Interventional Nephrology is a new and emerging subspecialty of Nephrology that mainly deals with ultrasonography of kidneys and ultrasound-guided renal biopsy, insertion of peritoneal dialysis catheters, tunneled dialysis catheters as a vascular access for patients undergoing hemodialysis as well as percutaneous endovascular procedures performed to manage dysfunction of arteriovenous fistulas or grafts in end stage renal disease patients.

Interventional Nephrology (IN) is a new and emerging subspecialty of Nephrology that mainly deals with:

i.            Ultrasonography of kidneys and ultrasound-guided renal biopsy.

ii.            Insertion of peritoneal dialysis catheters (PDC) in ESRD patients

iii.            Insertion of tunneled dialysis catheters (TDC) as a vascular access for patients undergoing hemodialysis and

iv.             Percutaneous endovascular procedures performed to manage dysfunction of arteriovenous fistulas or grafts in ESRD patients

 Insertion of Peritoneal Dialysis catheters

Peritoneal Dialysis (PD) as a method of RRT has many important advantages; preservation of residual renal function, improved middle molecule clearance, improved fluid and blood pressure control, reduced incidence of left ventricular hypertrophy, less likelihood of severe cardiac arrhythmias and better quality of life

The procedure can be accomplished by three techniques; the surgical, the blind or modified Seldinger and the peritoneoscopic technique. The first one is performed by surgeons under general anesthesia whereas the last one is performed more frequently by nephrologists under local anesthesia using a small peritoneoscope (2.2 mm). The peritoneoscopic technique is associated with lower incidence of complications and offers the unique possibility of direct visualization of abdomen where the PD is placed.

Dr Rezwanur Rahman has performend more than 50 CAPD catheter implantation and a good number of CAPD patients are getting dialysis under his care.

Ultrasound-Guided Renal Biopsy

A renal biopsy (commonly referred to as a kidney biopsy) is a procedure used to obtain a segment of renal tissue, usually through a needle or another surgical instrument. The 2 main types of biopsy are percutaneous and laparoscopic/open biopsy.

Indications for renal biopsy

Among the indications to perform renal biopsy in adults are the following conditions:

·       Unexplained renal failure

·       Acute nephritic syndrome

·       Nephrotic syndrome

·       Isolated nonnephrotic proteinuria

·       Isolated glomerular hematuria

·       Renal masses (primary or secondary)

·       Renal transplant rejection

·       Renal transplant dysfunction

·       Connective-tissue diseases (eg, systemic lupus erythematosus)

Dr Rezwanur Rahman has performend more than one thousand USG guided renal biopsy since 2010. He is regularly performing biopsy on graft kidney (transplant kidney) to detect various post transplant renal dysfunctions. 

There are three types of vascular accesses.

·       A tunneled cuffed dialysis catheter,

·       An arteriovenous fistula (AVF) and

·       An arteriovenous graft (AVG)

The TDCs are placed usually temporarily until the creation of an AVF or AVG. Traditionally, TDCs used to be placed by surgeons and radiologists. Recently, nephrologists have begun to perform this procedure safely and successfully. They also are involved in undertaking catheter exchange, removal and repairing their function with the utilization of angioplasty balloon catheters when TDC are occluded because of fibroepithelial sheath

Dr Rezwanur Rahman has performend more than 250 tunneled cuff dialysis catheter insertion.

AVFs as well as AVGs are often complicated by stenosis. Commonly the problem appears in AVGs. Although stenosis can occur anywhere within the dialysis access, the most common point of stenosis (60%) is venous anastomosis. The cause of stenosis is multifactorial but it is mainly attributed to neointimal hyperplasia. If stenosis is more than 50% it should be treated by percutaneous angioplasty balloon. The method is successfully performed by trained nephrologists with effectiveness and safety.

Most of the early failing fistulas did not mature because of stenosis in venous channel or because of a secondary vein which takes blood out of AVF^. Treatment of stenosis with percutaneous angioplasty balloon and obliteration of the secondary vein by a nephrology team in a multi-centered prospective study showed very satisfactory results.