Nephrology

The Nephrology Department is structured into three highly specialized care units: Clinical Nephrology, Dialysis, and Renal Transplantation. These units are composed of multidisciplinary teams and are integrated within two of the hospital’s Areas of Knowledge: the Renal System and Solid Organ Transplantation.

Despite the high level of subspecialization, all units operate within a highly collaborative and interconnected organizational framework, with strong interaction among all professionals. The department includes a Head of Department, two Section Heads, two Nurse Supervisors, attending nephrologists, nephrology residents, an Advanced Practice Nurse (APN), administrative staff assigned to each care area, as well as a highly specialized nursing team within the dialysis units.

Assistance

1. Clinical Nephrology

This unit is responsible for the diagnosis, management, and treatment of patients with both acute and chronic kidney failure who require a tertiary-level therapeutic approach. It encompasses all primary and secondary glomerular diseases, as well as hereditary and drug- or toxin-related conditions, which may present as acute kidney injury with a gradual, slow, or rapidly progressive course toward advanced renal failure that may require renal replacement therapy.

The unit manages patients who may be candidates for a range of diagnostic approaches, including non-invasive techniques (ultrasound, computed tomography, renal scintigraphy) and invasive procedures such as interventional radiology, including kidney biopsy and angioradiology.

Special Programs:

• Advanced Chronic Kidney Disease Unit (ACKD/ERCA): A cross-sectional unit that evaluates patients with advanced stages of chronic kidney disease (stages IV–V), providing preparation and guidance for the initiation of different renal replacement therapies in a preventive manner.
• Onconephrology Unit: A highly specialized unit focused on the prevention, diagnosis, and therapeutic support of patients who develop kidney impairment either due to the malignancy itself or as a result of novel anti-cancer therapies. 
• Cardiorenal Unit: A multidisciplinary unit involving both nephrology and cardiology, aimed at supporting and treating patients with varying degrees of advanced heart and kidney failure who require advanced supportive therapies.
• Adult Hereditary Kidney Diseases Unit (UREMHA): A highly specialized multidisciplinary unit working closely with the hospital’s genetics department to provide molecular diagnoses, and with the gynecology team to offer reproductive genetic counseling. It is a reference center in Catalonia for adult polycystic kidney disease. The unit also collaborates with the Pediatric Nephrology Department to ensure a smooth transition of patients with genetic diseases from pediatric to adult care.

2. Dialysis

This unit provides all types of extracorporeal renal replacement therapies through various dialysis techniques, including intermittent hemodialysis, continuous renal replacement therapies, and peritoneal dialysis. It also performs and manages specific apheresis techniques such as plasmapheresis, immunoadsorption, and lipoprotein apheresis.

• Hemodialysis unit for patients requiring both acute and chronic hemodialysis: delivery and monitoring of continuous renal replacement therapies across critical care units, including Intensive Care, recovery units, and the coronary care unit.
• Home dialysis unit:
• Peritoneal Dialysis Unit (PD): A high-volume unit (40–50 patients annually) offering different modalities, including automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD).
• Home hemodialysis program, enabling patients to receive renal replacement therapy at home.

3. Renal Transplantation

The Renal Transplant Unit (RTU) launched its kidney transplant program in 1975, and to date, more than 1,800 kidney transplants have been performed. In recent years, the program has significantly expanded, increasing from 60–80 transplants annually in the late 1990s to over 180 transplants per year.

The RTU is integrated within the hospital’s Solid Organ Transplantation Area of Knowledge, a unique inpatient model at the national level that brings together all solid organ transplant recipients treated at our center (kidney, liver, and lung). This structure is supported by a highly specialized nursing team, enabling strong collaboration and interaction among the various professionals involved in patient care.

Importantly, the unit works in close coordination with the Urology Department, which is responsible for carrying out all surgical procedures related to kidney transplantation.

The Renal Transplant Program of the RTU offers all available modalities with the aim of providing access to transplantation for all patients requiring chronic renal replacement therapy who are on the waiting list, preferably before the initiation of dialysis.

Deceased Donor Kidney Transplantation:

• Donors after brain death.
• Donors after controlled (Maastricht III) and uncontrolled (Maastricht II) circulatory death.
• En bloc kidney transplantation.
• Multiorgan transplants, such as combined liver–kidney and kidney–lung transplants.
• High immunological risk transplants within prioritization programs, requiring specific desensitization therapies.

Living Donor Kidney Transplantation:

• Direct living donor transplantation.
• Paired (cross-over) living donor transplantation.
• ABO-incompatible and high immunological risk transplants requiring specific desensitization therapies.

The transplant surgery program is supported by extensive experience and a strong professional track record, with expert transplant surgeons who incorporate the most advanced surgical techniques in kidney transplantation, including laparoscopic and robotic surgery.

Alongside its clinical activity, and as part of a university hospital, teaching and research are fundamental pillars of the department.

Teaching

Undergraduate Students:

The department hosts undergraduate students from the hospital’s Teaching Unit, affiliated with the Faculty of Medicine at the Universitat Autònoma de Barcelona (UAB), for clinical nephrology rotations. Practical teaching for medical students is shared across the three sections—Clinical Nephrology, Dialysis, and Transplantation—reflecting the rotation structure. This practical experience is essential to enrich and complement the theoretical knowledge of nephrology during their training in Medicine and Surgery at the university level.

Postgraduate Specialized Training:

The department places strong emphasis on postgraduate specialized training in Nephrology. Each year, the service welcomes two nephrology residents who undertake a four-year specialty program. The entire department is committed to providing comprehensive training across the different areas and sections.

In addition to nephrology residents, the department also hosts residents from other specialties who rotate through the service. Learning is fostered not only through self-directed study but primarily through supervised participation in daily clinical activities.

The department has two dedicated tutors—attending physicians—who play a crucial role in guiding and supporting residents throughout their specialized training. Theoretical teaching is complemented by seminars and departmental sessions, and residents are encouraged to attend external courses and conferences. Departmental seminars are prepared and delivered by the residents themselves, who present clinical cases and review topics to the team, providing an opportunity to progressively develop their communication skills.

Continuing Education:

The department organizes regular scientific sessions aimed at discussing complex cases, reaching consensus on diagnostic and therapeutic approaches, reviewing the latest research related to the various pathologies managed by the service, and facilitating the exchange of expertise among professionals from different fields who share common clinical interests. These include systematic bibliographic, anatomo-pathological, medical-surgical, and section-specific monographic sessions, as well as multidisciplinary sessions related to XUECs/CSUR programs, solid organ transplantation, pediatric care, and collaborative sessions with research groups at the Vall d’Hebron Institute of Research (VHIR).

Advanced Specialized Training:

The Renal Transplant Unit offers an advanced training course in kidney transplantation, hosting international nephrologists for one-year fellowships to refine their knowledge and skills in the field of renal transplantation. The department also participates in the Master’s Program in Translational Biomedical Research at the VHIR, further integrating clinical practice with research and advanced education.

Research

Alongside clinical excellence and teaching, a fundamental pillar of the Nephrology Department is the promotion and development of high-level academic research, with a particular emphasis on supporting doctoral theses.

The department has a dedicated Nephrology and Transplantation Research Laboratory at the Vall d’Hebron Institute of Research (VHIR), where projects are conducted across multiple areas of nephrology and transplantation, encompassing both translational and basic-experimental approaches. Our research group is accredited as a consolidated research group by the Agency for Management of University and Research Grants (AGAUR).

All units of the department actively participate in clinical trials across different phases, often in early stages, promoted both by the pharmaceutical industry and by the department’s own investigators through nationally and internationally competitive research projects.

Main Research Areas:

• Development and evaluation of new immunomodulatory molecules to prevent organ transplant rejection.
• Study of immunological factors that influence the risk of opportunistic infections and malignancies post-transplant, and development of new vaccines against opportunistic viruses.
• Investigation of the immunological mechanisms driving transplant rejection or tolerance.
• Study of pathological mechanisms in glomerular and systemic diseases directly affecting the kidney, such as diabetic nephropathy, vasculitis, and certain primary glomerulopathies.