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Nephrology

Scope of the specialty

Nephrology concerns itself with the diagnosis and treatment of kidney diseases including electrolyte disturbances and hypertension, and the care of those requiring renal replacement therapy, including dialysis and renal transplant patients. Many diseases affecting the kidney are not limited to the organ itself, but are systemic disorders, and may require not only a whole patient approach, but also special treatment, such as systemic vasculitides or other autoimmune diseases, such as lupus.

Who sees a nephrologist?

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

• Acute renal failure, a sudden loss of renal function

• Chronic kidney disease, declining renal function, usually with an inexorable rise in creatinine.

• Hematuria, blood loss in the urine

• Proteinuria, the loss of protein especially albumin in the urine

• Kidney stones, usually only recurrent stone formers.

• 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

• Diseases of the Bladder and prostate such as malignancy, stones, or obstruction of the urinary tract.

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, 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 However, 24-hour urine samples have recently, in the setting of chronic renal disease, been replaced by spot urine ratio of protein and creatinine.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 measurement of renal function (rarely done), and MAG3 scans for diagnosis of renal artery disease or 'split function' of each kidney;

• Angiography or Magnetic resonance imaging angiography when the blood vessels might be affected

Therapy

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 kidney disease.

When chronic kidney disease progresses to stage five, dialysis or transplant is required. Please refer to the main articles dialysis and renal transplant for a comprehensive account of these treatments.

If patients proceed to transplant, nephrologists will continue to follow patients to monitor the immunosuppressive regimen and watch for the infection that can occur post transplant.

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