Felipe Fernandez del Castillo, MD - Nephrology

Felipe Fernandez del Castillo
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“Even someone who just has 15% of kidney function might feel perfectly normal.”

Growing up in the Boston area with both a father and a grandfather who were physicians, it wasn’t surprising that Dr. Felipe Fernandez del Castillo also decided to devote his life to helping others.

As a nephrologist, Dr. Fernandez del Castillo takes care of patients who are having problems with their kidneys. “There’s really two different settings for taking care of patients with kidney disease,” he explains. “We take care of patients in the office and have various medications that we can use to slow progression of disease. In some cases, there are medications we can give to stop kidney disease and make it go away. We also take care of patients on chronic dialysis. My particular interest is home-based dialysis which I think is an underutilized treatment for kidney disease. It’s very effective and has been in use since the 70s and 80s.”

Dr. Fernandez del Castillo also has a clinical interest in blood pressure control. “I’m also a certified hypertension specialist as well as a nephrologist. Controlling blood pressure is very important for long term health, and I really enjoy that aspect of the care I provide patients.”

One of the issues with treating kidney disease is that symptoms do not show until the very late stages. “Even someone who just has 15% of kidney function might feel perfectly normal. The first thing we see are abnormalities in the blood work, and sometimes in the urine,” he explains. “Only at the very last stages do people start to feel what we call uremia – loss of appetite, nausea, and vomiting. Fluid can also accumulate and cause swelling and breathing problems, as well as confusion and fatigue.”

Dr. Fernandez del Castillo says that the technology we have today allows for very accurate prediction models when it comes to potential risks for kidney patients. “You can tell someone who might feel perfectly fine that they have a 60% chance of being on dialysis in five years,” he explains. “That really helps and allows them to make plans. The technology and data really make a difference.”

According to Dr. Fernandez del Castillo, patients undergoing dialysis only have a limited amount of kidney function, about 8%, so it can be difficult to care for them. “The kidneys have more roles than just cleaning the blood. They coordinate a complex system in the body including hormones and feedback loops that regulate important functions like bone health, vascular calcification and blood levels. So, dialysis can’t replace all those functions and we have to try to use other means. That’s why kidney transplants are really preferable for the right patients. Patients with kidney transplants often do very well.”

In his spare time Dr. Fernandez del Castillo enjoys hiking and being around his family. He also loves reading, including history, poetry, and fiction.

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