Nephrology

See the article on the kidney for the anatomy and function of healthy kidneys and a list of diseases involving the kidney.

Nephrology is the branch of internal medicine dealing with the study of the function and diseases of the kidney. The word nephrology is derived from the Greek word nephros, which means "kidney", and the suffix -ology, or "study of".

Scope of the specialism

Most diseases affecting the kidney are not limited to the organ itself, but are systemic disorders. Nephrology concerns itself with the diagnosis of kidney disease and its treatment (medication, dialysis), and follow-up of renal transplant patients. Given that most renal conditions are chronic, nephrologists "grow with their patients".

Who sees a nephrologist?

Patients are referred to nephrology specialists for various different reasons, such as :

• Acute renal failure, a sudden loss of renal function
• Chronic renal failure; another doctor has detected symptoms of declining renal function, often a rise in creatinine
• Hematuria (blood loss in the urine)
• Kidney stones
• Cancer of the kidney, mostly renal cell carcinoma
• Chronic or recurrent urinary tract infections

Urologists are surgical specialists of the urinary tract. They are involved in renal diseases that might be amenable to surgery:

• Cancer of the kidney
• Kidney stones

Diagnosis

As with the rest of medicine, important clues as to the cause of any symptom are gained in the history and physical examination.

Laboratory tests are almost always aimed at: urea, creatinine, electrolytes, calcium and phosphate levels, erythrocyte sedimentation rate, C-reactive protein and urinalysis. Collection of a 24-hour sample of urine can give valuable information on the concentrating capacity of the kidney and the amount of protein loss in some forms of kidney disease.

Other tests often performed by nephrologists are:

• Renal biopsy, to obtain a tissue diagnosis of a disorder when the exact nature or stage remains uncertain.;
• Ultrasound scanning of the urinary tract;
• CT scanning when mass lesions are suspected;
• Scintigraphy (nuclear medicine);
• Angiography when the blood vessels might be affected

Therapy

Many kidney diseases are treated with medication, such as steroids, DMARDs (disease-modifying antirheumatic drugs), antihypertenstives (many kidney diseases feature hypertension). Often erythropoietin and vitamin D treatment is required to replace these two hormones, the production of which stagnates in chronic renal disease.

When symptoms of renal failure become too severe, dialysis might be required. Please refer to dialysis for a comprehensive account of this treatment.

If patients proceed to renal transplant, nephrologist often monitor the immunosuppressive regimen and the infections that can occur at this stage.