Nephrology is a branch of internal medicine and pediatrics dealing with the study of the function and diseases of the kidney.
Nephrology concerns 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 acquired conditions such as systemic vasculitides (eg. ANCA vasculitis) and autoimmune diseases (e.g., lupus), as well as congenital or genetic conditions such as polycystic kidney disease.
In the USA, the National Kidney Foundation is a national organization representing patients and professionals who treat kidney diseases. Founded in 1966, the American Society of Nephrology (ASN) is the world’s largest professional society devoted to the study of kidney disease.
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 patients.
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 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.
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 measurement of renal function (rarely done), and MAG3 scans for diagnosis of renal artery disease or ‘split function’ of each kidney;
- Angiography or Magnetic resonance imaging angiography when the blood vessels might be affected
Many people may be in the early stages of kidney disease and not have any indication something is wrong with their kidneys. There are certain symptoms, however, that could be a sign you have kidney failure . When kidney failure is detected in the early stages, there are steps you can take to help slow the progression of kidney disease and improve your quality of life.
Below are lists of kidney failure symptoms that are grouped in categories based on a typical cause. If you have any of these symptoms, you should make an appointment with your doctor as soon as possible and ask that your kidneys be checked.
Kidney failure symptoms from buildup of wastes in the body
- A metallic taste in the mouth or ammonia breath
- Protein aversion (no longer wanting to eat meat)
- Nausea and vomiting
- Difficulty concentrating
- Loss of appetite
- Itchiness (pruritis)
Kidney failure symptoms from buildup of fluid in the body
- Swelling in the face, feet or hands
- Shortness of breath (from fluid in the lungs)
Kidney failure symptoms from damage to the kidneys
- Making more or less urine than usual
- Blood in the urine (typically only seen through a microscope)
- Urine that is foamy or bubbly (may be seen when protein is in the urine)
Kidney failure symptoms from anemia
- Shortness of breath
- Mental confusion
- Feeling cold all the time
- Desire to chew ice, clay or laundry starch (called pica)
To determine if the symptoms you have are because of kidney failure, your doctor will perform specific tests:
- Urinalysis – An examination of a sample of your urine to check for protein, blood and white blood cells in the urine
- Blood tests – Particularly a test for creatinine and BUN, waste products that healthy kidneys remove from the bloodstream.
Renal failure or kidney failure (formerly called renal insufficiency or chronic renal insufficiency) is a situation in which the kidneys fail to function adequately.
There are two forms: acute (acute kidney injury) and chronic (chronic kidney disease); either form may be due to a large number of other medical problems.
Biochemically, it is typically detected by an elevated serum creatinine. In the science of physiology, renal failure is described as a decrease in the glomerular filtration rate.
When the kidneys malfunction, problems frequently encountered are abnormal fluid levels in the body, deranged acid levels, abnormal levels of potassium, calcium, phosphate, hematuria (blood in the urine) and (in the longer term) anemia.
Long-term kidney problems have significant repercussions on other diseases, such as cardiovascular disease.