Nephrology

Nephrology is the branch of internal medicine dealing with the study of the function and diseases of the kidney. The word nephrology is derived from the Greek word nephros, which means "kidney", and the suffix -ology, or "study of".

Scope of the specialty
Most diseases affecting the kidney are not limited to the organ itself, but are systemic disorders. Nephrology concerns itself with the diagnosis of kidney disease and its treatment (medication, dialysis), and follow-up of renal transplant patients. Additionally, most nephrologists consider themselves to be expert in the care of electrolyte disorders and hypertension. Given that most renal conditions are chronic, nephrologists "grow with their patients".

Who sees a nephrologist?
Patients are referred to nephrology specialists for various different reasons, such as :
 * Acute renal failure, a sudden loss of renal function
 * Chronic renal failure; another doctor has detected symptoms of declining renal function, often a rise in creatinine.
 * Hematuria (blood loss in the urine)
 * Proteinuria the loss of protein especially albumin in the urine
 * Kidney stones
 * Cancer of the kidney, mostly renal cell carcinoma but this is usually the domain of the urologist
 * 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. 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.

Diagnosis
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:
 * Renal biopsy, to obtain a tissue diagnosis of a disorder when the exact nature or stage remains uncertain.;
 * Ultrasound scanning of the urinary tract and occasionally examining the renal blood vessels;
 * CT scanning when mass lesions are suspected or to help diagnosis nephrolithiasis;
 * Scintigraphy (nuclear medicine) for accurate measurment of renal function (rarely done), diagnosis of renal artery disease, or 'split function' of each kidney;
 * Angiography or Magnetic resonance imaging angiography when the blood vessels might be affected

Therapy
Many kidney diseases are treated with medication, such as steroids, DMARDs (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 renal disease.

When symptoms of renal failure become too severe, dialysis might be required. Please refer to dialysis for a comprehensive account of this treatment.

If patients proceed to renal transplant, nephrologist often monitor the immunosuppressive regimen and the infections that can occur at this stage.

List of useful articles and CME resources in Nephrology

Free Nephrology CME and educational Resources

 * Nephrology CME Center of Medscape
 * Cleveland Clinic's Disease Management Project Clinical Decisions Case-Based Lessons in Nephrology


 * Continuing Medical Education (CME) from OHSU - Oregon Health & Science University


 * CME list


 * The American Society of Nephrology


 * the American Society of Nephrology, the best source for upto date nephrology articles and archives of the recent publications


 * Nephrology Dialysis Transplantation from the European Renal Association, a collection of publications available online


 * Hypertension, Dialysis, and Clinical Nephrology - HDCN provides up-to-date, selected information on renal disorders and their treatment (hemodialysis, peritoneal dialysis), and about hypertension, dialysis, and clinical nephrology topics


 * The International Society of Nephrology (ISN) is a global professional organization representing physicians and scientists around the world with the mission to enhance knowledge, research, clinical practice and leadership in nephrology on a global level, according to local needs.