Definition and Overview

Nephrology is a branch of medicine and paediatrics that specializes in diagnosing, treating and managing diseases and issues of the kidneys, which include systemic conditions (such as autoimmune diseases and diabetes) and systemic issues that stem from kidney problems (such as hypertension and renal osteodystrophy).

A nephrologist is not a primary healthcare provider, which means that he is not the patient’s first point of contact when it comes to health issues. Typically, a primary care professional—such as a general practitioner or a family doctor—refers a patient to a nephrologist for an initial consultation if there are signs and symptoms pointing to an issue of the kidneys, or if an existing condition is affecting the patient’s renal function.

The referral is often made after the results of initial diagnostic tests, such as urinalysis, suggest the presence of chronic kidney disease, acute kidney failure, kidney stones, disorders of the electrolytes or acid/base and hypertension. Hematuria (the presence of blood in the urine) and proteinuria (abnormal levels of protein in the urine) are also common reasons for a nephrologist referral.

In some cases, the first visit with a nephrologist is the last, but other patients regularly see their nephrologist for follow-up visits to monitor the effectiveness of treatment or progress of the disease. The schedule of such follow-ups depends on the condition of the patient, the nature of the treatment and the discretion of the primary care physician and nephrologist.

Who Should Undergo and Expected Results

Patients experiencing moderate to serious kidney issues should see a nephrologist for a series of follow-up consultations. Those undergoing treatment for kidney diseases and disorders should also come in for consultation to monitor the progress of such treatments.

Nephrologists often supervise the care and treatment of patients who have or undergoing the following:

  • Dialysis or the clinical cleansing of blood through liquid particle separation. This treatment method is a substitute for the normal functions of the kidneys, and should be performed in a hospital or clinic under the supervision of a nephrologist.
  • Chronic kidney disease or chronic renal disease, which involves a progressive loss of kidney function over a specified period. Patients with this condition might also have diabetes or high blood pressure, which should be closely monitored by both the primary care physician and a nephrologist.
  • Polycystic kidney disease, a genetic disorder that results in the development and growth of abnormal cysts in the kidney. This condition can affect infants, children and adults.
  • Kidney stones or renal calculus, which are a solid piece of material that forms in the kidneys due to the presence of certain minerals in the urine. These stones usually leave the body when the patient is passing urine, but in some cases, they grow big enough to obstruct the ureter, which can then cause mild to severe pain.
  • Renal cancers, which include transitional cell carcinoma and renal carcinoma. In the United States, the overall five-year survival rate clock in at 73 percent, but the condition must be closely monitored by a nephrologist through follow-up consultations.
  • Renal transplantation in a patient suffering from an end-stage renal disease. After having this major procedure, the patient must regularly visit the nephrologist to monitor compatibility, prevent the immune system from rejecting the donor organ and promote general health by following a careful postoperative diet prescribed by the nephrologist.

How is the Procedure Performed?

It is important to be aware of pre-appointment restrictions set by the primary care physician or nephrologist, especially if laboratory tests or specific diagnostic procedures will be performed. These restrictions might include limiting the patient’s fluid or sodium intake.

A follow-up consultation with a nephrologist begins like a typical checkup with a primary care physician. The doctor will ask about the signs or symptoms of kidney diseases or disorders being experienced by the patient, as well as general questions about the patient’s perceived progress of his or her treatment.

If laboratory tests (such as blood, urine and electrolyte tests) were ordered before the follow-up consultation, the nephrologist will discuss the results with the patients. This discussion includes what the results mean for the patient’s health and the effectiveness of treatment. Based on these results, the nephrologist can make recommendations on lifestyle and habit changes, as well as prescribe new medications or treatment methods to improve the patient’s kidney health and functions.

Imaging tests such as renal ultrasonography, intravenous pyelography, CT scans, MRI, renal angiography, retrograde pyelography, diuretic renography, or radionuclide scanning might also be performed during the follow-up consultation to view the structures of the kidney and assess whether it is responding to treatment prescribed in the initial nephrologist consultation.

Possible Risks and Complications

Nephrology follow-up is a safe procedure, but certain risks and complications may arise if diagnostic tests are to be performed.

References:

  • National Kidney Foundation
  • American Kidney Fund
  • International Society of Nephrology
  • American Society of Nephrology
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