Nephrology concerns 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 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.
A nephrologist is a physician 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 stones), 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.
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 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
Urologists are surgical specialists of the urinary tract (see urology). 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.