Nephrology
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".
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. Additionally, most nephrologists consider themselves to be expert in the care of
electrolyte disorders and
hypertension. Given that most renal conditions are
chronic, nephrologists "grow with their patients".
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)
*
Proteinuria the loss of
protein especially
albumin in the
urine*
Kidney stones
*
Cancer of the
kidney, mostly
renal cell carcinoma but this is usually the domain of the
urologist*
Chronic or recurrent
urinary tract infections
*
Hypertension that has failed to respond to multiple forms of anti-hypertensive
medication or could have a secondary cause
*
Electrolyte disorders or acid/base imbalance
Urologists are surgical specialists of the
urinary tract. They are involved in renal diseases that might be amenable to
surgery:
* Diseases of the
Bladder and
prostate such as malignancy, stones, or obstruction of the urinary tract.
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, and
urinalysis-- which is frequently the key test in suggesting a diagnosis.
More specialized tests can be ordered to discover or link certain systemic diseases to kidney failure such as
hepatitis b or
hepatitis c,
lupus serologies, paraproteinemias such as
amyloidosis or
multiple myeloma or various other systemic diseases that lead to kidney failure. Collection of a 24-hour sample of
urine can give valuable information on the filtering capacity of the kidney and the amount of
protein loss in some forms of kidney disease. However, 24-hour urine samples have recently, in the setting of chronic renal disease, been replaced by spot urine ratio of protein and creatinine.
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 and occasionally examining the renal blood vessels;
*
CT scanning when mass lesions are suspected or to help diagnosis
nephrolithiasis;
*
Scintigraphy (
nuclear medicine) for accurate measurment of renal function (rarely done), diagnosis of renal artery disease, or 'split function' of each kidney;
*
Angiography or
Magnetic resonance imaging angiography when the
blood vessels might be affected
Many kidney diseases are treated with
medication, such as
steroids,
DMARDs (disease-modifying antirheumatic drugs),
antihypertensives (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.
*
On-line Nephrology Journal Club (via JournalReview.org)
