Branch of medicine dealing with kidney function and diseases. An understanding of kidney physiology is important not only in treating kidney disease but in knowing the effect of drugs, diet, and hypertension on kidney disease, and vice versa. The first scientific observations of the kidney were made in the mid-17th century by Lorenzo Bellini (1643–1704) and Marcello Malpighi; Carl Ludwig was the first to elaborate on their true physiological function (1844). A key development in nephrology was the permanent arteriovenous shunt (1960), which made repeated hemodialysis feasible, instantly changing the outlook for chronic-renal-disease patients from certain death to 90percnt survival. Seealso dialysis, kidney failure, kidney stone, kidney transplant, nephron.
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Nephrology (from Greek: nephros, "kidney"; and λόγος, logos, "speech" lit. "to talk about kidney") is a branch of internal medicine and pediatrics dealing with the study of the function and diseases of the kidney.
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 accredited program in 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 casuclar 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 nephrology examination. Subspecialties within nephrology include interventional nephrology, dialytician, and transplant 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.
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:
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.
Sub-specialties 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.
Nephrology Nursing Shortage and Solutions: group work presentations.(ANNA Summit on National Nephrology and Solutions)
Aug 01, 2003; After hearing the presentations, the Summit participants were divided into seven groups, with each group composed of a diverse...