Renal Services - Salford Royal

Nephrology Outpatients 

• General Nephrology

• Specialist Nephrology Clinics

• Vasculitis and SLE  

• Complex Glomerulonephritis 

• Multiple Myeloma  

• Metabolic Renal Cardiac (including Renal Diabetes)  

• Renovascular  

• Fibromuscular dysplasia  

• Polycystic Kidney Disease  

• Tuberous Sclerosis  

• Hypertension 

• Young Adult

• Obstetric Renal 

• Renal Tubulopathy

• Metabolic Stone Urology MDT

• Advanced Kidney Care Service 

• Vascular Access (including on site vascular access creation and interventional radiology service) 

• Renal Assessment Service 

• Transplant

• Live Donor

• Transplant Work-up/Assessment  

Service Details  

Transplant Work-up 

The Chronic Kidney Disease (CKD) team do the transplant work up for patients with CKD optimise the chance for a pre-emptive renal transplant. Patients with CKD can be activated on to the cadaveric transplant list when the kidney function is 15% or less.  

Patients who need complex transplant work up – which would involve a dobutamine stress echocardiogram - would attend our Transplant work up clinic and have all the investigations done on one day and also have a discussion with the specialist nurse about transplantation.  

Patients who require simple work up would have the basic cardiology investigations done in cardiology, then attend x-ray for a chest x-ray and then attend renal outpatients for bloods, then would have a virtual telephone appointment to discuss transplantation with the specialist nurse. 

Following completion of all the investigations, the patient would have an appointment with a nephrologist to re-cap the pros and cons of transplantation. The patient would then be referred to Manchester Royal Infirmary to get an appointment with the transplant surgeon to be assessed for transplant listing. 

Post-Transplant  

The Post-Transplant nursing team are based in the Hope Building within the Renal Outpatients, department and consist of one Senior Specialist Nurse, Two Specialist Nurses and a transplant Liaison Nurse. There are two transplant clinics per week at Salford, these are held I the mornings. We also provide transplant clinics at Bolton and Wigan and Oldham in the future, however your care will remain under NCA and you will see the same staff.   When attending clinic you will see the Consultant/registrar. 

The Specialist Nurse team also provide Nurse Led Clinics and annual review clinics alongside the medical team. The Nurse led clinic offer extra support to patients that perhaps changing their medication or require additional review.  You will also see the specialist nurse on return after transplant.  We encourage patient to attend their clinic appointments on time to avoid delays.  Each time you attend clinic, blood samples and a urine test will be required.  Post-transplant patients are at risk of developing some skin conditions, including cancer.  You will be  sent an appointment to see one of our Dermatology consultants every year, it is important that you follow skin care advice and that you attend your review, so that early detection of problems and treatment can occur .  

Live Donor Team 

The Live Donor team is a Consultant and Nurse Led Service that supports partners and family members through the live donor process.  

The most donated organ by a living person is a kidney. A healthy person can lead a normal life with only one functioning kidney and therefore they are able to donate the other to help someone in need of a kidney transplant. 

As a live donor you can donate a kidney to someone you know or to someone you don’t know which is called a non-directed altruistic kidney donor.  You can do this by registering your interest in donating a kidney by contacting your nearest or preferred transplant centres.  Once you have registered an interest to donate your kidney to a family member, or friend or to someone you don’t know. The Live donor team will contact you to make arrangements to commence the work up process which will involve multiple attendances at the Hospital; When you attend your appointments, re-imbursement can be discussed with your Live Donor Special nurse  

Once you have been passed as suitable for donation you will attend The Manchester Royal Infirmary for donation surgery.      

Peritoneal Dialysis 

The Peritoneal Dialysis nursing team are based in the Hope Building within the Renal Outpatients, department and consists of one Clinical Nurse Specialist, six specialist nurses and five health care assistants. The team provide training, support and monitoring to over 100 patients and their families and carers who are at home on peritoneal dialysis. 

The team cover a wide geographical area over the West sector of Manchester including Oldham, Rochdale, Bury, Bolton, Wigan, and Salford. 

Alongside the home visits from the nursing team, there are also 3 clinics per week at Salford, with a nurse-led clinic running alongside. At these clinics’ patients will be reviewed by a specialist consultant or registrar.  

The Specialist Nurse team provide support and education to patients before their journey onto home dialysis starts to ensure shared decision making for patients and their families and carers.  

Once established on dialysis the nursing team provide regular review and follow up to ensure optimum therapy for the patients, also offering support with any problems or queries having a dedicated ’in-house’ service available to triage problems over the telephone  and arrange review if necessary. 

The in-house team also support any peritoneal dialysis patients that have been admitted to hospital, ensuring that safe, adequate dialysis is prescribed and maintained during their admission. 

The team also provide an ‘Assisted dialysis’ program with support from an external provider. This service enables patients who may need some support to have a home therapy. The team can assist in the daily setting up of dialysis machines and monitoring the therapy being provided. 

Vascular Access 

Vascular access is the term used to describe access to someone’s bloodstream for the provision of haemodialysis treatment. Types of vascular access are arterio venous (AV) fistula, arterio venous (AV) graft and central venous catheter. The Renal Association guidelines (2015) recommends the AV fistula as the first choice of access. An AV fistula provides better quality of haemodialysis, has less risk of infection, and carries less risk of complications in comparison to the other types of vascular access.  

An AV fistula is formed when an artery and a vein are joined during an operation. This allows more blood into the vein making it larger than normal. It is usually created in the forearm or the upper arm. When haemodialysis is required, two needles are inserted into the fistula and then removed at the end of each haemodialysis session.  It takes approximately 6-12 weeks for the vein to develop enough to accommodate the needles required. It is therefore important that your fistula is ready before you need to start haemodialysis.  Some patients will have their fistula created several months ahead of requiring haemodialysis. 

Your doctor or nurse will discuss the need for vascular access with you when it’s required and if agreed, you will be referred to the vascular access team. The vascular access team consists of 2 specialist nurses, consultant transplant surgeons, consultant nephrologists, a vascular access co-ordinator and a consultant anaesthetist. 

The vascular access team will aim to see you in either the surgeon’s clinic (option A) or nurse led surgical assessment clinic (option B) at Salford Royal within 4 weeks. The decision for either option A or B is dependent on clinical criteria (see below).  You will be sent an appointment letter for the vascular access clinic date with at least 2 weeks’ notice or will receive a phone call if the appointment is less than 2 weeks away. 

It’s always helpful for patients to bring up to date list of medications with them.

Organ Donation: https://www.organdonation.nhs.uk/become-a-living-donor/donating-your-kidney/ 

The British Kidney Patient Association (BKPA): www.britishkidney-pa.co.uk  

Telephone: 01420 541424, email: info@britishkidney-pa.co.uk 

The British Transplantation Society: www.bts.org.uk 

Telephone 01625664547