Nephrology (from Greek: nephros, "kidney"; and ?????, 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 hypertension, 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.
Training
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 in nephrology.
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.[2] 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:
Acute renal failure, a sudden loss of renal function
Chronic kidney disease, declining renal function, usually with an inexorable rise in creatinine.
Hematuria, blood loss in the urine
Proteinuria, the loss of protein especially albumin in the urine
Kidney stones, usually only recurrent stone formers.
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 (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.
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