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.
Scope of the specialty
Nephrology concerns itself with the diagnosis and treatment of kidney diseases, including electrolyte disturbances
, 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 systemic vasculitides and autoimmune diseases
such as lupus
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
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.
Conditions requiring a nephrologist
Patients are referred to nephrology specialists for various reasons, such as:
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.
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:
Many kidney diseases are treated with medication
, such as steroids
(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.
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.
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.
- Robert J. Alpern, Dean of the Yale School of Medicine.
- Gerald B. Appel, leading authority on glomerular diseases and Director of Clinical Nephrology at Columbia University.
- Morrell Avram, among the first in the United States to use the artificial kidney to treat patients with kidney failure and alumnus of Long Island University.
- Hugh R. Brady, President of the University College Dublin, Ireland.
- William Bright, one of the initial physicians to realize that the microscopic presence of blood and protein in the urine indicated kidney damage, known today as glomerulonephritis.
- James Robert Cade, inventor of Gatorade.
- Joseph Castaigne, developer of the "Achard-Castaigne test", a urinary test using methylene blue dye to examine the excretory function of the kidneys, and "Castaigne test" for examining the density of urine.
- Graeme Catto, President of the General Medical Council in the United Kingdom.
- Joseph W. Eschbach, whose research led to the treatment of anemia in renal patients.
- Georg Haas, performer of the first human hemodialysis treatment.
- Steven C. Hebert, whose research led to a new class of drugs for the treatment of hyperparathyroidism in renal patients.
- Kamyar Kalantar-Zadeh, advancer of the controversial concept of reverse epidemiology.
- Willem Johan Kolff, pioneer in the development of the hemodialysis machine as well as in the field of other artificial organs.
- Jonathan Michael, knighted in the New Year's Honours List of 1 January 2005.
- Arthur Arnold Osman, first doctor to call himself a nephrologist.
- Hernán Padilla, former two-term Mayor of the oldest city in the United States: San Juan, Puerto Rico.
- Belding H. Scribner, one of the pioneers of ongoing kidney dialysis.
- Max Wilms, extensive researcher of renal tumors, also known as Wilms' tumor.
- Adrian Spitzer, extensive researcher, professor at Albert Einstein College of Medicine, Former Department Chair of Pediatric Nephrology at Montefiore Medical Center, founder of Spitzer-Weinstein Syndrome.
In the USA, the National Kidney Foundation
is a national organization representing patients and professionals who treat kidney diseases. The American Society of Nephrology (ASN) is a not-for-profit organization of 11,000 physicians and scientists dedicated to the study of nephrology and committed to providing a forum for the promulgation of information regarding the latest research and clinical findings on kidney diseases. 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