The mainstay for investigating kidney diseases lie in blood tests and urine tests. Scanning may be required and is usually an ultrasound in the first instance, but sometimes a CT or MRI might be indicated.

If a kidney biopsy is needed, this can be performed at either the Lister or London Bridge. In the private sector this is performed by consultant interventional radiologists who work closely with Dr Game and the analysis is performed by a consultant histopathologist colleague of Dr Game. An overnight stay post-biopsy for observation is normally required.

Please see page "about kidney problems"

Acute kidney Injury (AKI) is a medical emergency which needs prompt investigation and treatment. Dr Game can supervise this at either the Lister or London Bridge Hospitals.

Acute kidney injury has been stratified according to severity in the table below.

More information on AKI can be found here. 

Nephritis refers to inflammation within the kidney and vasculitis to inflammation within blood vessels - the latter can lead to serious kidney disease. Systemic Lupus Erythematosis (SLE, Lupus) can lead to both of these things.

Nephrotic syndrome refers to a heavy leak of protein from the kidney combined with a low protein level in the blood and swelling in the body (usually the legs).

These conditions are often detected in primary care or in an acute care setting. Symptoms can include red and painful eyes, rash, arthritis, headache, general tiredness, swelling, breathlessness, weight loss, decreased urine output. These symptoms are not specific to these conditions and therefore a medical opinion is essential. There is often associated raised blood pressure and abnormal blood tests and urine dipstick findings. If suspected these conditions require urgent referral to a nephrologist and diagnosis with specialised blood tests and a kidney biopsy. This can be done in the private sector.

Treatment can include aggressive treatment with blood pressure lowering agents, which also reduce protein-leak from the kidneys (e.g. ACE inhibitors, A2R blockers), and also drugs which suppress the immune system (e.g. steroids, mycophenolate, azathioprine, cyclophosphamide, rituximab).

Dr Game has extensive experience in the diagnosis and treatment of these conditions from his time at the Hammersmith Hospital and also currently at Guy's. He is also part of a regular joint renal-rheumatology clinic at Lewisham Hospital.

Dr Game runs a tubular dysfunction and metabolic stone clinic at Guy's Hospital and works closely with urologists at Guy's and London Bridge. He can investigate causes for kidney stones and advise about prevention of future stones. He also works closely with urology for other multidisciplinary cases such as pelviureteric junction obstruction, nutcracker kidney and nephrectomy in patients with CKD.

Dr Game is able to supervise dialysis in the private sector at London Bridge Hospital. It may also be possible to dialyse at one of the Guy's Hospital dialysis units as a private patient.

If you require vascular access for dialysis then this can be arranged. 

Please note that dialysis is not usually reimbursed by Health Insurance companies and therefore requires "self-pay". An estimate of cost can be provided on request. 

Dr Game has extensive expertise in all aspects of kidney and pancreas transplantation.

He can supervise:

Medical preparation "work up"  for transplantation

and

Immediate and long term post- transplant follow up.

The transplant operation itself is performed by a transplant surgeon. Work up and long term follow up can take place at either the Lister or London Bridge Hospital. Transplant surgery and immediate follow up is currently only available at London Bridge. 

Private sector transplant surgery is only permissible in the UK with a living donor. If the potential recipient has antibodies to the blood group or tissue type of the donor then the transplant may still be possible: please enquire. 

Dr Game has a research interest in transplantation. However, these techniques are research tools only and are not yet validated for clinical practice.