Nephrology is the branch of internal medicine that deals with the study of renal pathology. The word nephrology derives from the Greek nephros, which means „kidney”, and the suffix -logie, or „study of”. The role of nephrology is to diagnose kidney disease and treat it, as well as follow up on kidney transplant patients.
The kidneys are paired organs shaped like beans, located retroperitoneally, on either side of the lumbar spine. The main function of the kidneys is to filter and excrete excess water and toxic substances from the blood.
The kidneys provide three major functions:
• blood filtration and urine production to eliminate waste, thus preventing the accumulation of toxins in the blood
• regulating the concentration of minerals and electrolytes (sodium, calcium, potassium, phosphorus) and the amount of fluid in the body
• production of hormones that help regulate blood pressure (renin ), in the production of red blood cells (erythropoietin) or in the regulation of phospho-calcium metabolism, with influence on the bones (activation of vitamin D)
Patients are referred to a nephrologist for a specialist consultation for various reasons, such as:
acute renal failure (rapid loss of renal function);
• chronic renal failure (detection of increases in nitrogenous products: creatinine, urea, uric acid, during routine assessments or when investigating another condition, a sign of declining kidney function);
• hematuria (highlighting of blood in urine), proteinuria (highlighting of protein in urine);
• kidney stones (formation of kidney stones that can be located in the kidneys, ureters, bladder, urethra);
• neoplasm of the urinary tract (kidney, ureteral, bladder, prostate cancer);
• urinary tract infections, recurrent or chronic, high (pyelonephritis) or low (cystitis, urethritis, prostatitis);
• the hypertensive patient, whose antihypertensive treatment does not work and in whom a secondary, possibly renal, cause is suspected;
• diabetic patient who develops diabetic nephropathy or glomerular nephropathy;
• evaluation of renal cystic disease;
• evaluation of hydroelectrolytic and acid-base disorders (hyper / hypokalemia, hypo / hypernatremia, hypo / hypercalcemia, hypo / hyperphosphataemia, metabolic acidosis, etc.);
• evaluation of various systemic diseases with secondary renal impairment (systemic lupus erythematosus, amyloidosis, gout, multiple myeloma, rheumatoid arthritis, etc.).
What happens during the nephrological consultation:
• the doctor will try to obtain information about the current problem, but also about other past or present medical conditions that may affect the health of the kidneys, about the medicines prescribed by other doctors, or those without a prescription that the patient administers;
• will eventually perform a clinical examination and measure blood pressure;
• will recommend blood and urine tests, and possibly a kidney ultrasound, which should ideally be compared with previous ones;
• sometimes a kidney biopsy may be needed, in which case the risks and benefits will be discussed;
• develop a care plan with the patient, which will sometimes include specific treatment, but most often will consist of an adapted diet, lifestyle changes, strict blood pressure and diabetes control, and regular checkups. nephrology office to assess the results.