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Nephrology is that part of internal medicine that deals with kidney function, kidney problems and their treatment, and renal replacement therapy in case of renal failure (i.e., dialysis, transplantation).  Conditions that affect the kidneys, such as diabetes and autoimmune diseases, are studied along with problems arising from various kidney problems.  Urology, on the other hand, deals with the kidney’s morphology and diseases (i.e., kidney stones, cancer) as it relates to the urinary system.

The kidney has multiple functions: the removal of waste material through the urine, the maintenance of body fluids, acid and ion balance and the production of hormones (i.e., the blood forming erythropoietin and rennin for regulating blood pressure). If the kidney cannot perform the above functions due to infection, decreased blood supply, damage resulting from medications or chemicals, then we think of kidney failure.

A kidney problem may be very mild shown only in abnormal laboratory results; moderate or serious when general symptoms appear; or, end stage when kidney replacement therapy (dialysis) or transplantation becomes necessary. Kidney failure may develop acutely, with the symptoms appearing suddenly in two days or two weeks and corrected with treatment, or, chronically with the symptoms appearing gradually over a period of years, becoming irreversibly more serious.

What are the symptoms of kidney failure?

The most common, chronic kidney failures are asymptomatic at the start. The only indication of a possible problem is found in the urinalysis and blood test results. In the acute or advanced chronic stages, a person might experience high blood pressure, anemia, nausea, weakness, either too much or too little urine, oedema throughout the body or breathing difficulties.

What are the necessary tests?

Urinalysis is important for providing information on the composition of the urine, such as the presence of sugar. Microscopic testing of the sedimentation gained following urine centrifuge is also important for viewing blood cells, pus cells, and crystals that have become visible. The blood test results best showing kidney function are the urea, creatinine and GFR values.
In diagnostics, the ultrasound examination is the preferred method for determining the condition of the kidneys. This may be complemented by the Doppler for examining and measuring blood flow. Some cases may necessitate a biopsy of the kidney for cytological testing to determine the exact diagnosis and treatment.

When should you consult a nephrologist?

How to know when to consult a nephrologist and when a neurologist?

Generally, you will be referred to a nephrologist by another specialist, such as an internist or family doctor, as follows:
  • If you have pain in the kidney areas (lower back pain) especially if it is accompanied by fever.
  • Complaints at urination: this concerns an internist, gynecologist or urologist, not a nephrologist
  • Swollen ankles (periphery oedema)
  • only 20-25% are of nephrologic origin. However, if the ankle oedema is also accompanied by abnormal laboratory results for kidney function, a nephrologist should be consulted.
  • Other causes might be: heart disease, medication therapy (i.e., blood pressure medication or chronic varicose veins.
  • Reduced kidney function is a definite reason for seeing a nephrologist, often shown in the laboratory results as follows:
  • Proteinuria – excess protein in the urine
  • Microscopic haematuria – blood in the urine
  • Granular cylinders in the urinary sedimentation
  • Kidney function values: serum carbamide, elevated creatinine
  • High blood pressure – discover the cause, especially when it difficult to control.

Treatment of kidney disease

The treatment depends on the cause of the disease. Usually medication is sufficient; however, serious cases may require dialysis or transplantation.

Everyone, especially those prone to kidney problems, should undergo yearly physicals to check their kidney function.