Nephrology is the subspecialty of internal medicine concerned with kidney diseases and a broad range of kidney disorders and their effect on other body organs.
Nephrologists diagnose and treat kidney diseases, including both the conditions these diseases can produce — such as hypertension — as well as diseases that can cause kidney failure — such as diabetes mellitus and polycystic kidney disease.
Primary care physicians, surgeons or obstetricians-gynecologists usually refer patients to nephrologists in cases of protein or blood found in the urine, severe high blood pressure, kidney stones, renal insufficiency or kidney failure.
A nephrologist’s primary goal is to preserve the remaining kidney function.
There are many potential treatments, depending on the patient’s specific kidney problem. These may include medications to control problems such as inflammation of the kidneys, or they may require discontinuing other medications that could be harmful to kidney function. Dietary changes might also be appropriate. In almost all kidney diseases, control of high blood pressure is critically important to preserve kidney function.
Usually nephrologists work with other physicians, advising them about a specific diagnosis or treatment plan. In other cases they manage other skilled professionals including nurses, physical and occupational therapists, psychologists and social workers.
If a patient’s kidneys no longer function normally, an artificial kidney may be employed to carry out functions similar to a normal kidney. Called hemodialysis, this is a lifesaving treatment for chronic kidney failure. It is usually required three times a week, for three to five hours at a time.
An alternative treatment for some individuals is peritoneal dialysis. This involves placing a soft plastic catheter (tube) into the abdominal cavity so that a special fluid can be infused, allowing the removal of kidney poisons without using an artificial kidney. It is usually performed at home.
Patients with chronic renal failure will need to continue dialysis indefinitely, unless they undergo a kidney transplant. While nephrologists do not perform transplantation surgery, they determine whether a condition requires dialysis or transplantation. If a patient receives a transplant, the nephrologist usually participates in the patient’s care after surgery, helps manage the blood pressure and medication interactions, and treats other problems that might arise.