Nephrology

The Department of Nephrology of the First Affiliated Hospital of Dalian Medical University and the Institute of Nephrology of Dalian Medical University were established in the late 1970s. Over the past nearly 10 years, the discipline has continuously expanded in scale, integrating medical care, education, and research, while its medical standards and academic standing have continuously improved. In 2012, it was designated as one of the first batch of National Clinical Key Specialty Construction Units for nephrology by the Ministry of Health; a national standing committee member unit of the Nephrology Branch of the Chinese Medical Association, the Hemodialysis and Blood Purification Center Management Branch of the Chinese Hospital Association, and the Nephrology Physicians Branch of the Chinese Medical Doctor Association; one of the first batch of peritoneal dialysis training demonstration centers of the Ministry of Health; one of the first batch of specialist physician training bases for nephrology of the Ministry of Health; one of the first batch of county-level hospital blood purification training bases in China; a National Drug Clinical Trial Institution; an affiliated unit of the Dalian Blood Purification Quality Control Center; and a first-level key medical discipline of Dalian. It is one of the leading teams in the field of nephrology in Liaoning Province.

The discipline adheres to the patient-centered philosophy and makes unremitting efforts to standardize medical practices, improve the diagnosis and treatment of difficult cases, carry out clinical technological innovation, promote the concept of translational medicine, and improve the comprehensive quality of personnel, thereby achieving the goal of providing patients with high-quality medical services.

Specialty outpatient clinics and wards

The discipline currently has four subspecialty directions: primary kidney diseases, secondary kidney diseases, critical kidney diseases, and blood

purification. On this basis, it has established special outpatient clinics for IgA nephropathy, diabetic nephropathy, chronic kidney disease, lupus nephritis, and blood purification, as well as a kidney disease follow-up center; wards for chronic kidney disease, renal biopsy, acute kidney injury, and critical kidney diseases; a blood purification center, a peritoneal dialysis treatment center, and a continuous blood purification treatment center. Multiple specialty clinics led by renowned experts have been established. The specialized clinics for primary kidney diseases, IgA nephropathy, uremia, hemodialysis, vascular access, nephrotic syndrome, and peritoneal dialysis, among others, have earned an excellent reputation among kidney disease patients. Nearly 1,000 patient visits for difficult and critical kidney diseases are diagnosed and treated each year. The diagnosis and treatment capabilities for kidney diseases are at the domestic leading level, and comprehensive, high-quality medical services can be provided to patients, enabling kidney disease patients in the Dalian area to enjoy “national-level” medical services without leaving the urban area of Dalian.

Specialized technologies

Renal biopsy

The discipline is equipped with the most advanced ultrasound equipment internationally for renal biopsy and renal imaging examinations, and emergency renal biopsy can be performed at any time. Renal biopsy was initiated as early as the late 1980s. It is a renal pathology diagnosis center that was among the earliest in Liaoning to be equipped with professional renal pathologists, and is the only institution in Dalian capable of independently completing the entire process from imaging examination, specimen collection, and slide preparation to issuing a pathology report. It is the renal biopsy pathology center in the Dalian area with the most complete equipment and staffing and the largest number of renal biopsies. It has extensive experience with high-risk renal biopsy cases, including patients with a tendency to bleed, abnormal renal function, pregnancy, and children undergoing renal biopsy. In addition to routine staining, renal biopsy specimens undergo immunofluorescence testing for IgG subclasses, hepatitis B and C antibodies, and κ and λ chains, as well as special staining for Congo red, calcium salts, and fat, CD3 and CD60 immunohistochemistry, and electron microscopy, according to the specific case. It is one of the renal pathology centers in Liaoning with the most comprehensive renal biopsy slide preparation and staining techniques. For all pathological results, the department holds a clinicopathological discussion every week to ensure that pathological diagnoses are scientific and accurate and to formulate individualized treatment plans. Many diseases with atypical clinical symptoms or that cannot be definitively diagnosed at other hospitals, such as primary small-vessel vasculitis, anti-glomerular basement membrane disease, primary Sjögren syndrome, light-chain disease, early tumors, familial IgA nephropathy, thin basement membrane nephropathy, and Fabry disease, have been confirmed by renal biopsy in our department and have received timely and effective treatment.

Continuous blood purification technology and establishment of difficult vascular access

The discipline is equipped with the most advanced continuous blood purification machines internationally and carries out advanced blood purification technologies, including continuous renal replacement therapy (CRRT), sustained low-efficiency dialysis (SLED), high-flux hemodialysis (HFHD), high-volume hemofiltration (HVHF), double-filtration plasmapheresis, selective plasma adsorption, immunoadsorption, and hybrid renal replacement therapy (HRRT). The discipline independently performs highly difficult operations, including complex autologous arteriovenous fistula creation, re-creation after fistula occlusion, autologous and artificial vascular grafting, long-term indwelling deep venous catheter placement, and balloon dilatation of fistula stenosis under DSA and recanalization through stent implantation. It has developed advantages in many areas, including dialysis adequacy, individualized dialysis modes, individualized anticoagulation methods, and the widespread application of new blood purification technologies. During nearly 10 years of conducting CRRT, the discipline has rescued more than 6,000 episodes of various difficult and critical illnesses, involving patients ranging in age from 3 years to 93 years. At present, the discipline is at the domestic leading level in both the number of critically ill patients rescued with CRRT and its technical expertise. For patients with hemodynamic instability, CRRT combined with dynamic blood pressure monitoring technology and sequential ultrafiltration has been used to successfully rescue nearly 100 critically ill patients with severe infection complicated by septic shock, multiple organ failure complicated by cardiogenic shock, and conditions after cardiopulmonary resuscitation, among others. The discipline has extensive experience in blood purification treatment for children. It once performed CRRT continuously for 406 hours and successfully rescued a 10-year-old patient with multiple organ failure and severe persistent hypernatremia after multiple trauma. High-volume hemodiafiltration is used to increase the clearance of inflammatory mediators and cytokines, and nearly 500 episodes each year of rhabdomyolysis, sepsis complicated by multiple organ failure, and acute severe pancreatitis complicated by ARDS are successfully treated.

Critical kidney diseases

The discipline’s Kidney Disease Intensive Care Unit (KICU) is the first kidney disease intensive care unit in the Dalian area. It currently has 9 beds and is equipped with the most advanced monitoring systems and critical care treatment equipment internationally. It accepts patients with critical kidney diseases from Dalian and throughout Northeast China. It has extensive experience in critical kidney diseases, including rapidly progressive glomerulonephritis, hemolytic uremic syndrome (HUS), acute kidney injury (AKI), Goodpasture syndrome, severe lupus, multiple organ failure, refractory heart failure, severe acid-base imbalance, and electrolyte disorders.

Talent development

The discipline is an authorized doctoral and master’s degree conferral site in nephrology at Dalian Medical University and has a highly qualified technical backbone team, mainly composed of doctors and master’s degree holders, with extensive experience. It currently has 22 nephrologists (12 professors and associate professors in total), 1 renal pathologist, 1 researcher, and 5 technicians; 92% have a master’s degree or above, including 11 doctors. Over the years, many staff members have received further training and study at leading international nephrology centers in the United States, Japan, and Sweden, as well as at the General Hospital of the People’s Liberation Army and affiliated hospitals of Sun Yat-sen University. Academician Chen Xiangmei, a renowned expert in nephrology in China and president of the Nephrology Hospital of the General Hospital of the People’s Liberation Army, is a jointly appointed academician of our department and visits our hospital regularly each year to provide guidance on the diagnosis and treatment of difficult clinical cases and on scientific research.

Research capabilities

The discipline has a specialized nephrology laboratory with advanced facilities and equipment, including a renal pathology and molecular pathology laboratory, an ultrastructural pathology laboratory, a Class-10,000 clean cell laboratory, a glycobiology laboratory, a microfluidic chip laboratory, a morphology laboratory, and a biological sample bank. It can complete clinical renal pathology, ultrastructural pathology, and molecular pathology diagnoses, and has mastered high-end technologies in basic kidney disease research, including glycobiology, microfluidic chips, transgenic technology, and gene knockout technology. It has undertaken 6 national-level projects, including subprojects of the National Key Basic Research and Development Program of the Ministry of Science and Technology (973 Program), the 12th Five-Year National Science and Technology Support Program, and the Public Welfare Industry Research Special Fund of the Ministry of Health; 7 projects of the National Natural Science Foundation of China; and more than 20 provincial- and municipal-level research projects completed or currently under way. It participated in winning 1 second prize of the National Science and Technology Progress Award and has led the receipt of multiple provincial and municipal science and technology progress awards. Dozens of papers have been published in domestic and international academic journals, with a highest impact factor of 7.9. Seven monographs have been compiled, and its research capabilities are at the domestic leading level.

The discipline is a National Drug Clinical Trial Institution certified by the State Food and Drug Administration (SFDA), responsible for conducting clinical research and exploring new therapies. It has collaborated with well-known domestic hospitals, including the General Hospital of the People’s Liberation Army and Peking University First Hospital, as well as internationally renowned pharmaceutical companies such as Novartis and Abbott, and has undertaken more than 20 Phase II–IV clinical trials. It has undergone flight inspections by the SFDA and the Japanese Ministry of Health, Labour and Welfare many times, performed outstandingly, and received a major award at the annual meeting of the American Society of Nephrology.

Research comes from clinical practice and serves clinical practice. The discipline’s research work is always based on clinical practice, closely connected with clinical needs, and continuously applies the latest research achievements to clinical practice to benefit the large number of kidney disease patients. In 2014, it was recognized as the Liaoning Provincial Translational Medicine Center for Nephrology and established a multidisciplinary cooperation platform, enabling basic kidney disease research to be better applied to clinical practice in areas including early diagnosis of kidney disease, gene therapy, and new drug development.

Kidney Friends Association

While carrying out medical work, the discipline also undertakes social work to popularize knowledge about kidney diseases and has established the “Love Your Kidneys, Have a Home” Kidney Friends Club. Lectures on kidney disease knowledge, including diet, medication, and health care, are held regularly and are given by department professors and head nurses, who communicate face-to-face with patients and provide guidance on the treatment of kidney disease. This further strengthens the courage of the majority of kidney disease patients to overcome kidney disease and establishes a favorable treatment atmosphere, enabling patients and medical staff to work together to effectively curb kidney disease.