A nephrologist is a physician who specializes in field of nephrology.
Nephrology is a specialty of internal medicine that focuses on the management and treatment of kidney disease or kidney disorders.
The kidneys have several vital functions, including:
- removing waste and excess fluid from the blood
- maintaining your body’s electrolyte balance
- releasing hormones with functions such as managing blood pressure
Primary care physicians often work to help prevent early stages of kidney disease. As the situation progresses, a primary care physician may refer you to a kidney specialist, the nephrologist.
A Nephrologist has completed a 3 year residency in Internal Medicine and a specialty fellowship in nephrology that is typically at least 2 years. Some nephrologists have sub-specializations in areas of nephrology such as hypertension (high blood pressure), transplant, glomerular disorders (protein or blood in urine) or critical care medicine.
What conditions does a nephrologist treat?
- protein or blood in urine
- chronic kidney disease
- kidney stones
- kidney infections
- kidney swelling due to glomerulonephritis or interstitial nephritis
- kidney cancer
- polycystic kidney disease
- renal artery stenosis
- nephrotic syndrome
- end-stage kidney disease
- kidney failure, both acute and chronic
A nephrologist may also be involved in the management of the following common conditions:
- high blood pressure
- heart disease
- peripheral vascular disease
Types of tests a nephrologist may order
- Serum creatinine. Creatinine is a waste product and is present at higher levels in the blood of people with kidney dysfunction. This is the single best routine blood test to screen for kidney problems.
- Blood urea nitrogen (BUN). This is also a waste product related to protein that is found in the blood and a sign of kidney dysfunction.
- Glomerular filtration rate (GFR) – This test measures how well your kidneys are filtering your blood. GFR begins to decrease below normal levels in kidney disease.
- Estimated Glomerular filtration rate (eGFR) – This is a test that uses other laboratory data to approximate the glomerular filtration rate. The eGFR relates to the severity of kidney dysfunction which is broken into Stages from Stage 1 to Stage 5.
|Stage 1||Stage 2||Stage 3||Stage 4||Stage 5|
|eGFR in normal range (greater than 90) with other signs of kidney damage, like protein in urine or physical damage to the kidneys||eGFR in normal range (60-89) with other signs of kidney damage, like protein in urine or physical damage to the kidneys||eGFR 30-59, moderate kidney damage||eGFR 15-29, severe kidney damage||eGFR less than 15, the kidneys are close to failure or have already failed|
- Urinalysis. A simple urine test can help to reveal presence of abnormal amounts of blood, glucose, protein, or whether there may be an infection.
- Albumin/creatinine ratio (ACR). This measures the amount of the protein, albumin in your urine. Albumin in the urine may be a sign of kidney dysfunction.
- 24-hour urine collection for Creatinine Clearance. This method uses a special container to collect all of the urine that you produce during a 24-hour period to calculate the amount of creatinine that is cleared. This may provide a more accurate assessment of kidney function compared with the eGFR.
In addition to reviewing and interpreting laboratory tests, a nephrologist may also perform or work with other specialists on the following procedures:
- imaging tests of the kidneys, such as an ultrasound (Renal Sonogram)
- dialysis, including placement of the dialysis catheter or creation of a Fistula or Graft for dialysis use
- kidney biopsies
- kidney transplants
What is the difference between nephrologist and urologist?
The fields of nephrology and urology share some overlap because they can both involve the kidneys. Nephrologists are the medical specialists of the kidney whereas Urologists are surgical specialists of the kidneys. A Urologist also focuses on diseases and conditions that can affect the male and female urinary tract such as the ureters, bladder, and urethra. A urologist also works with the male reproductive organs, such as the penis, testes, and prostate.
When to see a nephrologist
Kidney disease is very common. About 1 in 7 Americans have kidney disease and it is estimated that 33% of the population is at risk. The risk factors for chronic kidney disease are:
- high blood pressure (hypertension)
- heart disease
- a family history of kidney problems
Early stages of kidney disorders may not have any symptoms or may have nonspecific symptoms such as fatigue, sleep problems, and changes in urination. Regular testing can monitor your kidney function, particularly if you’re at risk for kidney disease. Often it is an abnormality in one of the tests above that would lead to a referral to a nephrologist. You may also seek the attention of a nephrologist if you have:
- protein in your urine
- recurring kidney stones
- high blood pressure that’s more challenging to control
- swelling in your legs
- a rare or inherited cause of kidney disease
A nephrologist is a type of doctor that specializes in diseases and conditions that affect the kidneys. Nephrologists work to treat conditions such as chronic kidney disease and help to delay the progression of kidney disease to the end stage kidney disease (requiring dialysis or transplant).