Nephrology

Source: Wikipedia, the free encyclopedia.
Nephrology
A human kidney (click on image for description).
SystemUrinary
Significant diseasesHypertension, Kidney cancer
Significant testsKidney biopsy, Urinalysis
SpecialistNephrologist
GlossaryGlossary of medicine
Nephrologist
Occupation
Names
  • Physician
Occupation type
Specialty
Activity sectors
Medicine
Description
Education required
Fields of
employment
Hospitals, Clinics

Nephrology (from

renal and nephro as appropriate including in "nephrology" and "renal replacement therapy", respectively.[1]

Nephrology also studies systemic conditions that affect the kidneys, such as diabetes and autoimmune disease; and systemic diseases that occur as a result of kidney disease, such as renal osteodystrophy and hypertension. A physician who has undertaken additional training and become certified in nephrology is called a nephrologist.

The term "nephrology" was first used in about 1960, according to the French "néphrologie" proposed by Pr. Jean Hamburger in 1953, from the Greek νεφρός / nephrós (kidney). Before then, the specialty was usually referred to as "kidney medicine".[2]

Scope

Nephrology concerns the diagnosis and treatment of kidney diseases, including

renal transplant patients.[3][4] The word 'dialysis' is from the mid-19th century: via Latin from the Greek word 'dialusis'; from 'dialuein' (split, separate), from 'dia' (apart) and 'luein' (set free). In other words, dialysis replaces the primary (excretory) function of the kidney, which separates (and removes) excess toxins and water from the blood, placing them in the urine.[5]

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.[6]

Patients are referred to nephrology specialists after a urinalysis, for various reasons, such as

kidney stones, hypertension, and disorders of acid/base or electrolytes.[7]

Nephrologist

A nephrologist is a

intensive care medicine, clinical pharmacology, perioperative medicine, or pediatric nephrology.[8]

Nephrologists may further sub-specialise in

kidney transplantation, home therapies (home dialysis), cancer-related kidney diseases (onco-nephrology
), structural kidney diseases (uro-nephrology), procedural nephrology or other non-nephrology areas as described above.

Procedures a nephrologist may perform include native kidney and transplant

angiographic or surgical fistulogram and plasty), and bone biopsy
. Bone biopsies are now unusual.

Training

India

To become a nephrologist in India, one has to complete an

MBBS (5 and 1/2 years) degree, followed by an MD/DNB (3 years) either in medicine or paediatrics, followed by a DM
/DNB (3 years) course in either nephrology or paediatric nephrology.

Australia and New Zealand

Nephrology training in Australia and New Zealand typically includes completion of a medical degree (

PhD
) in a nephrology research interest (3–4 years) is optional but increasingly common. Finally, many Australian and New Zealand nephrologists participate in career-long professional and personal development through bodies such as the Australian and New Zealand Society of Nephrology and the Transplant Society of Australia and New Zealand.

United Kingdom

In the United Kingdom, nephrology (often called renal medicine) is a subspecialty of general medicine. A nephrologist has completed medical school, foundation year posts (FY1 and FY2) and

Membership of the Royal College of Physicians (MRCP) exam before competing for a National Training Number (NTN) in renal medicine. The typical Specialty Training (when they are called a registrar, or an ST) is five years and leads to a Certificate of Completion of Training
(CCT) in both renal medicine and general (internal) medicine. In those five years, they usually rotate yearly between hospitals in a region (known as a deanery). They are then accepted on to the Specialist Register of the General Medical Council (GMC). Specialty trainees often interrupt their clinical training to obtain research degrees (MD/PhD). After achieving CCT, the registrar (ST) may apply for a permanent post as Consultant in Renal Medicine. Subsequently, some Consultants practice nephrology alone. Others work in this area, and in Intensive Care (ICU), or General (Internal) or Acute Medicine.

United States

Nephrology training can be accomplished through one of two routes. The first path way is through an internal medicine pathway leading to an Internal Medicine/Nephrology specialty, and sometimes known as "adult nephrology". The second pathway is through

ACGME or AOA accredited fellowship in nephrology. Nearly all programs train nephrologists in continuous renal replacement therapy; fewer than half in the United States train in the provision of plasmapheresis.[9]
Only pediatric trained physicians are able to train in pediatric nephrology, and internal medicine (adult) trained physicians may enter general (adult) nephrology fellowships.

Diagnosis

flank
. A rash may be relevant too, especially as an indicator of autoimmune disease.

Examination of the urine (

renal tubules
. It is now more common to measure protein loss from a small random sample of urine.

Basic blood tests can be used to check the concentration of

creatinine clearance or estimated glomerular filtration rate
(GFR).

It is a good idea for patients with longterm kidney disease to know an up-to-date list of medications, and their latest blood tests, especially the blood creatinine level. In the United Kingdom, blood tests can monitored online by the patient, through a website called RenalPatientView.

More specialized tests can be ordered to discover or link certain systemic diseases to kidney failure such as infections (

paraproteinemias (amyloidosis, multiple myeloma) and metabolic diseases (diabetes, cystinosis
).

Structural abnormalities of the kidneys are identified with imaging tests. These may include

computed axial tomography (CT), scintigraphy (nuclear medicine), angiography or magnetic resonance imaging (MRI)
.

In certain circumstances, less invasive testing may not provide a certain diagnosis. Where definitive diagnosis is required, a

stage a problem affecting the kidney, allowing some degree of prognostication. In some circumstances, kidney biopsy will also be used to monitor response to treatment and identify early relapse
. A transplant kidney biopsy may also be performed to look for rejection of the kidney.

Treatment

Treatments in nephrology can include

plasma exchange
. Kidney problems can have significant impact on quality and length of life, and so psychological support, health education and advanced care planning play key roles in nephrology.

electrolyte disturbance
may need correction. Diuretics (such as furosemide) may be used to correct fluid overload, and alkalis (such as sodium bicarbonate) can be used to treat metabolic acidosis.

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 transplantation
is the most effective treatment for end-stage kidney failure although its worldwide availability is limited by lack of availability of donor organs. Generally speaking, kidneys from living donors are 'better' than those from deceased donors, as they last longer.

Most kidney conditions are chronic conditions and so long term followup with a nephrologist is usually necessary. In the United Kingdom, care may be shared with the patient's primary care physician, called a General Practitioner (GP).

Organizations

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. In 1959, Hamburger also founded the 'Société de Néphrologie', as a continuation of the older society. It is now called Francophone Society of Nephrology, Dialysis and Transplantation (SFNDT). The second society of nephrologists, the UK Kidney Association (UKKA) was founded in 1950, originally named the Renal Association. Its first president was Arthur Osman and met for the first time, in London, on 30 March 1950. The Società di Nefrologia Italiana was founded in 1957 and was the first national society to incorporate the phrase nephrologia (or nephrology) into its name.

The word 'nephrology' appeared for the first time in a conference, on 1–4 September 1960 at the "Premier Congrès International de Néphrologie" in Evian and Geneva, the first meeting of the International Society of Nephrology (ISN, International Society of Nephrology). The first day (1.9.60) was in Geneva and the next three (2–4.9.60) were in Evian, France. The early history of the ISN is described by Robinson and Richet[10] in 2005 and the later history by Barsoum[11] in 2011. The ISN is the largest global society representing medical professionals engaged in advancing kidney care worldwide.[citation needed] It has an international office in Brussels, Belgium.[12]

In the US, founded in 1964, the National Kidney Foundation is a national organization representing patients and professionals who treat kidney diseases. Founded in 1966, the American Society of Nephrology (ASN) is the world's largest professional society devoted to the study of kidney disease. The American Nephrology Nurses' Association (ANNA), founded in 1969, promotes excellence in and appreciation of nephrology nursing to make a positive difference for patients with kidney disease. The American Association of Kidney Patients (AAKP) is a non-profit, patient-centric group focused on improving the health and well-being of CKD and dialysis patients. The National Renal Administrators Association (NRAA), founded in 1977, is a national organization that represents and supports the independent and community-based dialysis providers. The American Kidney Fund directly provides financial support to patients in need, as well as participating in health education and prevention efforts. ASDIN (American Society of Diagnostic and Interventional Nephrology) is the main organization of interventional nephrologists. Other organizations include CIDA, VASA etc. which deal with dialysis vascular access. The Renal Support Network (RSN) is a nonprofit, patient-focused, patient-run organization that provides non-medical services to those affected by chronic kidney disease (CKD).

In the United Kingdom, UK National Kidney Federation and Kidney Care UK (previously known as British Kidney Patient Association, BKPA)[13] represent patients, and the UK Kidney Association used to represent renal physicians and worked closely with a previous NHS policy directive called a National Service Framework for kidney disease.

References

  1. PMID 33713333
    .
  2. ^ Professor Priscilla Kincaid-Smith, nephrologist, Australian Academy of Science, Interview by Dr Max Blythe in 1998.
  3. ^ "Nephrology Specialty Description". American Medical Association.
  4. ^ "Nephrology". American College of Physicians.
  5. ^ "Dialysis". nhs.uk. 2017-10-19. Retrieved 2022-09-14.
  6. ^ "Kidney failure (ESRD) - Symptoms, causes and treatment options | American Kidney Fund". www.kidneyfund.org. 2021-11-17. Retrieved 2022-09-14.
  7. ^ "5 Reasons Why You May be Referred to a Nephrologist - Durham Nephrology Associates, PA". 2021-09-15. Retrieved 2022-09-13.
  8. ISSN 0085-2538
    .
  9. PMID 18417748
    .
  10. ^ "Kidney International - A Forty Year History 1960-2000". Archived from the original on 2011-08-10. Retrieved 2015-05-05.
  11. ^ [1] [dead link]
  12. ISSN 0085-2538
    .
  13. ^ "Homepage". Kidney Care UK. Retrieved 2017-12-12.

External links

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