nephrology

Nephrology
Medical speciality









Nephrology is the medical specialty branch of internal medicine that deals with the study of renal structure and function, both in health and disease, including the prevention and treatment of kidney diseases. The word nephrology is derived from the Greek voice νεφρός (nephrós), which means kidney, and the suffix -logía (study, treatise).

Definition Edit

Nephrology can be defined as the clinical specialty that deals with the study of anatomy, physiology, pathology, health promotion, prevention, clinical, therapeutic and rehabilitation of diseases of the urinary system as a whole, including the urinary tract that have an impact on the renal parenchyma. Unlike urology, this is not a surgical specialty.

The specialist in nephrology is called a nephrologist. Nephrology should not be confused with urology, which is the surgical specialty of the urinary system and the male genital tract.
Scope of the specialty

Nephrology refers to the diagnosis of kidney disease and its treatment, both with medications and with renal replacement therapy (which includes the follow-up of kidney transplant patients). Additionally, to nephrologists as experts in the care of electrolyte disorders and hypertension. The majority of renal conditions are chronic.
Diseases that nephrology deals with

Patients are referred to nephrology specialists for different reasons, such as the following.

    Renal insufficiency is the condition in which the kidneys stop working correctly
        Acute renal failure, a sudden loss of kidney function.
        Chronic renal failure, another doctor has detected symptoms of decline in kidney function, often a rise in creatinine, which persists for more than 3 months.
    Hematuria, loss of blood through urine.
    Proteinuria, the loss of protein, especially albumin, in the urine.
    Kidney stones.
    Kidney cancer, especially renal carcinoma, but this is usually the domain of the urologist.
    Chronic or recurrent urinary tract infections.
    Hypertension that has failed to respond to multiple forms of antihypertensive medication or may have a secondary cause.
    Hydro-electrolyte alterations or acid-base imbalance.
    People who need to start renal replacement therapy such as kidney transplant, hemodialysis and peritoneal dialysis
    Glomerulonephritis Affectation directly to the glomerulus, a fundamental part of the Nephron which is responsible for preventing certain substances in the body from being excreted abnormally in the urine.
    Nephritic syndrome nephrological syndrome characterized by loss of proteins in urine in a range less than 3.5g / 24hrs, macro or microscopic hematuria and arterial hypertension.
    Nephrotic syndrome. Nephrologic syndrome characterized by loss of proteins in urine in a range greater than 3.5g / 24hrs, edema, hypoalbuminemia, dyslipidemia, lipiduria.
    Patients in renal replacement therapies such as:
        Peritoneal dialysis: Start, placement of a Tenckhoff catheter via percutaneous route, follow-up of the dialysis patient, management of complications, mainly peritonitis.
        Hemodialysis: Start, management and placement of temporary and definitive vascular accesses, follow-up of the patient in hemodialysis, as well as diagnosis and treatment of their complications.
    Kidney transplant: Initiation of the protocol, both of the living and cadaveric donor, follow-up, surveillance of the surgical event, follow-up of the immediate post-surgical, mediate and late, management of the immunosuppression.

Diagnose Edit

As with the rest of medicine, important clues as to the cause of any symptoms are obtained with the patient's history and physical examination.

Laboratory tests are almost always directed at: urea, creatinine, electrolytes, blood biometry and urinalysis, which is often the dominant test in suggesting a diagnosis.


Specialized tests may be ordered to discover or link / link certain systemic diseases to kidney failure, such as hepatitis B or hepatitis C serologies, or lupus, paraproteinemias such as amyloidosis, multiple myeloma, or other systemic diseases that lead to failure of the kidney. Collection of a 24-hour urine sample can provide valuable information about the filtering capacity of the kidney and the amount of protein loss in some forms of kidney disease. However, in the chronic kidney disease scene, 24-hour urine samples have recently been replaced by the ratio of urine to 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 scan of the urinary tract and occasionally examine the renal blood vessels
    Computerized axial tomography when mass lesions are suspected or to help diagnose nephrolithiasis
    Scintigraphy (nuclear medicine) for the exact measurement of renal function (rarely done), diagnosis of renal artery disease, or 'split function' of each kidney
    Nuclear magnetic resonance angiography when blood vessels may be affected

Treatments in nephrology

Many kidney diseases are treated simply with medication, such as diuretics, corticosteroids, immunosuppressants, antihypertensive drugs and others. Frequently, treatment with erythropoietin and vitamin D is required to replace these two hormones, whose production decreases in chronic kidney disease.

When the symptoms of renal failure become too severe, renal replacement therapy is required. The technique of choice is kidney transplantation. This is carried out by the urologist, and in some cases by the general surgeon. However, the nephrologist is responsible for the selection of the recipient of the transplant as well as its monitoring and treatment of its complications (especially rejection and infections derived from immunosuppressive treatment).

In cases in which transplantation is not indicated or is not possible, there are other techniques, generically called renal dialysis. These include hemodialysis, hemofiltration, hemodiafiltration and peritoneal dialysis.
Other medical specialties

In cases with CKD, the control and prevention of dehydration-acidosis is important: if an adequate water intake is not possible in these patients, they can quickly reach dehydration, decrease in renal perfusion and progressive deterioration of renal function.

In chronic nephropaths, metabolic acidosis results from the inability of the kidneys to excrete enough hydrogens and to reabsorb bicarbonate. The consumption of diets with high protein content can contribute to acidosis, and this in turn leads to a series of adverse effects: anorexia, nausea, vomiting, lethargy, weakness, muscle wasting and weight loss.