansing procedure most often used as treatment for kidney failure. The chief function of the kidneys is to filter waste products from the blood. When the kidneys fail, dialysis takes over their function. During dialysis, blood is removed from a vein in the patient’s arm or leg, circulated through a filtering machine, and returned to the body through an artery. Patients are required to undergo dialysis treatments several times a week, and may become extremely weak and fragile.
A transplant involves removing one or both kidneys, and replacing them with healthy kidneys from a donor. Transplants can often help restore patients’ health, but there are long waiting lists for receiving them. Post-transplant, patients require daily supplemental medications.
Both dialysis and kidney transplants have risks but, without treatment, end-stage renal disease leads to death.
Dialysis is a treatment to filter the blood and remove waste products when the kidneys are no longer functioning properly. During hemodialysis, the patient’s blood circulates through a machine to be cleansed before re-entering the body. This procedure takes place in a medical setting under the supervision of a healthcare professional.
Peritoneal dialysis, on the other hand, is an advanced form of dialysis, allowing patients to have portable treatments — at home, at work or while traveling. This is possible because peritoneal dialysis uses the lining of the abdomen, known as the peritoneal membrane to filter the blood instead of a machine.
Reasons for Peritoneal Dialysis
Peritoneal dialysis is suitable for some patients with kidney failure. Kidney failure may occur for a number of reasons, including:
- Kidney inflammation, known as glomerulonephritis
- Multiple cysts in the kidneys or polycystic kidney disease
Benefits of Peritoneal Dialysis
In addition to the mobility that peritoneal dialysis allows patients, it may also provide the following benefits:
- Fewer medications
- Less restrictive diet
- No use of needles
- Less fluctuation of fluid balance within the body
While peritoneal dialysis affords greater mobility and independence for those able who employ it, it is not appropriate for all patients with renal failure.
Obstacles to Peritoneal Dialysis
There are instances when peritoneal dialysis may not be appropriate and patients must undergo hemodialysis. These include:
- Extensive surgical scars in the abdomen
- A large abdominal hernia
- Inflammatory bowel disease or recurrent diverticulitis
- Limited ability for self-care and lack of care giving
The Peritoneal Dialysis Process
To prepare for peritoneal dialysis treatment, a catheter is surgically implanted in the abdomen. The placement of the catheter is done under general anesthesia and may be performed as open surgery or laparoscopically. With one end inserted in the abdomen and the other end protruding through the skin, the catheter allows the dialysis solution, known as dialysate, to flow freely in and out of the body with no need for repeated incisions.
After the catheter has been implanted by a doctor, patients are able to perform the dialysis treatments independently. They are able to insert the dialysate into the abdomen through the catheter. After a prescribed period of time, the solution and any waste products are drained into a sterile collection bag. This process is done on a continual daily basis. While the procedure is performed independently, patients using the peritoneal dialysis method remain under the supervised care of doctor.
Risks of Peritoneal Dialysis
Dialysis is a necessary procedure for many people who are suffering from kidney failure or kidney-related problems. While it is a beneficial health treatment, the risks of peritoneal dialysis may include:
- Infection in the abdominal cavity or at the site of the catheter insertion
- Weight gain or high blood sugar because the dialysate contains sugar
- Hernia because of abdominal distention
Nephrology is the branch of internal medicine that focuses on care of the kidneys, and diagnosis and treatment of kidney disease and disorders. Many kidney problems are systemic, and require medical evaluation and intervention not only by nephrologists, but by specialists in other fields, such as immunology or rheumatology.
The human body has two kidneys, which are located at the back of the abdomen; each is approximately the size of the human fist. The kidneys act as filters by removing waste from the blood, and producing urine, a fluid that contains the waste. As urine is collected, it passes into the bladder through tubes called “ureters.” When the bladder is full, urine passes through the urethra, and out of the body.
Function of the Kidney
Several times each day, all of the blood in the body passes through the kidneys to be cleared of waste. Kidneys perform the following functions:
- Remove waste products from the blood
- Regulate the balance of fluids in the body
- Regulate the body’s electrolyte balance
Each kidney contains approximately one million microscopic units called “nephrons.” Each nephron functions as a tiny filter, assisting in the removal of waste from the blood. Because of the huge number of nephrons, it is possible for a person to lose as much as 90 percent of kidney function yet remain asymptomatic.
Disorders of the Kidney
There are many disorders, including the following, that affect the kidneys:
- Congenital disorders (such as polycystic kidney disease)
- Infectious diseases (such as pyelonephritis)
- Inflammatory disorders (such as glomerulonephritis, interstitial nephritis)
- Abnormalities (such as kidney stones, renal cysts, nephrogenic diabetes insipidus)
- Kidney cancer
- Diabetic or hypertensive nephropathy
- Imbalance of electrolytes, or acids and bases
- Acute or chronic kidney failure
The most common type of kidney cancer in adults is renal-cell carcinoma; it usually affects men between 50 and 70 years old.
Diagnosis of Kidney Problems
Nephrologists employ many tests in diagnosing kidney disease and dysfunction. After a patient is given a thorough physical examination and provides a detailed medical history, the following tests may be performed: urinalysis, which checks urine for the presence of blood, protein, pus, and cancer cells; 24-hour urine collection, which measures urine output, daily loss of protein and creatinine clearance; blood tests, which establish the concentration of hemoglobin, platelets, and various minerals and secretions in the blood; specialized tests, which check for the presence of infections and autoimmune problems; diagnostic imaging tests, which check for structural abnormalities of the kidneys; and renal biopsies, which detect cancer and other types of disease.
Treatment of Kidney Disorders
Nephrologists treat kidney disorders, depending on their type and severity, in a variety of ways. Treatments for kidney disease include the following:
- Nephrostomy (catheter inserted directly into kidney to drain urine)
- Lithotripsy (shock waves used to shatter kidney stones)
- Nephrectomy (cancerous/severely damaged kidney is surgically removed)
- Hemodialysis (dialysis machine filters blood when kidneys fail)
- Peritoneal dialysis (fluid is siphoned into abdomen, and then drained, to filter blood)
A kidney transplant is necessary when kidneys are unable to function. Kidney-transplant donors may or may not be related to the transplant recipient.
Proteinuria is an abnormal amount of protein in the urine. While waste products are filtered out of the blood to leave the body through the urine, protein is essential in protecting the body against infection and ensuring proper fluid circulation. When protein is found in the urine, it may be a sign of chronic kidney disease.
Causes of Proteinuria
Proteinuria tends to occur in patients with diabetes, hypertension or a family history of proteinuria. Other people that may have a higher risk of developing proteinuria include those that are:
- African American
- American Indian
People who are obese may also be more susceptible to developing proteinuria.
Symptoms of Proteinuria
Early stages of proteinuria do not often produce any symptoms, but patients with large amounts of protein may notice the following symptoms:
- Swelling in the hands, feet and face
- Urine that appears foamy
Because of its potential implications and lack of symptoms, patients at risk for kidney disease should be tested on a regular basis.
Diagnosis of Proteinuria
Albumin is the main protein that is present in the blood. Proteinuria can be diagnosed through a simple urine test that compares the amount of albumin in the urine with the amount of creatinine, which is used to measure kidney function. The test is used to determine if these levels are off balance. Laboratory testing is the only way to detect excessive protein before extensive kidney damage has occurred.
Treatment of Proteinuria
Treatment for proteinuria involves managing blood sugar and blood pressure levels, which may be achieved with the following methods:
- Healthy diet
- Regular exercise
- Prescribed medication for diabetes and high blood pressure
A doctor may also prescribe medication to control swelling of the kidneys that may lead to proteinuria. Treatment may be required over a long period of time, depending on the severity of each patient’s individual condition.
Renovascular disease is the blockage or narrowing within the renal arteries or veins, the blood vessels that carry blood to and from the kidneys. The arteries are affected much more commonly than the veins. Renovascular disease can cause kidney damage or kidney failure. This condition occurs most often in older patients, although young women may also be at risk for a certain type of renovascular disease called fibromuscular dysplasia.
Causes of Renovascular Disease
Causes for renovascular disease may vary depending on the type of condition. Common causes may include:
- High blood pressure
- High Cholesterol
- Kidney Disorders
Types of Renovascular Disease
Types of renovascular disease may include:
- Renal artery stenosis, the blockage of an artery to the kidneys
- Renal artery thrombosis, the formation of a clot in a renal artery
- Renal vein thrombosis, the formation of a clot in a renal vein
- Renal artery aneurysm, a weakened area in the wall of an artery to the kidney
- Atheroembolic renal disease, a piece of plaque blocks the renal artery
- Fibromuscular dysplasia, an abnormal cell development which causes narrowing of the wall of a renal artery
Symptoms of Renovascular Disease
Patients who suffer from these conditions may experience common symptoms which may include:
- Chest pain
- Confusion or anxiety
- Loss of appetite
- Weight loss
- Flank pain
- Puffy eyes, hands or feet
- Nausea and vomiting
Diagnosis of Renovascular Disease
Renovascular disease can be diagnosed through a complete physical examination and a full review of symptoms and medical history. Additional tests may include:
- Angiogram or X-ray of the blood vessels
- Kidney function test
Treatment for Renovascular Disease
If left untreated, renovascular disease can lead to a heart attack, kidney damage, loss of vision or a stroke. Treatment may include medications to dissolve blood clots, or a procedure such as balloon angioplasty or insertion of a stent to clear the blockage and restore normal blood flow. Patients can reduce their risk of developing this disease by managing conditions such as diabetes and high blood pressure. It is important for patients to seek proper medical treatment for this condition in order to reduce the risk of complications.