Nephrology


Nephrology (from Greek νεφρός nephros “kidney”, combined with the suffix -logy, “the study of”) is a specialty of medicine and pediatrics that concerns itself with the study of normal kidney function, kidney problems, the treatment of kidney problems and renal replacement therapy (dialysis and kidney transplantation).

Systemic conditions that affect the kidneys (such as diabetes and autoimmune disease) and systemic problems that occur as a result of kidney problems (such as renal osteodystrophy and hypertension) are also studied in nephrology. A physician who has undertaken additional training to become an expert in nephrology may call themselves a nephrologist or renal physician.

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 (e.g. ANCA vasculitis) and autoimmune diseases (e.g., lupus), as well as congenital or genetic conditions such as polycystic kidney disease. Patients are referred to nephrology specialists after a urinalysis, for various reasons, such as acute kidney failure, chronic kidney disease, hematuria, proteinuria, kidney stones, hypertension, and disorders of acid/base or electrolytes.


Treatments in nephrology can include medications, blood products, surgical interventions (urology, vascular or surgical procedures), renal replacement therapy (dialysis or kidney transplantation) and plasma exchange. Kidney problems can have a significant impact on quality and length of life, and so psychological support, health education and advanced care planning play key roles in nephrology.

Chronic kidney disease is typically managed with the treatment of causative conditions (such as diabetes), avoidance of substances toxic to the kidneys (nephrotoxins like radiologic contrast and non-steroidal anti-inflammatory drugs), antihypertensives, diet and weight modification and planning for end-stage kidney failure. Impaired kidney function has systemic effects on the body. An erythropoetin stimulating agent may be required to ensure adequate production of red blood cells, activated vitamin D supplements and phosphate binders may be required to counteract the effects of kidney failure on bone metabolism, and blood volume and electrolyte disturbance may need correction.


Auto-immune and inflammatory kidney disease, such as vasculitis or transplant rejection, may be treated with immunosuppression. Commonly used agents are prednisone, mycophenolate, cyclophosphamide, cyclosporine, tacrolimus, everolimus, thymoglobulin and sirolimus. Newer, so-called “biologic drugs” or monoclonal antibodies, are also used in these conditions and include rituximab, basiliximab and eculizumab. Blood products including intravenous immunoglobulin and a process known as plasma exchange can also be employed.

When the kidneys are no longer able to sustain the demands of the body, end-stage kidney failure is said to have occurred. Without renal replacement therapy, death from kidney failure will eventually result. Dialysis is an artificial method of replacing some kidney function to prolong life. Renal transplantation replaces kidney function by inserting into the body a healthier kidney from an organ donor and inducing immunologic tolerance of that organ with immunosuppression. At present, renal transplantation is the most effective treatment for end-stage kidney failure although its world-wide availability is limited by lack of availability of donor organs.

Most kidney conditions are chronic conditions and so long term follow up with a nephrologist is usually necessary.

INTERESTING FACT
THE WORLD’S FIRST SOCIETY OF NEPHROLOGY WAS THE FRENCH ‘SOCIETE DE PATHOLOGIE RENALE’. ITS FIRST PRESIDENT WAS JEAN HAMBURGER, AND ITS FIRST MEETING WAS IN PARIS IN FEBRUARY 1949....Read More