Asif Arif, Byers Patricia, Vieira Cristovao F, Preston Richard A, Roth David
Division of Nephrology, Department of Medicine, University of Miami, School of Medicine, Miami, Florida 33136, USA.
Am J Ther. 2002 Nov-Dec;9(6):530-6. doi: 10.1097/00045391-200211000-00014.
The fragmented care of nephrology patients that results from referral to a radiologist for renal ultrasound (US) and biopsy, a surgeon for dialysis access placement, and an interventional radiologist for dialysis catheter placement and vascular access procedures often leads to delays in the treatment of these patients. Many specialists perform and interpret sonograms particular to their specialty rather than relying on technicians for performance and radiologists for interpretation, and nephrologists recently have begun to embrace this technology as an aid in the diagnosis and treatment of their patients. By combining an understanding of the pathophysiology of renal disease with the ability to perform clinical correlation and apply the laboratory data, the nephrologist is ideally suited to perform and interpret renal US and US guidance for percutaneous renal biopsies. Additionally, patients requiring peritoneal dialysis (PD) access have traditionally been referred to a general surgeon for catheter placement, which incurs additional delay in therapy and loss of decision-making control by the referring nephrologist. Recent data has emphasized that the peritoneal dialysis access procedure can be performed safely and effectively by a nephrologist trained in PD access procedures. Nephrologists also successfully perform tunneled hemodialysis catheter placement and vascular access procedures on an outpatient basis. The medical needs of patients with renal disease can be safely and efficiently delivered by a nephrologist trained in interventional nephrology (IN). This growing area of expertise will minimize delays, reduce cost, and allow physicians with training in the management of end-stage renal disease (ESRD) patients to be involved in the procedural aspects of their patients' care. An aggressive approach to the development of IN training programs at academic centers is warranted.
肾病患者的医疗护理往往较为分散，因为肾脏超声检查（US）和活检要转诊给放射科医生，透析通路放置要找外科医生，透析导管放置和血管通路手术则需介入放射科医生，这常常导致这些患者的治疗延误。许多专科医生会亲自操作并解读与其专科相关的超声检查，而不是依靠技术人员进行操作、放射科医生进行解读，肾病科医生最近也开始采用这项技术来辅助诊断和治疗患者。通过将对肾脏疾病病理生理学的理解与进行临床关联以及应用实验室数据的能力相结合，肾病科医生非常适合进行肾脏超声检查以及为经皮肾活检提供超声引导。此外，需要进行腹膜透析（PD）通路置管的患者传统上要转诊给普通外科医生，这会导致治疗进一步延迟，且转诊的肾病科医生失去决策控制权。最近的数据强调，经过腹膜透析通路手术培训的肾病科医生能够安全有效地实施腹膜透析通路手术。肾病科医生还能成功地在门诊进行带隧道涤纶套血液透析导管置入和血管通路手术。经过介入肾脏病学（IN）培训的肾病科医生能够安全有效地满足肾病患者的医疗需求。这个不断发展的专业领域将减少延误、降低成本，并使接受过终末期肾病（ESRD）患者管理培训的医生能够参与到患者护理的操作环节。有必要在学术中心积极开展介入肾脏病学培训项目。
