Departments

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.

The Hematopathology Program specializes in the evaluation of lymph nodes, bone marrow, blood, spleen, and hematolymphoid tissues in other organs. The faculty are board-certified in this specialty, and have expertise in both anatomic and clinical pathology aspects of hematopathology. We render critical, time-sensitive diagnoses of diseases ranging from lymphomas and leukemias to benign, infectious/inflammatory disorders. We use state-of-the-art technologies to make accurate and comprehensive diagnoses on a wide range of entities. These include, but are not limited to, aggressive and indolent lymphomas, chronic myeloid neoplasms, acute leukemias, and plasma cell neoplasms. We work closely with physicians in the hematology/oncology division of Internal Medicine, with one-on-one consultations, as well as multiple weekly multidisciplinary tumor conferences to discuss difficult diagnoses. Our services include examination of the following: · Hodgkin’s disease Non-Hodgkin’s lymphoma Lymphoma Leukemia Myelodysplasia Myeloproliferative disorders Anemia Immune deficiency and opportunistic infections

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 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

Our most comprehensive diagnostic service, Surgical Pathology includes the subspecialties of more than 40 physicians. Our board-certified pathologists offer complete pathology services for a wide range of cancerous and noncancerous diseases and conditions. We provide diagnostic services in the following specialty areas: Breast Pathology Bone & Soft Tissue Pathology Dermatopathology Endocrine, Head & Neck Pathology Gastrointestinal & Liver Pathology Genitourinary Pathology Gynecological Pathology Hematopathology Medical Renal Pathology and Electron Microscopy Neuropathology Ophthalmic Pathology Pediatric & Placental Pathology Thoracic Pathology

Kidney stones, which affect about 10% of Americans, can be an agonizing condition. Kidney stone disease can develop when urine contains unusually high levels of minerals and salts. Family history, as well as certain medical conditions, such as diabetes, obesity, or bowel disease, can increase a patient’s risk of developing a kidney stone. Yale Medicine Urology is a leader in providing the highest quality care for the diagnosis, treatment, and prevention of kidney stones. Our clinicians offer minimally invasive, state-of-the-art treatments. These include laser therapy, endoscopic surgery, or the delivery of energy (“shockwaves” or lithotripsy) to break up stones. Because there is a high chance of recurrent kidney stones—up to 50%—ours is one of the few programs in the country that also focuses on stone prevention. A team of urologists, nephrologists, and nutritionists will work with each patient, recommending individualized strategies, such as healthy dietary changes, that can help keep stones from developing in the future.

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

Since the field of dermatopathology began in 1792, Yale dermatologists and dermatopathologists have earned their place amid the discoveries, innovations, and milestones that have shaped the field. Today, Yale Dermatopathology is currently the most sophisticated and technically advanced laboratory in the region. In our Dermatopathology Lab, our team of highly specialized, board-certified histotechnologists brings a combined 100 years of experience to helping dermatologists provide the most accurate, timely diagnoses to their patients so they can begin the right treatment right away. Our services include examination of the following: Malignant melanoma Melanocytic nevi Cutaneous T cell lymphoma Psoriasis Lichen planus Basal cell carcinoma Kaposi’s sarcoma Erythema multiforme Leukocytoclastic vasculitis

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

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.

We are a nationally recognized center for diagnostic renal pathology and electron microscopy. As one of the few clinical electron microscopy services with digital imaging capability in the nation, the Yale Renal Pathology Laboratory is well positioned to serve a wide geographic area with rapid turnaround time combined with expert consultative services. We provide the most effective methodologies available for light microscopic, ultrastructural, and immunological diagnosis of kidney biopsies and surgical pathology specimens. These techniques include transmission electron microscopy, immunohistochemistry, and standard and confocal immunofluorescence microscopy. Our lab places special emphasis on the diagnosis of glomerular, tubulointerstitial, and vascular kidney diseases, as well as evaluation of transplant kidney biopsies. Electron microscopy is further of value in the diagnosis of ciliary abnormalities, metabolic disorders, microbial identification, and tumor diagnosis. In addition, electron microscopy has proven useful in the diagnosis of a wide range of viral diseases and in the diagnosis of unusual infectious agents such as spirochetes, microsporidia, and protozoa mechanisms.

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.