Departments

Our nephrologists offer comprehensive, compassionate care to children with acute and chronic kidney diseases and hypertension. We provide the complete spectrum of nephrology care from infancy to adolescence for patients from our local community and across the Northeast. Common conditions we treat include: Congenital kidney abnormalities Glomerular and vascular diseases Tubular diseases Polycystic kidney diseases Urinary tract abnormalities Hypertension Acid base disorders Fluid and electrolyte abnormalities Acute chronic renal disease End-stage renal disease Kidney transplants Nephrolithiasis Diabetic nephropathy

At Yale Medicine, our team of renowned physicians are leaders in the field of endocrinology. We specialize in understanding and treating the delicate balance of the endocrine system and the hormones that regulate essential body functions. Our physicians are also experts in the management of metabolic disease, which affects how your body processes food to create energy. We're here to provide you with advanced diagnostic and comprehensive treatment options that address these crucial hormonal and metabolic functions. Specialized care is offered in the following areas: Adrenal diseases, including adrenal masses, Cushing syndrome, hyperaldosteronism, and pheochromocytoma. Bone Center consists of a team of specialists with expertise in bone health who treat patients with bone diseases and disturbances in the metabolism of calcium and phosphorus, a mineral that helps build bones. Center for Weight Management, which offers assistance with weight and weight-related health conditions. Diabetes Center is comprised of diabetes specialists who help patients manage their diabetes and prevent long-term complications. Endocrine cancers of the thyroid and adrenal glands. Pituitary conditions and complex disorders. Thyroid diseases, including hyperthyroidism, thyroiditis, thyroid nodules, and thyroid cancer.

Our expert pathologists are key players in all health care provided by Yale Medicine. By studying bodily fluids and tissues, we help other physicians make diagnoses. We offer highly specialized diagnostic and consultation services in all major specialty and subspecialty areas of pathology. Our subspecialists attend all regular meetings in which a number of doctors from various specialties review and discuss a patient's medical condition and treatment options.They are on call around the clock, ensuring that doctors working in oncology, surgery, transplantation, and other service areas always have access to our expert knowledge. Our internationally recognized physicians offer specialized expertise in breast, cytopathology (cell), dermatologic, endocrine, gastrointestinal and liver, gynecological, head and neck, hematologic (blood), neurologic, ophthalmologic, pediatric, kidney, soft-tissue and bone, transplant, thoracic and urologic pathology, molecular and genomic pathology, and autopsy pathology. Specialized care is offered in the following areas: Accredited PD-LI testing Autopsy Cytopathology Intraoperative frozen section and tumor triaging service Molecular diagnostics and tumor genomics profiling Pediatric pathology Support laboratories: histology, immunohistochemistry, translational pathology, and electron microscopy and quantitative immunofluorescence analysis of multiplexed tumor markers Surgical pathology with subspecialty expertise in gastrointestinal tract and liver; prostate; bladder; kidney; gynecological tract; endocrine system; head, neck, and oropharynx; bone and soft tissue; hematologic and lymphoid system; brain, muscle and eye; pulmonary system; and transplantation

Treating complicated pregnancies is our priority. We provide care for the entire spectrum of conditions related to high-risk pregnancy, and for women whose pregnancies require special testing, monitoring, treatment, and care . We offer state-of-the-art approaches to caring for women with high-risk pregnancies related to diabetes, hypertension, heart disease, and genetic disorders, among other medical conditions that can complicate a pregnancy. Maternal-Fetal Medicine (MFM) at Yale pioneered the development of chorionic villus sampling (CVS) and fetal blood sampling (FBS), and has the most experienced team for these procedures in New England. In addition, our skilled specialists, who are internally recognized for their expertise, conduct fetal echocardiography to diagnose congenital heart disorders of the fetus. We offer a variety of services for our patients across the following specialty programs: High-Risk Pregnancy Program, which supports ongoing care and management for women with a history of pregnancy risks or current medical complications. Prenatal Genetic Diagnostic Program, which provides expert genetic screening and testing for MFM patients. Available tests include first-trimester screening, CVS, amniocentesis, and FBS. After diagnosis, we provide counseling and connect patients when necessary to appropriate support networks to help parents adjust to and prepare for their child's special needs. Recurrent Pregnancy Loss Program, offered in conjunction with Yale’s Reproductive Endocrinology and Infertility Section. Our multidisciplinary team of pathologists, geneticists, and perinatologists uses a whole-patient approach to help couples with recurrent miscarriages and/or pregnancy losses. Other services offered in our MFM section include: First-trimester risk assessment for Down Syndrome Targeted ultrasound Fetal therapy, including percutaneous umbilical blood sampling (PUBS) and intrauterine transfusion Antenatal testing Diabetes management MFM physicians can also co-manage patients with high-risk pregnancies with referring practitioners. We can develop care plans with community obstetricians for cases that require intensive oversight by the team, or consultative guidance alone.

A variety of diseases can affect the health of the kidneys. We care for patients at every stage of kidney disease, offering scientifically proven treatments and a personalized care plan. The Department of Urology is part of the Living Donor Transplant Program at the Yale New Haven Transplantation Center where we care for patients with renal disease who are candidates for kidney transplantation. We have expertise in performing laparoscopic, living-donor nephrectomies, delivering the highest quality care to the kidney donor-patient team at Yale. At Yale Medicine, our patients have full access to leading physicians who can help with all aspects of renal disease. Patients also have access to world-class resources at Smilow Cancer Hospital at Yale New Haven. Our doctors are at the forefront of kidney disease and kidney cancer treatment and research, including novel immunotherapy approaches and the genetic characterization of kidney cancers. In addition, the Yale School of Medicine's Hereditary Kidney Cancer and Genetic Assessment Program investigates potential genetic causes of kidney cancer in young patients, including those with a family history and individuals with multiple tumors, to help family members determine if they carry a risk for kidney cancer.

At Laboratory Medicine, we study the molecular and cellular components of blood and other body fluids. This work is crucial to diagnosing and managing illness and understanding the mechanisms and origins of disease.Our physicians, known as clinical pathologists, provide consultations to other doctors regarding optimal laboratory diagnostic approaches and the interpretation of complex laboratory tests. Our team includes pathologists, scientists, phlebotomists, medical technicians, technologists, and others who perform important support functions for our state-of-the-art laboratory. We are available every day, 24 hours a day, for physicians. We perform approximately 10 million tests each year, and also provide specialized high-tech testing to other hospitals in the Yale New Haven Health System and institutions throughout New England, and as far away as Puerto Rico. We also operate multiple satellite facilities and patient service centers located throughout the state. We ensure that every test we offer—at every location—is accurate and reliable. When physicians request to have patients’ blood drawn, here is what happens: Collection: A doctor, nurse, technician, or phlebotomist will draw the patient’s blood. Several tubes may be needed for different types of tests. Depending on what illness the patient might have, his or her doctor may want to obtain a urine sample, throat swab, or other sample. After the sample is collected, the container is labeled with the patient’s name and other information. The sample is received and processed by the Laboratory, and testing begins: Chemistry Testing Blood and other bodily fluids are tested for chemicals, drugs, and substances that indicate disease. We check cholesterol and other tests for risk of heart disease, glucose to monitor diabetes, or thyroxin to monitor the thyroid gland. Hematology Testing We analyze the amount and function of blood cells and plasma. Examples include the Complete Blood Count (CBC) that tells the doctor how many cells of each type are in the patient’s blood, and the prothrombin time (PT) to measure the time it takes for the blood to clot. Microbiology Testing We test a variety of specimen samples for infections caused by bacteria, fungi, or parasites. We often do urine cultures for urinary tract infections. Virology Testing We test for viral infections. This includes rapid tests for respiratory viruses such as influenza, molecular tests for noroviruses, and antibody tests for HIV. Immunology/Molecular Diagnostics Some tests are used to determine whether the immune system is functioning properly. State-of-the-art analysis of DNA and RNA is used to test for a variety of diseases and for the risk of developing certain diseases. Other specialized tests include the ANA, used to screen for autoimmune disease, and Factor V Leiden genotyping for patients with blood clots. Tumor Profiling Laboratory This lab analyzes tumor DNA to predict the sensitivity or resistance of tumors to a

Polycystic kidney disease (PKD) causes fluid-filled sacs called cysts to grow in the kidneys. The cysts can become large and cause scarring, eventually harming the organs’ function. This disease is caused by a gene mutation, usually passed down by a parent. Polycystic kidney disease is typically diagnosed using imaging studies, such as ultrasound, which will show the cysts in the kidneys. A genetic test performed on a blood or saliva sample can detect the gene mutations that cause the disease. The Yale Medicine Polycystic Kidney Disease Program, recognized as a Center of Excellence by the PKD Foundation, offers patients the opportunity to receive care from experts who can explain the nuances of inherited disorders to patients and skillfully manage the illness. Yale Medicine offers opportunities for patients with polycystic kidney disease to take part in clinical trials, which aim to help doctors better understand the disease and evaluate new treatment approaches. The experts at Yale Medicine are also at the forefront of basic research into the mechanisms underlying cyst formation. By seamlessly combining clinical expertise with research engagement, we provide patients with the best care and knowledge the PKD field has to offer.

Our program strives to provide optimal access to kidney transplants to individuals for whom this is the best option. We work in coordination with the Yale New Haven Hospital Transplantation Program, which has clinical facilities in New Haven and at Saint Francis Hospital in Hartford, providing easy access to care for patients in Connecticut and western Massachusetts. Our dedicated providers offer direct care and support to patients and donors throughout the pre- and post-transplant periods. We also provide a full range of nephrology consultation services for patients with other organ transplants including heart, liver, and bone marrow. For our patients, we are able to: Expedite donor and recipient evaluation for patients not yet on dialysis. Perform internal exchanges and participate in two national exchange programs for recipients with medically suitable donors willing to consider this option. Schedule a first visit within four weeks of initial referral. Advocate for patients who have exhausted dialysis access to receive emergency transplant listing status. Provide a medical home for our patients with open access to our clinic on an urgent basis.

Our nationally ranked team of caregivers are experts in diagnosing and managing a broad range of acute and chronic kidney diseases, both in the inpatient and outpatient settings. We offer around-the-clock primary care to patients with established renal disease or hypertension, and our physicians are readily available for consultation on newly referred patients. Our services are comprehensive. In some cases, we consult and collaborate with other doctors and work hand-in-hand with referring providers. In other circumstances, we are principal caregivers for our patients. In nearly all instances, our care is multidisciplinary, involving other physicians and specialists, nurse practitioners, physician associates, and skilled nurses. We are committed to: Being available 24/7 to our patients and referring physicians Open communication with patients, families and referring physicians Applying new approaches to treating and diagnosing renal diseases and their complications Advocating for our patients We offer: A dedicated nephrology floor at Yale New Haven Hospital A large outpatient peritoneal dialysis practice and home hemodialysis practice Clinical trials on the cutting edge of polycystic kidney disease (PKD) that attract patients from surrounding areas and states. Weekend seminars for patients with PKD and inherited kidney disease Dedicated subspecialty services for inherited kidney diseases, hypertension, cardio-renal syndrome, onco-nephrology, and kidney disease in pregnancy Our special services include evaluating and caring for patients with: Acute kidney injury Cardiovascular dysautonomia (e.g., orthostatic hypotension) Chronic kidney disease Diabetic kidney disease Dialysis therapies Electrolyte and/or acid-base disorders Glomerular diseases/Glomerulonephritis Hypertension Inherited kidney diseases Kidney disease and hypertension in pregnancy Kidney disease in cancer Kidney disease in heart failure Kidney transplantation Nephrolithiasis Polycystic kidney disease Largest—and rapidly expanding—kidney transplant program in New England with multidisciplinary care clinics Inherited kidney disease program, with coordinated access to multidisciplinary care for extra-renal disease, advanced genetic testing, and counseling Joint nephrology/urology kidney stone program for management of complex nephrolithiasis Multidisciplinary hypertension program for advanced diagnostic evaluation and management of complex hypertension and cardiovascular dysautonomia Advanced chronic kidney disease and end-stage renal disease program Dedicated nephrology floor at Yale New Haven Hospital Clinical trials and innovative research protocols in polycystic kidney disease, acute kidney injury, diabetic kidney disease, anemia in kidney disease, and peritoneal dialysis

Our goal at the Diabetes Center is to give patients the tools necessary to successfully manage the day-to-day challenges of living with diabetes and prevent long-term diabetes complications. We provide comprehensive management and education for adults with type 1 and type 2 diabetes. We focus on lifestyle interventions and use the latest medications and technologies to improve our patients’ health. We also treat patients with: Pre-diabetes and metabolic syndrome Obesity Polycystic ovarian syndrome Lipid or cholesterol abnormalities Our nationally recognized doctors and nurse practitioners work as a team to address our patients’ needs in managing diabetes and other conditions. We understand that living with diabetes presents challenges. We focus on education and making patients their own advocates. Through the most current and state-of-the-art treatments, we will help them better manage their care. Oral Medications There are several classes of oral diabetes medications that we may prescribe if patients have type 2 diabetes. These medications differ in the way they work to reduce blood glucose levels. Frequently, oral medications from different classes are used in combination. Sulfonylureas: These drugs increase the amount of insulin produced by the pancreas. Meglitinides: These drugs rapidly increase the amount of insulin produced by the pancreas. Biguanides: Metformin is the only biguanide on the market. It is thought to work by reducing the production of glucose in the liver. Alpha-Glucosidase Inhibitors: These medications reduce the amount of glucose absorbed in the intestines. Thiazolidinediones: This agent makes the body more sensitive to insulin. Dipeptidyl Peptidase 4 inhibitors (DPP-4 inhibitors): These drugs increase the amount of insulin produced by the pancreas after a meal and reduce the amount of glucose produced by the liver. Injection Therapies There are several classes of injection therapies for diabetes. These treatments are given by an injection under the skin. The most common injection therapy is insulin, which comes in many different formulations that differ in how fast they work and how long they last. Below is a list of the different types of insulins. Technologies and Experimental Treatments Insulin Pumps: Insulin pumps were first pioneered at Yale in the 1970s. An insulin pump is an electronic, pager-sized, battery-powered device that delivers insulin continuously through a small plastic catheter under the skin. Insulin is delivered in different amounts (“basal” or “bolus” levels) during the day and controlled by the patient. While fasting, patients will administer a low level of continuous “basal” insulin to keep their blood glucose in the normal range. Prior to meals, they will determine a “bolus” of insulin based on the amount of carbohydrates in the meal. Continuous Glucose Monitoring systems (CGM): A CGM is a device that measures glucose under the skin (also known as “interstitial” glucose) every five minutes thr

Pulmonary hypertension is high blood pressure in the arteries of the lungs, which makes the heart work harder and can lead to heart failure. If it is diagnosed properly and quickly, we have effective therapies that can slow the progression of the disease and possibly reverse some of the damage to the lungs and heart. Our doctors have extensive experience dealing with pulmonary hypertension, and we treat adults and children over the age of 12. We are fully committed to defeating pulmonary hypertension and caring for the disease regardless of its cause, which may include pulmonary arterial hypertension (PAH), pulmonary venous hypertension, or chronic thromboembolic pulmonary hypertension, among other causes. We are a national Pulmonary Hypertension Association-accredited Center of Comprehensive Care and Center of Excellence. As the only accredited pulmonary hypertension program in the state, we offer patient- and family-centered care to patients from throughout the Northeast. Our doctors, nurses, coordinators, and researchers are specifically trained and experienced at managing and treating patients with pulmonary hypertension. Patients will have access to other highly skilled specialists, including pulmonologists, cardiologists, rheumatologists, and gastroenterologists. We work closely with members of the Adult Congenital Heart Disease Program, General and Advanced Heart Failure Program, Hereditary Hemorrhagic Telangiectasia Program, and the Liver Transplant Program. We also work in concert with specialists in connective tissue disease such as scleroderma (we are a Scleroderma Center as designated by the Scleroderma Foundation), lupus, Sjogren’s disease, myositis, and dermatomyositis—pulmonary hypertension can be a serious complication of these conditions. Outpatient specialized clinic Designated floors in the hospital for pulmonary hypertension patients State-of-the-art heart catheterization laboratory Highly trained and qualified cardiologists who read echocardiograms focusing on the right side of the heart, which is a key clinical factor in patients with pulmonary hypertension Physicians, nurses, pharmacists, and quality-tested systems in place that provide effective complex therapies to patients in a safe environment.

The Cardiovascular Disease and Pregnancy Program at Yale offers comprehensive and individualized support before, during, and after pregnancy for people with heart conditions. Our mission is to improve outcomes in pregnancy for patients with either pre-existing or newly diagnosed heart disease and ensure that pregnant patients receive appropriate and specialized risk assessment, treatment, and support. Cardiovascular disease is the number one cause of maternal mortality in the United States. While most people with pre-existing cardiovascular conditions can safely and successfully become pregnant, carry a baby to term, and breastfeed, patients with cardiovascular conditions are at higher risk of complications during pregnancy and after delivery. Pregnancy can also reveal or cause previously undiagnosed heart problems, and certain pregnancy complications can put patients at a higher risk for future cardiovascular disease. Yale’s Cardiovascular Disease and Pregnancy Program brings together cardiologists, maternal-fetal medicine specialists , nutritionists, pharmacists, lactation consultants , social workers, and family planning specialists who utilize their unique expertise to provide comprehensive patient care. Our multidisciplinary team meets regularly to create individualized care plans for each pregnant patient with heart disease. We provide care to: People with known heart disease, including congenital heart disease and acquired heart diseases, such as abnormal heart rhythms (arrhythmias), heart failure, and ischemic heart disease (coronary artery disease) People who develop cardiovascular disease or are newly diagnosed with heart disease during pregnancy (for example, peripartum cardiomyopathy) People who develop pregnancy-specific complications (including preeclampsia and related hypertensive disorders or gestational diabetes) that put them at higher risk for future cardiovascular disease Before pregnancy Contraception counseling: We provide individualized contraception counseling to patients with cardiovascular conditions to help determine the best and most reliable form of contraception for them based on a variety of factors, including specific heart conditions, interaction with other medications, and personal preferences. Comprehensive risk assessment: We provide a comprehensive risk assessment for patients with heart conditions who wish to become pregnant. We coordinate care to ensure they receive updated imaging and diagnostic studies and are on pregnancy-safe medications before they conceive. We also work closely with patients to provide nutrition and exercise guidance. Preconception counseling: We provide consultations to explore and discuss a potential pregnancy and family building. During this visit, we will answer all patient questions and develop care recommendations to support patients prior to, during, and after pregnancy. We also introduce members of the care team. During pregnancy Prenatal care management: We work wi