Nephrology - Treating Diseases of the Kidney and Urinary System

Nephrology is the medical discipline that studies and treats diseases of the kidney and urinary system. Diseases of the kidney can range from cancer, hormonal issues, and electrolyte disturbances. There are a number of diseases that affect the structure and/or function of the kidney and a nephrologist is trained to diagnose and treat them. Perhaps surprisingly, the kidney is directly involved with setting our circulating blood pressure and so nephrology often covers diseases of high blood pressure or hypertension.

 

 

It requires several years of training to become board certified in nephrology. After successful completion of medical school, doctors must complete a three year residency in internal medicine. Upon successful completion of this residency, nephrology training takes place in the form of a nephrology fellowship. A nephrology fellowship usually lasts an additional two years after internal medicine (or three years if fellows pursue a year of research). In general, the completion of a nephrology fellowship trains the physician to treat patients with medical kidney disease and prepares them to take the internal medicine subspecialty examination in nephrology. Once passed, the physician is a clinical nephrologist.

 

Alternatively, a pediatric nephrologist begins by receiving training in pediatrics and then completes a fellowship in pediatric nephrology. The board certification process is separate from adult clinical nephrology but each type of doctor sees both adults and children during their fellowship.

 

A nephrologist is often called to diagnose difficult acid/base disorders. The acidity or pH of the blood needs to be maintained within a very tight range in order for the cells and organs of the body to function properly. The kidneys, along with the lungs, have a critical part to play in this matter. A long list of diseases and disorders can jeopardize this acid balance. By examining an arterial blood gas, a nephrologist can make some difficult diagnoses and propose steps to correct them.

 

Kidney dialysis is directed by a nephrologist. Renal or kidney dialysis is a process by which the blood is filtered through a dialysis machine because the kidneys no longer function as a blood filtration organ. Renal dialysis is more involved than simply hooking a person up to a machine. It requires that the nephrologist carefully calculate the concentration of various elements in the blood like sodium, potassium, and chloride among others. The filtration process removes wastes from the blood but it can also remove salts that are needed by the body. The nephrologist must replace these elements carefully and in the proper proportions.

 

One of the major concerns for patients undergoing hemodialysis is that the dialysis machine must be able to access the blood. Access for kidney dialysis is no trivial matter and requires entry into a large blood vessel that will not clot or clog. Other than vascular surgeons, the specialist that is concerned with providing and maintaining hemodialysis access is an interventional nephrologist. An interventional nephrologist is expert in placing and removing tunneled catheters, catheters for peritoneal dialysis, and central catheters. They can also perform angiography of the blood vessels of the kidney (a test to check for blockages in the artery).