Since its start in 1984 as the first University Hospital of Tribhuvan University, Tribhuvan University Teaching Hospital (TUTH) has always played leadership roles in the fields of health service, education and research in Nepal.
Nephrology is a distinctive subspecialty of medicine. Even though it is considered subspecialty, it is reputed for its huge span encompassing comprehensive care of every aspect of clinical medicine.
Department of Nephrology has been providing a complete care for the patients with kidney diseases inside and outside the premises of TUTH
Nephrology specialty service started in TUTH in 1992. Initially it started with acute peritoneal dialysis (PD) for patients with acute kidney failure. Hemodialysis (HD) services started in 1996 (2053BS) with the support of two dialysis machines donated by the Government of Japan.
Initially nephrology service was provided by the Department of Internal Medicine as Nephrology Unit through a team of a few dedicated faculties committed in contributing to the care of patients with kidney disease. Later on, this endeavor was reinforced by the initiation of other kidney care services through dedicated nephrology service beds, specialty outpatient clinic, peritoneal dialysis and initiation of living donor kidney transplantation services in 2008.
Department of Nephrology was convened in 24 Dec 2012 (Poush 9, 2069 BS).
The department currently delivers its clinical and academic services through a team of six faculties who have individually demonstrated high level of excellence in the field. Patient care, bedside teaching, ward rounds, OPD services are highly appreciated by faculty members of other specialties and postgraduate trainees rotating through their postings in nephrology. We have best quality nursing personnel taking care of our inpatients.
Besides, our team also comprises of 5 nephrology specialist trainees and a team of dedicated trained hemodialysis nurses and dialysis technicians. Our wards are provided with most competent nurses and support staff.
Every year, hundreds of patients are diagnosed as incident chronic kidney disease (CKD). We serve over 15,000 patient visits in our outpatient clinic every year.
General medicine & Nephrology
New patients and follow up
Nephrology Specialty Clinic
Follow up only
Mon, Wed, Friday
Booked cases only
2. Inpatient service
Nephrology ward is located at Level 2. We provide service through 34 inpatient beds, 10 dialysis beds, 2 post transplant ICUs and shared ICUs. It has occupancy of almost 100% with huge number of additional renal patients admitted in other wards in the hospital. Total number of nephrology inpatients averages 45 to 50 in any day.
3. Hemodialysis services
Hemodialysis (HD) is one of the fundamental services provided by the Nephrology Department. HD is essential lifesaving therapeutic modality for patients with kidney failure. While it is medical facility to sustain survival of patients with kidney failure, it is also important bridging therapy for kidney failure patients planning to have a kidney transplant.
Our hemodialysis unit is equipped with 10 machines in HD ward, and one dedicated hemodialysis machine in the ICU and two CRRT machines (ICU plus Dialysis ward). Two 4 hour sessions are run every day for booked outpatient HD patients, followed by unrestricted service for indoor and emergency patients 24/7. Our specialist nurses have trained hundreds of nurses throughout the country and also have helped to establish HD units in various hospitals nationwide.
We perform over 11000 HD sessions for new and old CKD and AKI patients every year. We provide regular outpatient dialysis to over 60 patients under the Nepal Government subsidized dialysis service. Shortage of dialysis machines and growing number of ESRD patients has left over 700 registered patients await the standard of care in our HD unit.
Nephrology Department has been able to establish plasma exchange, bedside dialysis in ICU, pediatric nephrology care and living donor kidney transplantation in the country.
Our medical team also covers CRRT service in Manmohan Cardiovascular Thoracic and Transplant Centre.
4. Kidney transplantation
Living related kidney transplantation services started on 8th of August 2008. Prof Dibya Singh Shah lead this program. Over 650 living donor kidney transplants have been performed till March 2020. Second kidney transplant, ABO incompatible kidney transplantation, transplantation of sensitized patients, transplantation of HBsAg/anti HCV/HIV positive patients are some of our notable works in kidney transplantation. We feel proud to have successfully accomplished the second living donor kidney transplantation for the Prime Minister Rt’ Honourable KP Sharma Oli on 4th March 2020.
At present, TUTH performs 2 kidney transplants every week.
a. Academic activities
We teach undergraduate (MBBS) students, train post graduate (MD Internal Medicine) students and confer super-specialty post masters DM (Nephrology) degree to deserving candidates.
DM Nephrology is an academic residential post masters level training on Nephrology. This three year comprehensive academic course is designed for MD doctors aspiring for doctorate level training in kidney care. Every year 1-2 physicians are enrolled. The program follows an integrated curriculum comprising cohesive learning of nephrology, nephro-pathology, radiology, kidney transplantation, transplant immunology, dialysis, preventive nephrology, communication skills, medical ethics etc along with mandatory research article publication in peer reviewed journal and compulsory thesis writing. Renowned Nephrologists from Nepal and abroad examine the trainees before they are awarded the “Doctorate of Medicine (DM) Nephrology” degree which is academically equivalent to PhD degree in other academic disciplines.
We have trained many aspiring doctors from various other hospitals who wish to learn dialysis and nephrology. We have also run 3 months comprehensive dialysis training for Nurses. TUTH, currently is one of the training center for Dialysis Nurses on Hemodialysis of the Government of Nepal
b b. Our alumni
We are proud to have conferred the DM in Nephrology degree to some of the most deserving clinicians of the country. As of Macrh 2021, our alumni are:
1. Dr Mahesh Raj Sigdel
2. Dr Shailendra Shrestha
3. Dr Mukunda Prasad Kafle
4. Dr Sagar Kumar Duwal Shrestha
5. Dr Midhan Shrestha
6. Dr Rabin Nepali
7. Dr Bikash Khatri
8. Dr Santosh Chhetri
9. Dr Jagadish Lamsal
Nurses are incredible health professionals who can reach the odds of the country. Nurses are available round the clock in hospitals and also in the community whether it is city or a village, reaching those corners of the country where doctors may not be accessible. They are of phenomenal importance in sharing knowledge and implementing various preventive strategies to the community. Even in multispeciality hospitals of the cities, nurses spend more time with the patients than doctors do. The department periodically conducts special training for nurses from various part of the country.
Majority of kidney diseases can be prevented. Kidney diseases secondary to diabetes mellitus and high blood pressure are the best examples of preventable kidney diseases. Moreover, progression of kidney damage by a known disease can be slowed down if appropriate preventive measures are taken. Department of Nephrology conducts and promotes various kidney disease prevention programs.
Mass education and awareness campaigns are the most cost effective means to create a significant public impact. The department conducts educational exhibitions in Tribhuvan University Teaching Hospital and awareness rallies in Kathmandu city. The faculties, residents and nursing professionals actively participate in these activities. Leading mass media houses imposingly cover messages by our faculties in print and audio visual media. Our faculties also participate in interviews, discussions and talk programs in radio and television. The prime minister of Nepal was also actively participated in a walkathon program organized by the department in 2018. These programs are organized in various occasions like World Kidney Day (2nd Thursday of March every year) and TU Teaching Hospital KidneyTransplant Day (8th of August every year).
Best age to educate someone is in the school. Children grasp new ideas quicker and more effectively especially when this is provided through their teachers. Children are of key importance in a family. Children are key messengers to the family because parents usually comply with their children. The department organizes kidney disease awareness and disease screening program in various schools in separate modules for the students and teachers. We have observed that students are very curious and many times they have brought their parents to the hospital for checkup. We have detected children at risk for kidney damage and successfully treated them.
1) Our commitment
Department of Nephrology is committed to work in promotion of kidney health of fellow countrymen in Nepal and overseas. We are convinced that this will be achieved through clinical works, education and research in kidney diseases.
The department has been collaborating with various organizations, including Nepal Society of Nephrology and similar societies from across the globe. It works together with the press and other socially motivated organizations like Nepal Medical Students Society in the advancement of kidney care of the country. Department also participates in such activities organized in other occasions, e.g. World Kidney Day, World Diabetes Day, World Hypertension Day.
a Research publications
1. Ranabhat K, Khanal P , Mishra SR , Khanal A, Tripathi S, . Health related quality of life among haemodialysis and kidney transplant recipients from Nepal: a cross sectional study using WHOQOL-BREF. BMC Nephrology (2020) 21:433
2. Maharjan S, Chhetri S, Khatri B, Sapkota N, . Post-Transplant Erythrocytosis in Live Donor Kidney Transplant Recipients: A Retrospective Single Center Study. JIOM Nepal. 2020 Dec;42(3):62-66
3. Pradhan RR, . Prevalence, Clinical Presentation, and Outcome of Tuberculosis in Patients with Chronic Kidney Disease at a Tertiary Care Hospital in Nepal. International Journal of Nephrology, 2020,
4. Upadhaya P, Thapa P, Gajurel RM, . Incidence of Contrast Induced Acute Kidney Injury, Its Risk Factors and In-Hospital Outcomes in Patients Undergoing Coronary Angiography and Angioplasty. JIOM Nepal. 2020 Aug;42(2):59-63
5. Sah R, Khadka S, Neupane S, Nepal G, Singha S, Kumari P, Sah S, Sah R, Sah S, Adhikari M, Shah N, Pokharel B, Rijal B, . (2020). Disseminated infection with Nocardia otitidiscaviarum in a patient under steroid therapy. Clinical Case Reports. 8. 10.1002/ccr3.2640.
6. Shrestha GS, Paneru HR, Acharya SP, Shrestha SK, , Tiwari S, et al. Preparedness for Coronavirus Disease in Hospitals of Nepal: A Nationwide Survey. J Nepal Med Assoc 2020;58(224):248-51
7. Rawal S, Paudyal P, . Systemic lupus erythematosus and pregnancy outcome in tertiary level hospital of Nepal. Nep Med J 2019;2(1):167-72. DOI 10.3126/nmj.v2i1.24496
8. , Poudyal A, Chalise P, Shah D. (2019). Pediatric kidney transplantation in Nepal. Pediatric Transplantation. 23. 10.1111/petr.13588.
9. , Shah D. (2019). Experience of starting ABO incompatible renal transplant in Nepal. Transplantation Reports. 4. 100026. doi: 10.1016/j.tpr.2019.100026.
10. Khadka P, . (2019). Managing nocardiosis: a review and case series of its treatment with trimethoprim–sulfamethoxazole. Drugs Ther Perspect 35, 563–570. https://doi.org/10.1007/s40267-019-00661-5
11. , Singh D, Sigdel MR, Kafle MP. Study of abnormalities in protocol graft kidney biopsy done at six months post transplantation in a tertiary care center hospital of Nepal. Transplantation Proceedings (2018), doi: 10.1016/j.transproceed.2018.03.042.
12. , Shah D. (2018). Medical Complications in Living Donor Kidney Transplant Recipients in the Developing World. Transplantation. 102. S633. doi:10.1097/01.tp.0000543543.17401.4a.
13. , Sigdel MR, Shrestha M, Shah DS. Spectrum of infections in living donor kidney transplant recipients: An experience from a tertiary center in Nepal. Transplantation Proceedings (2018), doi: 10.1016/j.transproceed.2018.05.011.
14. , Pradhan RR. Chronic Kidney Disease in a Tertiary Care Hospital in Nepal. Journal of Institute of Medicine 2018 Aug; 40:2
15. Nepali R, Shah DS. Pulmonary aspergillosis in a renal transplant recipient, Journal of Institute of Medicine, April, 2018, 40:1, 130-133
16. Timalsina S, , Baniya S, Subedee S. Status of vitamin D and parameters of calcium homeostasis in renal transplant recipients in Nepal: a cross sectional study. BMC Nephrology (2018) 19:290
17. , Sigdel MR, Shrestha M, Nepali R, Chhetri S, Shah DS. Tuberculosis in Living Donor Kidney Transplant Recipients. Transplantation. 2018 July; 102: S664 doi: 10.1097/01.tp.0000543597.47545.0a
18. , Sigdel MR, Singh Shah D. Rhabdomyolysis in Earthquake Victims In Nepal, Kidney International Reports (2017), doi: 10.1016/j.ekir.2016.11.009.
19. Sah R, Khadka S, et al.(2017). Vancomycin resitant enterococcus fecalis causing diarrhea in renal transplant patient. International Educational Applied Scientific Research Journal. 2(9); 2017 Sep.
20. Joshi U, Subedi R, Poudel P, Ghimire PR, Panta S, . Assesment of quality of life in patients undergoing hemodialysis using WHOQOL-BREF questionnaire: a multicenter study. Int J Nephrol Renovasc Disn. 2017;10:195-203.
21. Mishra DR, Shah N, . Incidence and Outcome of Ventilator Associated Pneumonia in ICU of a Tertiary Care Hospital in Nepal. J Nepal Med Assoc 2017;56(207):304-8.
22. , Shah DS. Immunoglobulin A (IgA) Nephropathy in Protocol Graft Kidney Biopsy done at six months Post Transplantation in a Tertiary Care Center Hospital of Nepal. Journal of Nobel Medical College [Online], 6.1 (2017): 6-11. Web. 5 Sep. 2018
23. Lamichhane S, Bajracharya SR, . Lipid profile in renal transplant recipients receiving immunosuppressive therapy. Int J Basic Clin Pharmacol. 2017 Feb;6(2):393-398
24. , Kafle MP, Shah DS. Outcome of low dose cyclophosphamide for induction phase treatment of lupus nephritis, a single center study. BMC Nephrology. 2016;17:145. doi:10.1186/s12882-016-0361-0
25. Nepali R, Sigdel MR, Shah DS. Hepatitis C induced severe myositis. Journal of Institute of Medicine 2016 Apr; 38(1):98-99
26. , Lee VW. Systemic lupus erythematosus in Nepal: A review. Lupus. 2016 Aug; 25(9): 1054-61. doi: 10.1177/0961203316637430. Epub 2016 Mar 7.
27. Khadka P, Mishra SK, , Rijal BP. Primary Pulmonary Nocardiosis and Candidosis with Cutaneous Involvement in Nephrotic Syndrome Patient under Steroid Therapy. International Journal of Clinical Case Report 2016; 6(11):1-7. doi: 10.5376/ijccr.2016.06.0011
28. Kafle MP. Unit-6: Renal disorders. In: Sayami A, Shrestha H, Devkota S, editors. Cardiology and critical care. Kathmandu: National Centre for Health Professions Education; 2015. p.245-58
29. , Shah DS, Shrestha S, Sigdel MR, Raut KB. Prevalence of specific types of kidney disease in patients undergoing kidney biopsy: a single centre experience. Journal of Advances in Internal Medicine 2014; 03(01): 5-10
30. , Raut KB. Wasp Bite in a Referral Hospital in Nepal. J Nepal Health Res Counc 2013 Sep;11(25):244-50
31. Shrestha S, Raut KB, Sigdel MR, Kafle MP, Shah DS. Renal transplant in Nepal: medical complications in first three months. Journal of Institute of Medicine 2013 Aug; 35(02): 38-44.
32. , Shrestha S, Kafle MP. Renal transplantation in Nepal: beginning of a new era! Nephrology (Carlton). 2013 May; 18(5): 369-75. doi: 10.1111/nep.12046.
33. , Shah DS, Raut KB. Lupus Nephritis: A comprehensive review. Journal of Institute of Medicine. 2013 Apr; 35: 58-70
34. Lamsal KS, . Hypertension, as an iceberg disease in the high hilly areas of Nepal. Journal of Institute of Medicine 2012 Dec; 34(03): 4-7
35. , Shah D S, Kafle MP, Raut K B. Severe Immune Thrombocytopenic Purpura Treated with Plasma Exchange. Kathmandu Univ Med J 2012 Jan-Mar; 10(37): 85-87. Doi: 10.3126/kumj.v10i1.6922
36. , Kafle MP, Raut KB. Distal Renal Tubular Acidosis in Adolescence with Severe Growth Retardation and Nephrocalcinosis. J Nepal Med Assoc 2012; 52(187): 135-7.
37. Chalise PR, Sharma UT, Gyawali PR, Shrestha GN, Joshi BR, Gurung GS, Ghimire RK, , Sigdel MR, Shah DS, Raut KB, Sidharth. Urological complications after Kidney transplantation. Kathmandu Univ Med J 2010 Jul-Sep; 8(31): 299-304. doi:10.3126/kumj.v8i3.6216.
38. Chalise PR, , Sharma UK, Gyawali PR, Shrestha GK, Joshi BR, Kafle MP, Sigdel M, Raut KB, Francis DM. Renal transplantation in Nepal: The first year's experience. Saudi J Kidney Dis Transpl 2010; 21(3): 559-64.