The analysis of a 24-hour urine specimen holds a particular importance in the evaluation of renal functions. The renal capacity to concentrate urine, the amount of salt consumed within meals and the amount of protein lost by renal means can be calculated by conducting a 24-hour Urinalysis on many patients who apply to Nephrology Subdivision. The specimen of urine within a period of 24 hours should be collected for this analysis. For this procedure:

Collecting the urine specimens for 24 hours starts with the first urination in the morning. While the first urination of the morning is urinated into the loo, all of the remaining urine specimens of the day as well as the first urine in the next morning should be collected in a clean water pot. Thereby, the urine collection procedure is brought to completion in the next day. You should bring all of the urine specimen you have collected to Nephrology Laboratory. The amount of your urine will be measured and a part of it will be reserved for measuring protein level in Nephrology Laboratory. Then, you will be asked to bring your urine specimen to the Clinic Pathology Laboratories on floor C, so that urine collection capacity of your kidneys and the total amount of your salt consumption can be determined.

These procedures are carried out on the condition that your physician has asked for these and you have suitable test papers.

Your blood pressure is monitored for 24 hours or longer as your physician deems suitable with this system. 24-hour blood pressure monitoring is one of the most accurate methods in the diagnosis of hypertension and determining the response to a treatment. A cuff that is connected to a small device (sized about a walkman) is worn by the patient in this method. You should wear the device, which is also attached to your belt, for 24 hours. In this method, blood pressure is monitored by an automatic device during your usual living conditions (at home, at work, while eating or sleeping, etc.) periodically (30-60 min.). The method, which enables monitoring blood pressure during the daily life and at sleep, does not have any adverse effects.

Considerations for the procedure

• - You should bring 4 AA batteries for the blood pressure monitoring device. Besides, the device will be delivered to you in return for an official ID card, which will be retained in the unit for 24 hours. So, you may want to have a spare ID card with you.

• - Patients on hypertension medication should continue to use it. There is no need for any restriction in activity during the blood pressure monitoring procedure. You should continue all of your daily habits.

• - The device measures your blood pressure automatically. The device gives a sound signal before measuring your blood pressure, then the cuff around your arm will start to inflate. You should not bend your elbow during the monitoring. Your blood pressure is monitored in intervals of 30 minutes between 06:00 and 22:00; and in intervals of 60 minutes between 22:00 and 06:00. These intervals can be altered if deemed necessary by your physician.

• - Your blood pressure will be recorded by the device for 24 hours and reported with a computer in the outpatient clinic.

• - 24 hour blood pressure monitoring device is not affected by mobile telephones or any other electronic equipment.

You may need a renal biopsy in the event that your physician deems necessary for diagnosing kidney diseases, particularly types of nephrites. A detailed evaluation is required before a biopsy is approved for performing in order to ensure that no obstacle is posed before the biopsy.

Considerations before the procedure

• Your kidneys are evaluated with an ultrasound before kidney biopsy and you are given a prescription for the biopsy needle suitable for the procedure.

• You will need to be hospitalized for at least 24 hours for kidney biopsy. Therefore, you should have a suitable referral for hospitalization procedures.

• You should fast for at least 6 hours before the procedure. However, heart and hypertension medications that are regularly used, should be taken with a little amount of water. Patients who will undergo a biopsy should stop using aspirin and any other blood thinning medication at least 7-10 days before the procedure. If you are on any of these medications, please consult your physician.

• Biopsy is performed with ultrasound by experienced experts. You should lay face down for a while for the procedure called needle biopsy. After your skin, subcutaneous tissue and renal membrane are anesthetized locally, 2 pieces are collected from the kidney with the help of a needle. The dimensions of pieces are 1-1.5 cm in length and 0.3-0.5 cm in diameter.

• Kidney biopsy poses a scarce risk of bleeding. Therefore, you may need to be monitored in the hospital and meet your toilet needs in a bed-bound state for 24 hours as of the procedure. You will need an all-day visitor to help you during this process.

• You can start drinking water right after the procedure. You need to wait for at least 4-6 hours and take approval of your physician before you can eat.

• Your post-procedural urine should be evaluated in respect to bleeding. Therefore, you should show your urine to your physician before discarding it.

• You can be discharged one day after the procedure unless there is a problem. Your kidney biopsy result is reported within a few days.

The reason for hypertension or renal dysfunction in certain patients is the narrowness of blood vessels in kidney. Your renal blood vessels should be evaluated with an angiogram so that this narrowness can be understood. Angiogram is given in Radiology Department.

Considerations before the procedure

• You should have blood tests before angiogram in order to determine bleeding-related issues.

• As you wil need to be hospitalized for 1 day after angiograms, the dates for angiogram appointment you will receive from Radiology Department and inpatient service appointment you will receive from Nephrology Department should be the same day.

• You are recommended to shave off your groin area as angiogram procedure is usually performed by using the blood vessels in this area. You should keep an empty stomach without having anything for breakfast on the morning you arrive for the procedure However, please remember to use your heart and hypertension medications that you are on with a little amount of water.

• 24 hours of bed rest is recommended after the procedure. You will need an all-day visitor to help you during this process.

• Your angiogram result will be reported to you on the next day following the procedure.

• In the event that a narrowness is detected in your renal blood vessels, it can be widened with the help of a balloon or stent. These procedures highly resemble to angiogram.

Tissue typing of kidney recipient and donor candidates is one of the most important stages of transplantation preparation. This procedure is performed by a specialized team using molecular biology techniques in Nephrology Laboratories. For this procedure, your physician should examine you and request the test. A tube (approx. 10 ml.) blood is collected from the donor and the recipient for tissue typing.

Hemodialysis procedure restores certain functions of kidney in patients with severe renal dysfunction. Urea and other substances accumulated in the blood are filtrated and removed from the body. Your physician will inform you on the necessity and continuity of the procedure.

A vascular access is requires for hemodialysis. This access is provided by either connecting two vessels in wrist (fistula) or inserting a catheter to a large blood vessel in the neck. Fistula is the healthiest method for patients who are in need of hemodialysis for a long period. As fistula needs at least 2-3 weeks before it can be used, it should be prepared a while before the hemodialysis. Catheterization should be applied before emergency dialysis procedures to patients who do not have a fistula or whose fistula is inoperable.

Your physician will schedule the suitable time for your hemodialysis and the dialysis prescription by contacting Hemodialysis Unit when necessary. Dialysis usually lasts 4 hours. You will lay on a bed where you receive dialysis with the help of a machine during this period.

Similar to hemodialysis, peritoneal dialysis is a treatment method applied to patients with severe renal dysfunction. Urea and other substances accumulated in blood are removed from body by infiltration through peritoneal membrane. Your physician decides on the suitability of this treatment and how it is to be applied for you.

A catheter should be placed into the abdomen for peritoneal dialysis. This procedure is performed by Urology Department with a minor surgery. Peritoneal dialysis is an ambulatory treatment which is performed under domestic conditions. After receiving peritoneal dialysis treatment, the patient operates the procedure by at home. Peritoneal dialysis treatment and practices are realized in Peritoneal Dialysis Unit by experienced medical personnel.

Renal transplantation can be performed from either alive or a cadaver donor. Recipients and donors are evaluated in detail and subjected to required tests for the procedure. Patients receiving dialysis in Hemodialysis Center of our hospital are periodically evaluated and included in kidney transplantation waiting list. Also, patients who receive dialysis treatment from other centers are also offered these services upon request.

Patients with a relative (such as parents or siblings) volunteering to donate kidney are evaluated in our outpatient clinic as well. Alive donors should share the same blood type and should not suffer from any serious medical problem, particularly hypertension and diabetes. After basic tests for diagnosis, tissue typing and imaging renal vessels with tomography are performed for these patients. After suitable recipients and donors are discussed at the Transplantation Council, renal transplantation is performed by Urology Department. You will need to be hospitalized for 10-14 days after the transplantation. You should use certain medication in order to prevent your body from rejecting the organ. Follow-up check-ups of our patients are periodically given in the outpatient clinic after the transplantation.