Nephrology Clinic
Nephrology Clinic
Nephrology Clinic is responsible for the treatment of patients with acute or chronic renal diseases separately or within the wide spectrum of complex systemic and other internal diseases requiring monitoring and intensive multidisciplinary medical and nursing interventions.
The history of the Nephrology Service began with the establishment of the Nephrology Department in 1963. A year later, the first hemodialyses were performed. Having grown into the Clinic, it continued to develop in professional and personnel terms. With the development of Kidney Transplantation and Peritoneum Dialysis Programs, setting up of Urotract Calculosis Center and Organ Donor Program (serving as the cornerstone of the National Transplantation Program) over the recent years, it has become the most responsible for the development of nephrology in our country.
Services:
• Laboratory, morphological, histopathological, immunological, ultrasound/Doppler and other diagnostic procedures;
• Outpatient examinations and hospital treatment of a wide array of internal diseases, primary and secondary renal conditions;
• Peritoneal dialysis and hemodialysis, plasma exchanges, immunoadsorption, multifiltration;
• Diagnosis and the treatment of the urotract calculosis,
• Pre-transplantation assessment, kidney transplantation, immunosuppressive protocols, etc.
Organizational structure:
• The First and the Second Department of the Clinical Nephrology
• Kidney Transplantation Department
• Peritoneal Dialysis Department
• Hemodialysis Department
• Extracorporeal Shock Wave Lithotripsy (ESWL) Department
• Nephrology Functional Diagnostic Unit and Ward (within the Outpatient Diagnostic Clinic)
The First and the Second Department of the Clinical Nephrology
Those two departments are mainly responsible for diagnosis and the treatment of renal diseases, assessment and preparation of patients for treatment with dialysis, management of complications in dialysis patients and pretransplantation examination and treatment. They operate 46 beds and 2 apartments. The Clinic provides full range of diagnostic procedures from laboratory, functional, immunological and morphological analyses to kidney biopsies and histopathological analyses of biopsy specimens.
It usually takes 5 to 7 days to establish the final diagnosis; the estimated cost of the complete treatment ranges between 60 and 70 000 RSD, and may vary based on the charges for expensive drugs, dialysis if included in the treatment, etc.
Along with the daily routine practice, the Clinic provides continuous medical education and training for physicians undergoing specialization in Internal Medicine and subspecializing in Nephrology. It is also involved in scientific and research activities.
Patients are admitted on the referral or self-pay basis. The referral should be pre-certified by the patient’s respective Social Insurance Agency.
Kidney Transplantation Department
It operates 3 Intensive Care ‘boxes’ well-equipped with video monitoring system, 10 bed Semi-Intensive Care Unit and the Ward for Ultrasound and Color Doppler Ultrasonography for transplanted outpatients.
It conducts pretransplantation evaluation of potential organ donors and receivers, the treatment and additional evaluation of transplanted patients. It applies the state-of-the-art immunosuppressive protocols, and the survival rates of the patients and grafts are comparable with the rates in European and world centers.
Kidney transplantation may be scheduled through the referral procedure or on the self-pay basis. The estimated cost of the kidney transplantation ranges between 750.000-1.500.000 RSD, and may vary based on the kind of transplantation and applied immunosuppressive therapy. Post-transplantation complications may considerably increase the estimated costs. Admission to the Clinic is scheduled upon ambulatory diagnostic evaluation. The pre-transplantation treatment lasts for 5 days on average. The final decision on the acceptance of the money for transplantation is taken by the multidisciplinary team. The kidney donors are discharged on an average of 10 days postoperatively and the receivers 15 to 21 days after the surgery.
Peritoneal Dialysis Department
This Department has the capacity of 12 beds, two of them within the Intensive Care Unit. The most often services it provides include placement of peritoneal dialysis (PD) catheters, laparoscopic repositioning of malfunctioning PD catheters, central auditory processing disorders (CAPD) auditory processing disorders (APD), treatment of peritonitis, problems associated with ultrafiltration, anemia, bones and malnutrition.
It mainly uses two techniques for placement of PD catheters: standard surgical technique under local or intravenous anesthesia of short-duration, and laparoscopic assisted technique. Peritonitis rate: 1 epozodes/25 months (CAPD), i.e. 1/33 (APD).
This Department is fully integrated with Hemodialysis and Kidney Transplantation.
Departments in the treatment process, what ensure that all the three methods of treatment are available to the kidney patients at any point of time. The average cost per day for hospital stay is about 2500 RSD and for the same day treatment of CAPD/APD depending on the type of solution and system used ranges between 4.000-10.000 RSD.
Ambulatory patients undergo follow-up three times a week at the Functional Diagnostic Unit.
Hemodialysis Department
Apparatus, equipment and dialysis sets are provided from renowned manufacturers and dialysis sets are for single use only (there are no reuse dialysis devices in use).
This Department performs bicarbonate hemodialysis, hemofiltrations, hemodiafiltrations, therapeutic exchange of plasma, hemoperfusions, immunoadsorptions and continuous dialysis. It operates 35 dialysis cabinets over two shifts through Monday to Saturday. All emergency hemodialysis and other eventual depuration cases (for instance poisoning and autoimmune) are handled by a duty nurse and a nephrologist.
This Department has about 125 patients receiving regular hemodialysis treatment and around 250 patients undergoing intermittent dialysis. It regularly tests all the patients for hepatitis B, C and HIV viruses. Those who are confirmed to be virus-positive are placed into separate rooms and treated by separate dialysis apparatuses. Dialysis patients staying in our country for tourist or business purposes are offered so called Holiday dialysis services. However, it does not deal with dialysis patients under the age of 14.
ESWL Department
Extracorporeal Shock Wave Lithotripsy is a method employed for disintegration of kidney and ureteral stones by means of electromagnetic generated shock waves. The waves penetrate into the body and disintegrate stones into particles, which are passed in the urine. Coupled with endourologic methods, the ESWL has almost eliminated any need for surgical treatment. The advantages of this method are the following: it is minimum invasive, relatively painless and rarely associated with any serious complications. The procedure itself usually takes about 30 minutes, and it is performed on an ambulatory basis.
So far, this department has performed over 30 000 ESWLs, The youngest patient was 3,5 and the oldest was at the age of 95.
Services
• Specialist exam;
• US/Dopler diagnostics of the abdomen;
• Metabolic investigation of the calculosis etiology;
• ESWL of the kidney and ureteral calculi;
• Medicamentous treatment;
• Prescription of adequate hygienic-dietary regime for various types of calculosis;
• Long-term follow-up of the patient’s condition, kidney function, metabolic disorders, therapeutic effects, and
• Periodic ultrasound evaluation for prevention of residuals.
The cost of the first ESWL is 14.190 RSD, the second costs 11.700 RSD and every next is 10.440 RSD. After pre-procedure physical examination and evaluation of the patient (conducted at the ESWL Department on the 4th floor, room No 101) and nephrologist’s indication for extracorporeal shock wave lithotripsy, the procedure is scheduled and performed within the next 3 to 15 days. In emergency cases (based on the nephrologist’s assessment), the procedure can be performed on the same day.
Medical team:
Head of the Nephrology Clinic
Col. Prof. Dr. Zoran Kovačević, specialist in Internal Medicine-nephrologist
Head of the First Department of the Clinical Nephrology and Deputy Head of the Nephrology Clinic
Col. Prof. Dr. Dragan Jovanović, specialist in Internal Medicine-nephrologist
Head of the Second Department of the Clinical Nephrology
Col. Neven Vavić, MD, MS, specialist in Internal Medicine-clinical pharmacologist
Head of Transplantation Department
Col. Milorad Radojević, MD, specialist in Internal Medicine-nephrologist
Head of the ESWL Department
LtCol. Dragan Savić, MD, specialist in Internal Medicine-nephrologist
Violeta Rabrenović, MD, specialist in Internal Medicine-nephrologist
Assist. Primarius Ljiljana Ignjatović, specialist in Internal Medicine-nephrologist
Mijušković Mirjana, MD, specialist in Internal Medicine-nephrologist
Katarina Obrenčević, MD, specialist in Internal Medicine-nephrologist
Dejan Pilčević, MD, specialist in Internal Medicine
Zoran Čukić, MD, specialist in Internal Medicine
Marijana Petrović, MD, specialist in Internal Medicine
Jelena Tadić, MD, specialist in Internal Medicine
CONTACT:
Nephrology Clinic, MMA, Belgrade, 17 Crnotravska St.
• MMA’s Information Office: 381 11 2661 122, 2662 755
• Head of the Clinic, Col. Prof. Dr. Zoran Kovačević: 381 11 3608 123
• Main Medical Nurse: 381 11 3608 143
• Clinic’s Administration Office: 381 11 3609 189
• Organ Donation Unit: 381 11 3670 784
• Center for Diagnostics and Treatment of Urotract Calculosis: 381 11 3609 049
