We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
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The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
Haemodialysis is an extra-renal filtration procedure that replaces kidney function using an external system. It acts as a filter for the patient's blood by connecting to the patient’s circulatory system via a catheter or by being directly inserted into the vein, usually in the arm. In other cases, an arteriovenous fistula may be created, connecting an artery to a vein beneath the skin on the arm. When an artery is connected to a vein, pressure in the vein increases, strengthening the vein walls. This stronger vein is able to withstand the needles used in haemodialysis and greater blood flow is achieved.
People with kidney failure starting a haemodialysis programme typically have less than 10% of normal kidney function. Above this figure, haemodialysis is usually not necessary.
Haemodialysis must be performed regularly in four-hour sessions, usually three times a week, although the duration and frequency will depend on the patient and their circumstances.
Haemodialysis is based on biophysics in the sense that the blood passes through a filter and exchanges substances with the fluid on the other side of the filter, which is circulated by a machine. The exchange gets rids of the urea, potassium, phosphorus and other waste substances that build up due to lack of kidney function. These substances partly pass through the membrane by themselves, as there are different concentrations of the substances and they tend to equalise, and is also due to the changes in pressure exerted by the haemodialysis machine.
Possible complications of haemodialysis are the infection of the catheter or being unable to find a viable vascular access site in patients who have had dialysis for many years.
Haemodialysis may continue for years, although it is usually an intermediate step between kidney failure and transplant.
A kidney transplant is the best treatment for chronic kidney failure and significantly improves the quality of life for patients with a lack of kidney function and who need haemodialysis or peritoneal dialysis. Nowadays this is a routine procedure, which is not risk-free but which does allow patients subsequently to lead a normal, or close to normal, life. The transplant process consists of surgery to connect the renal artery and vein and also the ureter of the transplanted kidney to the recipient's bladder.Following a few hours in the Intensive Care Department for monitoring, the patient will be transferred to the nephrology ward and will remain there for a few days before progressively resuming their normal life.
It is very important to consider that people who receive a kidney transplant will have to take medication for the rest of their lives to ensure the body does not reject the transplanted organ. Regular appointments to monitor the functioning of the transplanted kidney and the levels in the blood of medication used to control rejection are also necessary. The medication used partly reduces the body’s defences and can allow opportunistic infections and neoplastic diseases to occur. Strict monitoring of immunosuppression levels must therefore be carried out at all times. A kidney biopsy may be necessary at different stages of the kidney transplant’s evolution in order to determine the condition of the organ, as blood tests only give an indirect indication. The life expectancy of patients who have had a kidney transplant may be similar to that of the general population, but other factors mentioned must be taken into account in addition to cardiovascular health such as weight, blood sugar levels and lipids in the blood in addition to arterial pressure.
Performing a kidney transplant requires careful preparation once the patient is experiencing kidney failure. A kidney donor must be found. This may be a living donor or a kidney from a deceased person. Outcomes are very good in both instances, and the choice of which to use depends on the personal situation of each patient. For example, a kidney from a living donor would be chosen if someone volunteers to donate and if compatibility tests carried out before the transplant are positive. If there is no donor, a kidney from a deceased donor will be considered, providing the compatibility tests are positive.
Diagnostic tests related to kidney transplant include the assessment performed before it is carried out. These are general assessments of the recipient's health to ensure they will be able to recovery from the surgery without any issues and also immunology tests to minimise the risk of organ rejection. Tests to prepare for the transplant include imaging tests (ultrasound and CT scan) to determine the implantation area, compatibility tests, and subsequent follow-up tests for monitoring (ultrasounds and blood tests).
To ensure the success of a transplant, in other words, good initial function that lasts over time:
Over 500 transplants are carried out in Catalonia every year, with very good transplanted kidney survival rates. However, this is variable and cannot be predicted in each case. As advances in knowledge and technology are made, we are increasingly able to accurately monitor and control transplanted kidneys to lengthen their lifespan.
Biotechnology and translational research (which creates a network of different biomedical specialisations) will be able to make important advances over the coming years. The success of kidney transplants nowadays is largely down to the precise nature of the medication used to prevent rejection.
Although there is no treatment to cure chronic fatigue syndrome, a multidisciplinary therapeutic approach can help to improve patients’ quality of life. The aim is to reduce the symptoms of the condition and the chronic problems associated with it in order to overcome possible limitation in daily life.
A multidisciplinary therapeutic approach for patients with CFS should be based on four key elements:
There are four basic parts to treating renal insufficiency.
Controlling arterial pressure, if it is high; levels of urea; the balance of mineral salts (sodium, potassium, calcium, phosphorus, magnesium); acidity and anaemia. Analytical testing provides a lot of information which enables the origin and severity of the kidney disease to be established.
A kidney biopsy allows a microscopic study that is often essential. Genetic testing also provides very important information.
There are three different levels of treatment:
a) medical, with the use of medication or hormones to substitute the alterations mentioned. A diet that creates little urea or that contains low levels of potassium, drugs to control excess or lack of sodium, potassium, calcium, phosphorus, magnesium or acidity. And medication to treat anaemia.
b) extrarenal purification methods: haemodialysis (passing the blood through an external circuit to purify it and filter out toxic substances using a suitable filter), and peritoneal dialysis, during which a solution is circulated inside the patient's peritoneal cavity and is then extracted, taking the toxic substances usually expelled through urine with it.
c) kidney transplant from a living or deceased donor. In this instance, the new kidney takes over the functions of the diseased kidney. How long a kidney graft lasts varies and relies on controlling episodes of organ rejection that may occur after transplant. A young patient with kidney insufficiency may require more than one kidney transplant over their lifetime, although the useful life of these grafts is increasing day by day thanks to new immunosuppressant drugs.
Most strokes occur when the clots pass through a blood vessel or block blood flow in this area, which is called an ischemic stroke.
The treatment for strokes takes several forms, mainly surgical and pharmacological.
Drug therapy aims to dissolve clots obstructing circulation as quickly as possible by using drugs called thrombolytics.
If administered within 3 hours of the onset of the first symptoms, thrombolytics allow us to limit the damage and disability caused by a stroke.
Before administering this treatment, we must:
The drug dissolves the clot that prevents blood circulation in the affected brain area.
The most common risk is cerebral haemorrhage.
Although a migraine cannot be cured, proper treatment can alleviate pain and prevent future occurrences.
Migraines can be alleviated with:
In the first group, there are anti-inflammatory drugs and triptans. Preventive treatment is indicated when migraines are very common or do not respond adequately to symptomatic treatment.
The choice between symptomatic and preventative treatment must be taken by a doctor. It is very important to avoid self-medication, to prevent the onset of chronic daily headaches, which is triggered by abuse of analgesic medication. Prescription-free drugs that are used frequently or in large doses can cause other problems.
The basis for recovery is pharmacological treatment, which has improved a lot in recent years, and the adoption of healthy lifestyle habits.
In terms of treatment, there are several options, such as corticosteroids, immunosuppressants and biological agents, which are used based on the activity or location of the illness, and depending on the complications that may arise.
Most importantly, once the treatment with the specialist has been agreed upon, it should not be stopped, as this would entail relapses and less control over the illness.
Currently, there are two medications that are used to treat Chagas disease: benznidazole and nifurtimox.
In the event of a cardiac and/or digestive disease, specific treatment is required.
Hypoglycaemia usually occurs in people with diabetes, when the level of glucose in the blood falls dangerously low. Hypoglycaemia is when the capillary glycaemia (measured in a drop of blood from the finger) falls below 70 mg/dl. It can occur in the case of an excessive dose of antidiabetic treatment (pills or insulin), due to a decrease or delay in intake of food, an increase in normal exercise or alcohol abuse.
The symptoms of hypoglycaemia are sweating, trembling, chills, hungry sensation, headaches, blurred vision, irritability, dizziness and, in very serious cases, loss of consciousness.
For people who may experience hypoglycaemia, we recommend:
Haemophilia is a disease that is characterised by the presence of haemorrhages, and is caused by a deficiency of a coagulation factor. Treatment consists of replacing this deficient factor.
Treatment for haemophilia consists of substituting the deficient factor in cases of acute bleeding via intravenous administration, before any aggressive examination or surgical intervention. Factor VIII or IX concentrates can be made from plasmas or by recombining those obtained using biotechnology. In mild cases, other drugs such as desmopressin, a synthetic derivative of vasopressin, can be used.
In severe haemophilia, preventive treatment must be started before the age of two or after the first haemarthrosis to avoid serious joint complications caused by repeated bleeding, and can be used as a preventive treatment of brain haemorrhages. In haemophilia A, factor VIII should be administered three days a week and two times for haemophilia B. New treatments currently in development will allow future infusions to be spaced further apart.
Plasma and recombinant factors are currently effective and safe for the control and prevention of haemorrhages. The most serious complication in treatment is the onset of an inhibitor, and it appears in 30% of cases with severe haemophilia A and between 2% and 4% of haemophilia B cases.
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