Department of Nephrology, Tribhuvan University Teaching Hospital (TUTH)
1) Introduction
Since its start in 1984 as the first University Hospital of Tribhuvan University, Tribhuvan University Teaching Hospital (TUTH) has always played leadership roles in the fields of health service, education, and research in Nepal.
Nephrology is a distinctive subspecialty of medicine. Even though it is considered a subspecialty, it is reputed for its huge span encompassing comprehensive care of every aspect of clinical medicine.
The Department of Nephrology has been providing complete care for patients with kidney diseases inside and outside the premises of TUTH.
2) History
Nephrology specialty service started in TUTH in 1992. Initially, it started with acute peritoneal dialysis (PD) for patients with acute kidney failure. Hemodialysis (HD) services started in 1996 (2053 BS) with the support of two dialysis machines donated by the Government of Japan.
Initially, nephrology service was provided by the Department of Internal Medicine as the Nephrology Unit through a team of a few dedicated faculties committed to contributing to the care of patients with kidney disease. Later on, this endeavor was reinforced by the initiation of other kidney care services through dedicated nephrology service beds, specialty outpatient clinics, peritoneal dialysis, and the initiation of living donor kidney transplantation services in 2008.
The Department of Nephrology was convened on 24 Dec 2012 (Poush 9, 2069 BS).
3) Human Resources
The department currently delivers its clinical and academic services through a team of six faculties who have individually demonstrated a high level of excellence in the field. Patient care, bedside teaching, ward rounds, and OPD services are highly appreciated by faculty members of other specialties and postgraduate trainees rotating through their postings in nephrology. We have the best quality nursing personnel taking care of our inpatients.
Besides, our team also comprises 5 nephrology specialist trainees and a team of dedicated trained hemodialysis nurses and dialysis technicians. Our wards are provided with the most competent nurses and support staff.
4) Clinical Services
1. Outpatient Service
Every year, hundreds of patients are diagnosed as incident chronic kidney disease (CKD). We serve over 15,000 patient visits in our outpatient clinic every year.
2. Inpatient Service
The Nephrology ward is located at Level 2. We provide service through 34 inpatient beds, 10 dialysis beds, 2 post-transplant ICUs, and shared ICUs. It has an occupancy of almost 100% with a huge number of additional renal patients admitted to other wards in the hospital. The total number of nephrology inpatients averages 45 to 50 on any given day.
3. Hemodialysis Services
Hemodialysis (HD) is one of the fundamental services provided by the Nephrology Department. HD is an essential life-saving therapeutic modality for patients with kidney failure. While it is a medical facility to sustain the survival of patients with kidney failure, it is also an important bridging therapy for kidney failure patients planning to have a kidney transplant.
Our hemodialysis unit is equipped with:
- 10 machines in the HD ward
- 1 dedicated hemodialysis machine in the ICU
- 2 CRRT machines (ICU + Dialysis ward)
Two 4-hour sessions are run every day for booked outpatient HD patients, followed by unrestricted service for indoor and emergency patients 24/7. Our specialist nurses have trained hundreds of nurses throughout the country and also have helped establish HD units in various hospitals nationwide.
We perform over 11,000 HD sessions for new and old CKD and AKI patients every year. We provide regular outpatient dialysis to over 60 patients under the Nepal Government subsidized dialysis service. Shortage of dialysis machines and the growing number of ESRD patients has left over 700 registered patients awaiting the standard of care in our HD unit.
The Nephrology Department has been able to establish:
- Plasma exchange
- Bedside dialysis in ICU
- Pediatric nephrology care
- Living donor kidney transplantation in the country
Our medical team also covers CRRT service in Manmohan Cardiovascular Thoracic and Transplant Centre.
4. Kidney Transplantation
Living-related kidney transplantation services started on 8th August 2008 under the leadership of Prof. Dibya Singh Shah. Over 650 living donor kidney transplants have been performed till March 2020.
Some of our notable achievements in kidney transplantation include:
- Second kidney transplant
- ABO incompatible kidney transplantation
- Transplantation of sensitized patients
- Transplantation of HBsAg/anti-HCV/HIV positive patients
We feel proud to have successfully accomplished the second living donor kidney transplantation for the Prime Minister Rt’ Honourable KP Sharma Oli on 4th March 2020.
At present, TUTH performs 2 kidney transplants every week.