Exploring Nephrologist: A Complete Guide to Nephrology and Kidney Care Health


Exploring Nephrologist: A Complete Guide to Nephrology and Kidney Care

A Complete Guide to Nephrology and Kidney Care

What is Nephrology?

Nephrology, also known as renal medicine is a study and treatment of kidney functions and problems. This also includes diet, medication, and transplantation. The systemic problems that affect the kidney like diabetes are also studied in nephrology. The examples of systemic problems include vasculitides, autoimmune diseases as well as genetic conditions. Most notable nephrologists treat End Stage Renal Disease (ESRD) in the form of transplantation or dialysis.

Many patients from around the world suffer from many disorders which come under general medicine. However, many have disorders which develop to the last stage requiring transplantation. As the people with kidney disease increases, renal medicine is expanding quickly. Specialists are obtaining sub-specialties in specific fields like kidney transplantation, academic nephrology, haemodialysis and peritoneal dialysis.

A nephrologist also treats Acute Renal Failure (ARF) and Chronic Kidney Disease (CKD). This part is also included so that the patient does not reach ESRD stage. A nephrologist also specializes in electrolyte disorders like potassium, high blood pressure, and magnesium.

What is a Nephrologist?

A nephrologist is a physician who specializes in the advanced treatment of kidney disease. A nephrologist requires additional training to become an expert with advanced skills. They also provide care for people who work in transplant medicine, general medicine, and ICU or pediatric nephrology. They can help in the diagnosis of kidney failure and suggest appropriate treatment. They are responsible for complete care during the treatment.

A nephrologist performs native kidney transplant or biopsy, dialysis access insertion, fistula management and bone biopsy. They may also be responsible for taking care of the patient before and after a kidney transplant. This might be necessary as diabetes and high blood pressure must be under control before a surgery.

Once the surgery gets completed, the patients and the doctors should be in touch. This is important so that they can take care if any problems arise in case kidney gets rejected by the body.

What do nephrologists learn during their fellowship training?

The training for nephrologists differs from country to country. All practicing nephrologists must be approved by the board. In order to qualify according to their standards, adequate training must be adequate. Let us see how the training differs in each country.

The United States of America

There are two ways of completing nephrology in the USA. Firstly, it can be through an internal medicine pathway which leads to nephrology specialty or internal medicine. This is also known as adult nephrology. Secondly, after completing medical school in USA adult nephrologists completes 3-year residency. Otherwise, the medical student can also opt for four-year Combined Internal Medicine and Pediatrics residency followed by a 3-year residency in Pediatrics Nephrology.

In order to practice nephrology, the person should have the approval of one of the following boards.

  • American Board of Internal Medicine (ABIM)
  • American Osteopathic Board of Internal Medicine (AOBIM) nephrology examination.

A student must fulfill the requirements or training and education in nephrology to take the examination of the board. The student will also need 3 years of training in AOA or ACGME accredited fellowship in nephrology.

New Zealand and Australia

Nephrology training includes completion of medical degree and examination of Royal Australasian College of Physicians and Advanced Physician Training in Nephrology. The entire training is overlooked by Royal Australasian College of Physicians.

The United Kingdom

Here, nephrology is a subspecialty of general medicine. After completing medical school one has to successfully pass the Membership of the Royal College of Physicians (MRCP). This has to be done before National Training Number (NTN) in renal medicine. Many subspecialty trainees working in clinic often opt for research degrees.

What does a nephrologist do?

The primary responsibility of a nephrologist is to diagnose any kind of disease and design a plan to take care of the patient. The nephrologist reviews all of the patient’s kidney disease including over the counter painkillers. The nephrologists must also analyze the unnecessary risks involved and potentially harmful interactions of the drugs. They also coordinate with other physicians who treat other conditions like high blood pressure, anaemia and diabetes which can affect the kidney.

During a serious condition a nephrologist orders a course of dialysis which helps to cleanse the blood in the same way healthy kidneys do. Ultimately, many patients need a transplant to survive. Urologistperforms surgeries, but nephrologists care for the patients before and after the surgery. Making lifestyle changes like eating habits are a part of the treatment plan.

Nephrologist vs. Urologist: Understanding the difference

Since both can be consulted for treating kidney diseases, one can easily become confused about the services both provide. The specialties often overlap and one might need to see both for the same condition. Urologists are focused on treating structural or anatomical problems or the urinary tract and related organs. The areas which can be treated by urologists include:

  • Bladder
  • Urethra
  • Kidneys
  • Adrenal Glands
  • Epididymis
  • Prostate
  • Seminal vesicles

The surgical specialty includes the following:

  • Urinary tract infection
  • Anatomical kidney defects
  • Adrenal problems
  • Kidney Stones
  • Conditions of male productive organs
  • Ureter conditions

Both treat kidney problems but urologists focus on anatomical or structural disorders and urinary tract. Urologists treat problems like kidney stones, blockages, and cancer. Urologists are also qualified to perform surgeries and medical procedure to correct such conditions.

On the other hand, nephrologists are medical specialists with their primary focus on disorders. This includes treating diabetes. They prescribe nonsurgical treatments for these disorders.

The services which nephrologists should be consulted include:

  • Blood Pressure monitoring
  • Dialysis treatment
  • Electrolyte balance and monitoring fluid in the body
  • Medication for hypertension and kidney disease
  • Acute kidney failure
  • Chronic kidney disease

People who have a higher risk of developing kidney disease should see a nephrologist and get a routine test. Detecting the problem early can help you save your life and release you from a life-long disease. Doctors use laboratory data to interpret your medical condition. For nephrologists, BUN and creatinine help to assess your kidney conditions.

A creatinine is a molecule which the muscles make in your body. This is produced at a constant rate. If the body is not able to flush it out they get accumulated causing diseases. On the other hand, BUN suggests that the toxins are stored and not removed. A low BUN suggests malnutrition and high might suggest dehydration. Creatinine is a better test result because BUN has many factors involved. The patient might need kidney dialysis to not only remove fluid but also clear toxins not represented by the BUN.

When a person referred to a kidney doctor?

Patients are first assessed and examined by general physicians who then refer them to nephrologists when abnormalities are confirmed. Below are the reasons for which nephrologists should be visited.

  • Presence of casts, crystals, proteins in urine
  • Recurring or long-term kidney infections including bladder infections or kidney infections.
  • Uncontrolled high blood pressure
  • Cancers or urinary bladder
  • Diabetic nephropathy
  • Hypertensive nephrosclerosis
  • Nephritic Syndrome
  • Nephrotic syndrome
  • Toxins or drugs which have caused kidney damage
  • Clinical disorders of Calcium Ca2+, Potassium K+, Phosphates PO42-, and Magnesium Mg2+.
  • Diabetic kidney disease
  • Acute renal failure or loss of kidney functionality
  • Long-term decline in kidney functions

During your first visit, the doctor will ask you for some routine tests like blood and urine tests. Sometimes, to confirm the diagnosis, some additional tests might be necessary like CT scan, sonogram, or ultrasound. The patient will also be about the renal history of the family and any current medications you might be taking.

Where to find the best nephrologist for you

Majority of the kidney diseases are treatable as the specialists prescribe medications.  Some of the best nephrologists’ hospitals in the USA include the following:

  1. Cleveland Clinic – Formally also known as Cleveland Clinic Foundation. It is a well-known multi-specialty hospital located in Cleveland, Ohio, USA. Founded in 1921, the purpose is to provide patient care, medical education, and research.
  2. Mayo Clinic – Founded in 1889, Mayo Clinic is a non-profit medical research center based in Rochester, Minnesota. The hospital has more than 3300 physicians, researchers and scientists working on diagnosis and treatment. The Nephrology Division consists of the world’s largest groups of nephrologists.
  3. New York Presbyterian University Hospital of Columbia and Cornell – This is a famous hospital in NY which as affiliation with two Ivy League medical schools. It has two distinctive medical centers: Columbia University Medical Center and Weill Cornell Medical Center. The kidney transplant program is one of the oldest in the region and also the largest in the country. The doctors complete more than 450 kidney transplants in a year.
  4. UCSF Medical Center – University of California is a well-known research center and teaching hospital. They have kidney disease clinic, nephrology, and hypertension at Parnassus and dialysis center at Mount Zion.
  5. John Hopkins Hospital – Located in Baltimore is well known for its kidney transplant and treatment. The hospital assures top quality care for all patients at any stage of kidney disease. The nephrology remains active in research and finding treatments for kidney diseases.


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