Nephrology
Encyclopedia
Nephrology is a branch of internal medicine
and pediatrics
dealing with the study of the function and diseases of the kidney.
s and hypertension
, and the care of those requiring renal replacement therapy
, including dialysis
and renal transplant patients. Many diseases affecting the kidney are systemic disorders not limited to the organ itself, and may require special treatment. Examples include acquired conditions such as systemic vasculitides (e.g. ANCA vasculitis) and autoimmune diseases (e.g., lupus
), as well as congenital or genetic conditions such as polycystic kidney disease.
Patients are referred to nephrology specialists for various reasons, such as acute renal failure
, chronic kidney disease, hematuria
, proteinuria
, kidney stone
s, hypertension
, and disorders of acid/base or electrolyte
s.
who has been trained in the diagnosis and management of kidney disease, by regulating blood pressure
, regulating electrolytes, balancing fluids in the body, and administering dialysis
. Nephrologists treat many different kidney disorders including acid-base disorders, electrolyte disorders, nephrolithiasis (kidney stone
s), hypertension (high blood pressure), acute kidney disease and end-stage renal disease. Nephrology is a subspecialty of internal medicine
. In the United States
, after medical school
nephrologists complete a three year residency
in internal medicine followed by a two year (or longer) fellowship
in nephrology.
Knowledge of internal medicine is required to obtain certification. To become a nephrologist requires many years of school and training. Nephrologists also must be approved by the board. To be approved, the physician must fulfill the requirements for education and training in nephrology in order to qualify to take the board's examination. If a physician passes the examination, then he or she can become a nephrology specialist. Typically, nephrologists also need two to three years of training in an ACGME or AOA
accredited fellowship in nephrology. Only pediatric trained physicians are able to train in pediatric nephrology, and internal medicine (adult) trained physicians may enter general (adult) nephrology fellowships. Physicians that achieved training in both medicine and pediatrics may subspecialize in both adult and pediatric nephrology.
Information that a nephrologist learns in training are fluid and acid base and electrolyte physiology, medical management of acute and chronic renal failure
, glomerular and vascular disorders, tubular/interstitial disorders, mineral metabolism
, clinical pharmacology
, hypertension, epidemiology, and nutrition. Procedures a nephrologist may learn in a training program include native and transplant kidney biopsies, ultrasound guidance, placement of temporary dialysis catheters, placement of tunneled hemodialysis
catheters and placement of peritoneal dialysis catheters. Nearly all programs train nephrologists in continuous renal replacement therapy
; fewer than half train in the provision of plasmapheresis
. Once training is satisfactorily completed, the physician is eligible to take the ABIM or AOBIM nephrology examination. Subspecialties within nephrology include interventional nephrology, dialytician, and transplant nephrology.
, important clues as to the cause of any symptom are gained in the history and physical examination.
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:
s, DMARDs (disease-modifying antirheumatic drugs), antihypertensive
s (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.
Subspecialties within nephrology include interventional nephrologists who focus on access placement and maintenance, a dialytician who focus upon ordering dialysis for patients, and transplant nephrologists who focus on the acute or sub-acute monitoring of immunosuppression in the transplant patient.
If patients proceed to transplant, nephrologists will continue to follow patients to monitor the immunosuppressive regimen and watch for complications that can occur post-transplant.
is the largest global society representing medical professionals engaged in advancing kidney care worldwide. In the USA, the National Kidney Foundation
is a national organization representing patients and professionals who treat kidney diseases. Founded in 1966, the American Society of Nephrology
(ASN) is the world’s largest professional society devoted to the study of kidney disease. In the United Kingdom, the National Kidney Federation represents patients, and the Renal Association
represents renal physicians and works closely with the National Service Framework
for kidney disease. The Renal Support Network
(RSN) is a nonprofit, patient-focused, patient-run organization that provides non-medical services to those affected by chronic kidney disease (CKD). The American Association of Kidney Patients (AAKP) is a non-profit, patient-centric group focused on improving the health and well-being of CKD and dialysis
patients.
Internal medicine
Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...
and pediatrics
Pediatrics
Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...
dealing with the study of the function and diseases of the kidney.
Scope of the specialty
Nephrology concerns the diagnosis and treatment of kidney diseases, including electrolyte disturbanceElectrolyte disturbance
Electrolytes play a vital role in maintaining homeostasis within the body. They help to regulate myocardial and neurological function, fluid balance, oxygen delivery, acid-base balance and much more. Electrolyte imbalances can develop by the following mechanisms: excessive ingestion; diminished...
s and hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
, and the care of those requiring renal replacement therapy
Renal replacement therapy
Renal replacement therapy is a term used to encompass life-supporting treatments for renal failure.It includes:*hemodialysis,*peritoneal dialysis,*hemofiltration and*renal transplantation.These treatments will not cure chronic kidney disease...
, including dialysis
Dialysis
In medicine, dialysis is a process for removing waste and excess water from the blood, and is primarily used to provide an artificial replacement for lost kidney function in people with renal failure...
and renal transplant patients. Many diseases affecting the kidney are systemic disorders not limited to the organ itself, and may require special treatment. Examples include acquired conditions such as systemic vasculitides (e.g. ANCA vasculitis) and autoimmune diseases (e.g., lupus
Lupus erythematosus
Lupus erythematosus is a category for a collection of diseases with similar underlying problems with immunity . Symptoms of these diseases can affect many different body systems, including joints, skin, kidneys, blood cells, heart, and lungs...
), as well as congenital or genetic conditions such as polycystic kidney disease.
Patients are referred to nephrology specialists for various reasons, such as acute renal failure
Acute renal failure
Acute kidney injury , previously called acute renal failure , is a rapid loss of kidney function. Its causes are numerous and include low blood volume from any cause, exposure to substances harmful to the kidney, and obstruction of the urinary tract...
, chronic kidney disease, hematuria
Hematuria
In medicine, hematuria, or haematuria, is the presence of red blood cells in the urine. It may be idiopathic and/or benign, or it can be a sign that there is a kidney stone or a tumor in the urinary tract , ranging from trivial to lethal...
, proteinuria
Proteinuria
Proteinuria means the presence of anexcess of serum proteins in the urine. The protein in the urine often causes the urine to become foamy, although foamy urine may also be caused by bilirubin in the urine , retrograde ejaculation, pneumaturia due to a fistula, or drugs such as pyridium.- Causes...
, kidney stone
Kidney stone
A kidney stone, also known as a renal calculus is a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine...
s, hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
, and disorders of acid/base or electrolyte
Electrolyte
In chemistry, an electrolyte is any substance containing free ions that make the substance electrically conductive. The most typical electrolyte is an ionic solution, but molten electrolytes and solid electrolytes are also possible....
s.
Training
A nephrologist is a physicianPhysician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
who has been trained in the diagnosis and management of kidney disease, by regulating blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
, regulating electrolytes, balancing fluids in the body, and administering dialysis
Dialysis
In medicine, dialysis is a process for removing waste and excess water from the blood, and is primarily used to provide an artificial replacement for lost kidney function in people with renal failure...
. Nephrologists treat many different kidney disorders including acid-base disorders, electrolyte disorders, nephrolithiasis (kidney stone
Kidney stone
A kidney stone, also known as a renal calculus is a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine...
s), hypertension (high blood pressure), acute kidney disease and end-stage renal disease. Nephrology is a subspecialty of internal medicine
Internal medicine
Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...
. In the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, after medical school
Medical school
A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...
nephrologists complete a three year residency
Residency (medicine)
Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a medical degree , Podiatric degree , Dental Degree and who practices...
in internal medicine followed by a two year (or longer) fellowship
Fellowship (medicine)
A fellowship is the period of medical training in the United States and Canada that a physician may undertake after completing a specialty training program . During this time , the physician is known as a fellow...
in nephrology.
Knowledge of internal medicine is required to obtain certification. To become a nephrologist requires many years of school and training. Nephrologists also must be approved by the board. To be approved, the physician must fulfill the requirements for education and training in nephrology in order to qualify to take the board's examination. If a physician passes the examination, then he or she can become a nephrology specialist. Typically, nephrologists also need two to three years of training in an ACGME or AOA
American Osteopathic Association
The American Osteopathic Association is the representative member organization for the over 78,000 osteopathic medical physicians in the United States...
accredited fellowship in nephrology. Only pediatric trained physicians are able to train in pediatric nephrology, and internal medicine (adult) trained physicians may enter general (adult) nephrology fellowships. Physicians that achieved training in both medicine and pediatrics may subspecialize in both adult and pediatric nephrology.
Information that a nephrologist learns in training are fluid and acid base and electrolyte physiology, medical management of acute and chronic renal failure
Renal failure
Renal failure or kidney failure describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood...
, glomerular and vascular disorders, tubular/interstitial disorders, mineral metabolism
Metabolism
Metabolism is the set of chemical reactions that happen in the cells of living organisms to sustain life. These processes allow organisms to grow and reproduce, maintain their structures, and respond to their environments. Metabolism is usually divided into two categories...
, clinical pharmacology
Pharmacology
Pharmacology is the branch of medicine and biology concerned with the study of drug action. More specifically, it is the study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function...
, hypertension, epidemiology, and nutrition. Procedures a nephrologist may learn in a training program include native and transplant kidney biopsies, ultrasound guidance, placement of temporary dialysis catheters, placement of tunneled hemodialysis
Hemodialysis
In medicine, hemodialysis is a method for removing waste products such as creatinine and urea, as well as free water from the blood when the kidneys are in renal failure. Hemodialysis is one of three renal replacement therapies .Hemodialysis can be an outpatient or inpatient therapy...
catheters and placement of peritoneal dialysis catheters. Nearly all programs train nephrologists in continuous renal replacement therapy
Hemofiltration
In medicine, hemofiltration, also haemofiltration, is a renal replacement therapy similar to hemodialysis which is used almost exclusively in the intensive care setting...
; fewer than half train in the provision of plasmapheresis
Plasmapheresis
Plasmapheresis is the removal, treatment, and return of blood plasma from blood circulation. It is thus an extracorporeal therapy...
. Once training is satisfactorily completed, the physician is eligible to take the ABIM or AOBIM nephrology examination. Subspecialties within nephrology include interventional nephrology, dialytician, and transplant nephrology.
Diagnosis
As with the rest of medicineMedicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, important clues as to the cause of any symptom are gained in the history and physical examination.
More specialized tests can be ordered to discover or link certain systemic diseases to kidney failure such as hepatitis b or hepatitis c
Hepatitis C
Hepatitis C is an infectious disease primarily affecting the liver, caused by the hepatitis C virus . The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years...
, lupus
Lupus nephritis
Lupus nephritis is an inflammation of the kidney caused by systemic lupus erythematosus , a disease of the immune system. Apart from the kidneys, SLE can also damage the skin, joints, nervous system and virtually any organ or system in the body....
serologies, paraproteinemias such as amyloidosis
Amyloidosis
In medicine, amyloidosis refers to a variety of conditions whereby the body produces "bad proteins", denoted as amyloid proteins, which are abnormally deposited in organs and/or tissues and cause harm. A protein is described as being amyloid if, due to an alteration in its secondary structure, it...
or multiple myeloma
Multiple myeloma
Multiple myeloma , also known as plasma cell myeloma or Kahler's disease , is a cancer of plasma cells, a type of white blood cell normally responsible for the production of antibodies...
or various other systemic diseases that lead to kidney failure. Collection of a 24-hour sample of urine
Urine
Urine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...
can give valuable information on the filtering capacity of the kidney and the amount of protein
Protein
Proteins are biochemical compounds consisting of one or more polypeptides typically folded into a globular or fibrous form, facilitating a biological function. A polypeptide is a single linear polymer chain of amino acids bonded together by peptide bonds between the carboxyl and amino groups of...
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 biopsyBiopsyA biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
, to obtain a tissue diagnosis of a disorder when the exact nature or stage remains uncertain.; - UltrasoundMedical ultrasonographyDiagnostic sonography is an ultrasound-based diagnostic imaging technique used for visualizing subcutaneous body structures including tendons, muscles, joints, vessels and internal organs for possible pathology or lesions...
scanning of the urinary tract and occasionally examining the renal blood vessels; - CT scanning when mass lesions are suspected or to help diagnosis nephrolithiasis;
- ScintigraphyScintigraphyScintigraphy is a form of diagnostic test used in nuclear medicine, wherein radioisotopes are taken internally, and the emitted radiation is captured by external detectors to form two-dimensional images...
(nuclear medicineNuclear medicineIn nuclear medicine procedures, elemental radionuclides are combined with other elements to form chemical compounds, or else combined with existing pharmaceutical compounds, to form radiopharmaceuticals. These radiopharmaceuticals, once administered to the patient, can localize to specific organs...
) 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 imagingMagnetic resonance imagingMagnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
angiography when the blood vesselBlood vesselThe blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...
s might be affected
Therapy
Many kidney diseases are treated with medication, such as steroidSteroid
A steroid is a type of organic compound that contains a characteristic arrangement of four cycloalkane rings that are joined to each other. Examples of steroids include the dietary fat cholesterol, the sex hormones estradiol and testosterone, and the anti-inflammatory drug dexamethasone.The core...
s, DMARDs (disease-modifying antirheumatic drugs), antihypertensive
Antihypertensive
The antihypertensives are a class of drugs that are used to treat hypertension . Evidence suggests that reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34%, of ischaemic heart disease by 21%, and reduce the likelihood of dementia, heart failure, and mortality from...
s (many kidney diseases feature hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
). Often erythropoietin
Erythropoietin
Erythropoietin, or its alternatives erythropoetin or erthropoyetin or EPO, is a glycoprotein hormone that controls erythropoiesis, or red blood cell production...
and vitamin D
Vitamin D
Vitamin D is a group of fat-soluble secosteroids. In humans, vitamin D is unique both because it functions as a prohormone and because the body can synthesize it when sun exposure is adequate ....
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
Dialysis
In medicine, dialysis is a process for removing waste and excess water from the blood, and is primarily used to provide an artificial replacement for lost kidney function in people with renal failure...
or transplant is required. Please refer to the main articles dialysis
Dialysis
In medicine, dialysis is a process for removing waste and excess water from the blood, and is primarily used to provide an artificial replacement for lost kidney function in people with renal failure...
and renal transplant for a comprehensive account of these treatments.
Subspecialties within nephrology include interventional nephrologists who focus on access placement and maintenance, a dialytician who focus upon ordering dialysis for patients, and transplant nephrologists who focus on the acute or sub-acute monitoring of immunosuppression in the transplant patient.
If patients proceed to transplant, nephrologists will continue to follow patients to monitor the immunosuppressive regimen and watch for complications that can occur post-transplant.
Organizations
The International Society of NephrologyInternational Society of Nephrology
The International Society of Nephrology is an international body representing specialists in nephrology . Its headquarters are located in Brussels, Belgium....
is the largest global society representing medical professionals engaged in advancing kidney care worldwide. In the USA, the National Kidney Foundation
National Kidney Foundation
The National Kidney Foundation, Inc. is a major voluntary health organization in the United States, headquartered in New York City...
is a national organization representing patients and professionals who treat kidney diseases. Founded in 1966, the American Society of Nephrology
American Society of Nephrology
Founded in 1966, the American Society of Nephrology is the world’s largest professional society devoted to the study of kidney disease. Composed of 11,000 physicians and scientists, ASN promotes expert patient care, advances medical research, and educates the renal community...
(ASN) is the world’s largest professional society devoted to the study of kidney disease. In the United Kingdom, the National Kidney Federation represents patients, and the Renal Association
Renal Association
The Renal Association is a British professional organisation of nephrologists . It was founded in 1950 by Arthur Arnold Osman after the example of the French Societé de Pathologie Renale. The current president is Professor Peter Mathieson...
represents renal physicians and works closely with the National Service Framework
National Service Framework
National Service Frameworks are policies set by the National Health Service in the United Kingdom to define standards of care for major medical issues such as cancer, coronary heart disease, mental health and diabetes...
for kidney disease. The Renal Support Network
Renal Support Network
The Renal Support Network is an American nonprofit, kidney patient-focused, kidney patient-run organization that works to benefit individuals affected by chronic kidney disease...
(RSN) is a nonprofit, patient-focused, patient-run organization that provides non-medical services to those affected by chronic kidney disease (CKD). The American Association of Kidney Patients (AAKP) is a non-profit, patient-centric group focused on improving the health and well-being of CKD and dialysis
Dialysis
In medicine, dialysis is a process for removing waste and excess water from the blood, and is primarily used to provide an artificial replacement for lost kidney function in people with renal failure...
patients.
External links
- International Society of Nephrology, a global humanitarian society
- American Society of Nephrology
- Nephrology Now – Literature Update Service and Meta-Journal
- Latin American Nephrology Nursing Association
- Asian Pacific Society of Nephrology
- National and Regional Societies of Nephrology
- Institute of Nephrology of Academy of Medical Science of Ukraine