Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
There are two main types of dialysis: "hemodialysis" and "peritoneal dialysis."
Hemodialysis uses a special type of filter to remove excess waste products and
water from the body. Peritoneal dialysis
uses a fluid that is placed into the patient's stomach cavity through
a special plastic tube to remove excess waste products and fluid from
the body.
During hemodialysis, blood passes from the patient's body through a
filter in the dialysis machine,
called a "dialysis membrane." For this procedure, the patient has a specialized
plastic tube placed between an artery and a vein in the arm or leg (called a
"gortex graft"). Sometimes, a direct connection is made between an artery and a
vein in the arm. This procedure is called a "Cimino fistula."
Needles are then placed in the graft or fistula, and blood passes to
the dialysis machine, through the filter, and back to the patient.
In the dialysis machine, a solution on the other side of the filter
receives the waste products from the patient.
Peritoneal dialysis uses the patients own body tissues
inside of the belly (abdominal cavity) to act as the filter. The intestines lie in
the abdominal cavity, the space between the abdominal wall and the
spine. A plastic tube
called a "dialysis catheter" is placed through
the abdominal wall into the abdominal cavity. A special fluid is
then flushed into the abdominal cavity and washes around the
intestines. The intestinal walls act as a filter between this fluid
and the blood stream. By using different types of solutions, waste
products and excess water can be removed from the body through this
process.
Treatment for hemodialysis takes place in a hemodialysis unit.
This is a special building that is equipped with machines that
perform the dialysis treatment. Special equipment adds the proper
materials to purified water for the dialysis machines. The dialysis
unit is also the place where patients can receive dietary counseling
and help with social needs.
Patients generally go to the dialysis unit three times a week for
treatment. For example, the schedule is either Monday, Wednesday,
and Friday or Tuesday, Thursday, and Saturday. Before treatment,
patients weigh themselves so that excess fluid accumulated since the
last dialysis session can be measured. Patients then go to assigned
chairs that are like lounge chairs. The area of the graft or fistula
(the connection between the artery and vein), is cleaned thoroughly.
Two needles are then inserted into the graft or fistula. One takes
the blood to the machine where it is cleaned. The other needle
allows blood that is returning to the patient to go back into the
patient's body.
Treatments last from 2 ½ to 4 ½ hours. During this time, the
dialysis staff checks the patient's blood pressure
frequently and adjusts the dialysis machine to ensure that the proper amount of
fluid is being removed from the patients body. Patients can read, watch
television, sleep, or do other work during treatment.
Peritoneal Dialysis
Peritoneal dialysis requires the
patient to play a more active role in their dialysis treatment. Of primary
importance is the
patient's responsibility for maintaining a clean surface on the
abdomen, where
treatment is administered, in order to prevent infection.
In this process, the patient weighs herself/himself to
determine the fluid to be used. The patient then puts on a mask and cleans the
peritoneal catheter site. Fluid that has been allowed to stay in the peritoneal
cavity is drained back into the plastic bag that originally contained the fluid.
The patient then disconnects this bag and connects a new bag of solution that is
allowed to drain into
the peritoneal cavity. Once the fluid is in the body, the new bag is
rolled up and placed in the patient's underwear until the next
treatment. This procedure usually takes 30 minutes to accomplish and
must be done four to five times a day.
As an alternative to this treatment, some patients on peritoneal
dialysis use a machine called a "cycler." This cycler is used every
night. Five to six bags of dialysis fluid is used on the cycler and
the machine automatically changes the fluid while the patient
sleeps.
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
There are several types of kidney cancer, including renal cell cancer (renal adenocarcinoma or hypernephroma), transitional cell carcinoma, and Wilms tumor. Symptoms of kidney cancer include blood in the urine, an abdominal lump or mass, chronic pain in the side, and tiredness. Treatment of kidney cancer--which may include surgery, arterial embolization, radiation therapy, biological therapy or chemotherapy--depends upon the stage of the disease and the patient's overall health.
Sepsis (blood poisoning) is a potentially deadly infection with signs and symptoms that include elevated heart rate, low or high temperature, rapid breathing and/or a white blood cell count that is too high or too low and has more than 10% band cells. Most cases of sepsis are caused by bacterial infections, and some cases are caused by fungal infections. Treatment requires hospitalization, IV antibiotics, and therapy to treat any organ dysfunction.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited.
Thrombocytopenia refers to a decreased number of platelets in the blood. There are many causes of thrombocytopenia such as decreased platelet production (viral infections for example rubella, mumps, chickenpox, hepatitis C, and HIV); increased platelet destruction or consumption (for example sulfonamide antibiotics, heparin, blood transfusions, and lupus); or increased splenic sequestration (enlarged spleen due to conditions for example liver disease, blood cancers, and more). Treatment of thrombocytopenia depends on the cause.
Encephalopathy means brain disease, damage, or malfunction. Causes of encephalopathy are varied and numerous. The main symptom of encephalopathy is an altered mental state. Other symptoms include lethargy, dementia, seizures, tremors, and coma. Treatment of encephalopathy depends on the type of encephalopathy (anoxia, diabetic, Hashimoto's, hepatic, hyper - hypotensive, infectious, metabolic, infections, uremic, or Wernicke's) are examples of types of encephalopathy.
Polycystic kidney disease (PKD) is characterized by numerous cysts in the kidneys. Polycystic kidney disease is a genetic disorder. There are two major inherited forms of PKD, autosomal dominant PKD, and autosomal recessive PKD. Symptoms include headaches, urinary tract infections, blood in the urine, liver and pancreatic cysts, abnormal heart valves, high blood pressure, kidney stones, aneurysms, and diverticulosis. Diagnosis of PKD is generally with ultrasound, CT or MRI scan. There is no cure for PKD, so treatment of symptoms is usually the general protocol.
Hypercalcemia is a condition in which calcium levels in the blood are elevated. Hypercalcemia is associated with other conditions such as hyperparathyroidism, lung cancer, breast cancer, kidney failure, and elevated levels of vitamin D. Symptoms of hypercalcemia include constipation, nausea, abdominal pain, kidney stones, to name a few. Treatment depends on the cause of hypercalcemia.
Arsenic comes in two forms, inorganic and organic. Organic arsenic poisoning is usually not poisonous to humans; however, inorganic arsenic in large enough amounts can lead to shock and death. Symptoms of arsenic poisoning include nausea, abdominal pain, diarrhea, dehydration, dark urine, vertigo, delirium, shock, and death. Treatment for arsenic poisoning includes Hemodialysis and a variety of drugs.
Fabry disease (Fabry's disease, alpha-galactosidase-A) is a genetic disorder with symptoms such as burning sensations in the hands, small-raised reddish-purplish blemishes on the skin, fever, decreases sweating, and GI difficulties. Fabry disease patients are at increased risk of heart attack, heart disease, kidney failure, and stroke. Symptoms of Fabry disease can be treated with medication.
In the United States diabetes is the most common cause of kidney failure. High blood pressure and high levels of blood glucose increase the risk that a person with diabetes will eventually progress to kidney failure. Kidney disease in people with diabetes develops over the course of many years. albumin and eGFR are two key markers for kidney disease in people with diabetes. Controlling high blood pressure, blood pressure medications, a moderate protein diet, and compliant management of blood glucose can slow the progression of kidney disease. For those patients who's kidneys eventually fail, dialysis or kidney transplantation is the only option.
Hemolytic uremic syndrome (HUS) is a diseases in which blood clots within the capillaries. Causes associated with HUS include E. Coli, birth control pills, pneumonia, medications such as chemotherapy, Ticlid, and quinine. Symptoms of HUS include gastroenteritis, abdominal cramping, vomiting, and bloody diarrhea. Diagnosis of HUS includes medical history, physical examination, and medical tests. Treatment includes rest, fluids, possible hospitalization for blood transfusion or complications due to kidney failure.
Renal osteodystrophy is a bone disease. The kidneys fail to maintain required levels of phosphorous and calcium in the blood. Renal osteodystrophy is common in patients with kidney disease and affects dialysis patients. Diagnosis is performed with a blood sample, and in some cases a bone biopsy. Medication is the general treatment for renal osteodystrophy.
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