Renal Services

UHCW’s Renal Unit provides a sub-regional service for Nephrology and Transplantation. The catchment population for Nephrology and Dialysis includes not only Coventry but also the neighbouring districts of North Warwickshire, Rugby and South Warwickshire, totalling approximately 900,000.  In addition, the Transplantation Service extends to patients from the West Midlands increasing to approximately 2 million.

The Renal Department is located in the East Wing on the 5th floor at UHCW. It is a purpose built fully integrated facility with renal inpatient beds, a transplant unit, outpatient haemodialysis, an acute haemodialysis and plasma exchange unit, CAPD unit as well a day case unit. There is office accommodation in the facility for the Consultants and their secretaries as well as for junior medical and nursing staff.

There has been a significant increase in the number of patients developing ESRF in the last 20 years. This has been accommodated in the expansion of the satellite haemodialysis programme, home therapies (both PD and home haemodialysis), pre-emptive transplantation and a conservative care programme. At UHCW we take on average 120 patients per year for dialysis, representing an annual take-on rate of over 150 patient’s pmp.  At present there are approximately 470 patients on renal replacement therapy, 360 hospital based haemodialysis, 17 on home haemodialysis, 95 on the CAPD, APD or assisted PD programme.

We perform over 60 transplants per year with the majority being live related transplants.

Prof Higgins has successfully developed a desensitisation programme for antibody Incompatible transplantation, which now is recognised internationally to be one of the most Successful programmes. It has resulted in referrals from units both within and outside of the West Midlands and we currently have a contract with Ireland to provide an antibody incompatible live transplant service. The program is expected to continue expanding and we have two transplant research fellows, one specifically to assist with the desensitisation programme. The programme is led by Dr Nithya Krishnan.

There are four consultant transplant surgeons. Mr Lam, Mr Kashi, Mr Tan and Mr Roy (locum) have general surgical commitments and a vascular surgeon Prof Imray is also on the transplant rota.  Mr Fernando is an Associate Specialist who assists with transplantation.

Outpatient Clinics

Outpatient clinics are held in Coventry, Rugby, Nuneaton, Warwick and Stratford. Clinics are supported with a Renal Nurse Specialist and Dietician. The clinic Template for a dedicated new patient clinic would be 5 and for a dedicated follow up 12 patients.

Junior Medical Staff

There are currently four Specialist Registrars and they are individually responsible on a rotational basis for the following areas: Ward 50, General Medical patients attached to Infectious Diseases, the Renal outliers and Transplantation. They attend outpatient clinics and rotate from the higher specialist training programme in the West Midlands. There are two research registrars and along with the SpR’s provide the middle grade and emergency on-call cover for the Department out of normal working hours until 9pm at night.

The on call consultants provide cover over night although there is a medical registrar to provide middle grade cover at UHCW overnight.

There are three CMTs in Renal Medicine as part of the UHCW medical rotation and there is a Foundation Year 1 Doctor.

The new appointment will have equal access to the junior medical staff, both on call and in clinics.

Support for Renal Services

Support facilities for the investigation of renal disease are excellent, including ultrasound, CT, MRI and radioisotope imaging. There is a separate on call rota for interventional radiology which provides a comprehensive service including angiography, stenting and the placement of percutaneous nephrostomies.

Renal biopsies are undertaken in the radiology department and there are 2 Consultant Renal Histopathologists.

Information on renal patients is currently stored on the Proton computer system, with wide distribution to the ward, dialysis unit, and offices and outpatient’s areas, allowing rapid access to results and clinical letters.  This system is used for audit by the Renal Registry, which Coventry joined in 1998. Dr Dan Ford is the clinical lead for IT and Karen Pickles has recently been appointed as a Systems Manager.

There is a large IT department with training and support facilities provided.

Management Structure for Renal Services

We have organised the renal department so that are clinical leads and lead nurses as appropriate for the following clinical areas:

• Acute Kidney Injury
• Chronic Kidney Disease
• Home Haemodialysis and IT
• Hospital and Satellite based Haemodialysis
• Transplantation

The management of the department is coordinated through a series of meetings and forums to ensure discussion and effective communication.

Specialty Management meeting held on Thursday morning held with the CD, Deputy CD General Manager, Finance Manager and Modern Matron.

The Clinical Director meets with the weekly on a Friday afternoon. There is a monthly Junior Doctor Forum

There is a monthly QPS and Clinical Forum held on a Friday morning attended by the following:

• Clinical Director (Chair)
• Clinical Lead in Renal Medicine
• Consultants in Renal Medicine
• Modern Matron in Acute Medicine
• Ward Manager ward 50
• Renal Nurse Specialists
• General Manager or Deputy
• Junior Doctors to present audits