Kidney stone treatment produces a collaboration between nephrology, urology
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Nephrologist Edward R. Gould, MD, and urologist Ryan Hsi, MD, FACS, have a collaborative role at Vanderbilt’s Complex Stone Clinic, where they treat and manage patients with kidney stones.
“This clinic allows patients to see the urologist, the nephrologist and the renal dietitian concurrently,” Gould told Nephrology News & Issues. “Most importantly, it allows us to collaborate on an approach for any individual patient. We present a clear delineation of labor to patients, so they understand who is managing what part of their treatment, and they have a single point of contact if they aren’t sure.
“Further, for those patients who have chronic kidney disease, irrespective of its cause, it gives an opportunity for them to connect with nephrology consideration of their CKD if they haven’t seen us previously,” he said.
Added Hsi: “From the urology standpoint, we discuss the imaging available – where are the stones, their size and whether they have changed over time; symptoms such as pain, [urinary tract infections] UTIs or blood in the urine; and shared decision-making about observation and surveillance versus surgical intervention,” he told Nephrology News & Issues.
Alan C. Pao, MD, co-director of Stanford’s Kidney Stone Center, agrees that the collaboration is important. He works with several urologists to care for patients with urinary stone disease at Stanford. “The management for urinary stone disease is best accomplished with a urologist and nephrologist,” Pao told Nephrology News & Issues. “The urologist typically addresses surgical options for removing stones. The nephrologist addresses secondary prevention.”
The collaborative effort at Vanderbilt’s Stone Center “has been universally well-received both by patients and our colleagues,” Gould said. “The patients like to be able to see the proceduralist who is or has addressed their existing stones and get nutritional advice and medication adjustments that will help prevent stone recurrence in the future. Our colleagues like the support that the clinic offers to help ensure that the nephrolithiasis problem is being fully addressed.”