About Nephrologist Speciality

Nephrology is the study of kidney function and kidney diseases and a nephrologist is a medical practitioner who has additionally completed at least three years of post graduate training in general internal medicine and two years of specialised training in nephrology. Blood or protein present in urine, high blood pressure (hypertension), kidney stones, electrolyte disorder, fluid retention are some of the conditions that could prompt a person to see a nephrologist. The nephrologist will look at your medical history and ask questions about any signs or symptoms you are currently experiencing to get a picture of your entire health. You will be given a physical exam and have tests done, which may include a urinalysis, urine culture, blood test, X-ray, sonogram or kidney biopsy.
Kidney disease develops through five stages.

A nephrologist will plan a suitable course of treatment for the stage you are in. The early stages of kidney disease may be treated with a healthy kidney-friendly diet, exercise and medicine that bring high blood pressure and diabetes under control.

A nephrologist is a trained medical professional who diagnoses and treats diseases related to the kidneys in men, women and children. Acute renal failure, chronic kidney diseases, decline in kidney function, chronic urinary tract infections, repeat urinary tract infections, high blood pressure that does not respond to medication, kidney stones, blood loss in the urine, protein loss in the urine are some of the medical conditions that a nephrologist provides treatment for. 

In order to become a certified nephrologist, one must complete graduation from a medical college followed by 3 years of residency in Internal Medicine. After that, nephrologists must complete a two- to three-year fellowship in nephrology. During fellowship, nephrologists learn about glomerular/vascular disorders, tubular/interstitial disorders, hypertension, dialysis, kidney transplantation, mineral metabolism, management of acute kidney failure, management of chronic kidney disease, nutrition and interpretation of x-rays, sonograms and other tests. 

When to see a nephrologist?

Following are some medical conditions which require attention of a nephrologist:

  • Acute renal failure or sudden loss of kidney functions
  • Chronic renal/kidney disease or CKD with long term decline in kidney functions
  • Presence of blood, proteins or casts and crystals in the urine
  • Long term or recurring kidney infections including cystitis (bladder infections) and Pyelonephritis (kidney infection)
  • Kidney stones or patients who have recurrence of kidney stone formation
  • Uncontrolled high blood pressure
  • Acid base imbalance or electrolyte disorders
  • Cancers of the kidneys or urinary bladder
  • Diabetic nephropathy or diabetic kidney disease
  • Hypertensive nephrosclerosis or kidney damage due to high blood pressure
  • Atheroembolic kidney disease or kidney damage due to atherosclerosis and resulting thrombosis
  • Renal blood vessel disease
  • Nephritic syndrome
  • Nephrotic syndrome
  • Glomerulonephritis
  • Acute tubular necrosis
  • Dialysis and its long term complications - dialysis includes haemodialysis as well as peritoneal dialysis
  • Autoimmune diseases including autoimmune vasculitis, lupus, etc.
  • Hydronephrosis or damage to the kidneys due to backward flow of urine possibly due to obstruction in the outflow of urine.
  • Tubulo/interstitial renal diseases
  • Cystic diseases including polycystic kidney disease where fluid filled sacs are formed in the kidney impairing functions
  • Drugs or toxins that have caused kidney damage
  • Clinical disorders of major electrolytes
  • Medical conditions treated by a nephrologist

Kidney Failure

Kidney failure is a condition where your kidneys fail to filter waste from your blood adequately. This condition leads to dangerous levels of wastes accumulation. A nephrologist is a specialist with expertise in the management of kidney failure. 

Symptoms of Kidney failure
Symptoms include decreased urine output, fluid retention, causing swelling in your legs, ankles or feet, drowsiness, shortness of breath, fatigue, confusion, nausea, seizures or coma in severe cases, chest pain or pressure. 

Treatment of Kidney failure
A nephrologist may prescribe medications to control blood potassium, to restore blood calcium levels and dialysis to remove toxins from your blood. 

Chronic Kidney Disease

Chronic kidney disease refers to a gradual loss of kidney function. In this disease, dangerous levels of fluid, electrolytes and wastes can build up in your body. A nephrologist is a specialist with expertise in the management of chronic kidney disease. 

Symptoms of chronic kidney disease
Symptoms include nausea, vomiting, loss of appetite, fatigue and weakness, sleep problems, changes in how much you urinate, decreased mental sharpness, muscle twitches and cramps, swelling of feet and ankles, persistent itching, chest pain, shortness of breath, and high blood pressure.

Treatment of chronic kidney disease
A nephrologist may prescribe medications to control high blood pressure, to lower cholesterol, to treat anaemia, to relieve swelling, to protect your bones, to minimize waste products in your blood. In severe cases, a nephrologist may recommend dialysis or kidney transplant. 

Polycystic Kidney Disease

Polycystic kidney disease is a hereditary kidney disorder which causes fluid-filled cysts to form in the kidneys. This disease can have a serious impact on the kidney functionality. A nephrologist is a specialist with expertise in the management of polycystic kidney disease. 

Symptoms of polycystic kidney disease
Symptoms include pain or tenderness in the abdomen, blood in the urine, frequent urination, pain in the sides, urinary tract infection, kidney stones, heaviness in the back, skin that bruises easily, pale skin colour, fatigue, joint pain and nail abnormalities. 

Treatment of polycystic kidney disease
A nephrologist may prescribe pain medication, except Ibuprofen, blood pressure medication, antibiotics for urinary tract infection, a low sodium diet, diuretics to help remove excess fluid from the body or surgery to drain cysts and help relieve discomfort.

Kidney Stones

Kidney stones refer to as small, hard mineral deposits that form inside your kidneys. These stones can form in urinary bladder as well. A nephrologist is a specialist with expertise in the management of kidney stones. 

Symptoms of kidney stones
Symptoms include severe pain in the side and back, pain that spreads to the lower abdomen and groin, pain that comes in waves and fluctuates in intensity, pain on urination, red or brown urine, foul-smelling urine, nausea and vomiting, persistent need to urinate, urinating more often than usual, fever and chills if an infection is present, urinating small amounts of urine.

Treatment of kidney stones
A nephrologist will suggest drinking at least 3 litres of water a day to flush out your urinary system. Additionally, he may prescribe pain relievers such as ibuprofen if a small stone causes some discomfort. For larger stones, a nephrologist may recommend using sound waves to break up stones or surgery to remove very large stones in the kidney.

Glomerulonephritis

Glomerulonephritis refers to damage to tiny filters inside your kidneys. More often than not, it is caused by your immune system attacking healthy body tissue. A nephrologist is a specialist with expertise in the management of glomerulonephritis. 

Symptoms of Glomerulonephritis
Symptoms include pink or cola-coloured urine from red blood cells in your urine, foamy urine due to excess protein, high blood pressure, fluid retention with swelling evident in your face, hands, feet and abdomen.

Treatment of Glomerulonephritis
Treatment for glomerulonephritis depends on the cause and severity of your condition. Mild cases may not need any treatment. A nephrologist may prescribe medicines to lower blood pressure, such as angiotensin-converting enzyme (ACE) inhibitors. 

Acute Kidney Injury

Acute kidney injury refers to sudden damage to the kidneys that causes them to not work properly. The damage can be minor in nature of there is complete kidney failure. A nephrologist is a specialist with expertise in the management of acute kidney injury. 

Symptoms of acute kidney injury
Symptoms include nausea and vomiting, dehydration, confusion, high blood pressure, abdominal pain, slight backache and a build-up of fluid in the body.

Treatment of acute kidney injury
Treatment of acute kidney injury depends on the underlying cause and extent of illness. A nephrologist may advise stopping any medication that may be causing the situation along with treating underlying infections. In severe cases, dialysis may be needed.

Kidney cysts

Kidney cysts are abnormal, fluid-filled sacs that form in the kidneys. They are associated with certain disorders that may damage kidney function. A nephrologist is a specialist with expertise in the management of kidney cysts. 

Symptoms of kidney cysts
Symptoms include dull pain in your back or side, fever and upper abdominal pain. 

Treatment of kidney cysts
In order to treat kidney cysts, a nephrologist may puncture and drain it and then fill it with alcohol or perform surgery to remove it. 

Kidney Infection (Pyelonephritis)

Kidney infection is a form of urinary tract infection that has travelled to the kidney from an infection in the bladder. A kidney infection can permanently damage your kidneys if left untreated. A nephrologist is a specialist with expertise in the management of kidney infection. 

Symptoms of Kidney infection
Symptoms include fever, back, side or groin pain, abdominal pain, frequent urination, strong, persistent urge to urinate, burning sensation or pain when urinating, pus or blood in your urine, urine that smells bad or is cloudy.

Treatment of Kidney infection
A nephrologist may prescribe antibiotics because that is generally the first line of treatment for kidney infections. In severe cases, you may be given antibiotics intravenously.    

Nephrotic Syndrome

Nephrotic syndrome is a common kidney problem where your body excretes more than required protein in your urine. It is generally caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood. A nephrologist is a specialist with expertise in the management of nephrotic syndrome. 

Symptoms of nephrotic syndrome
Symptoms include severe swelling particularly around your eyes and in your ankles and feet, foamy urine, which may be caused by excess protein in your urine and weight gain due to excess fluid retention.

Treatment of nephrotic syndrome
A nephrologist may prescribe angiotensin-converting enzyme inhibitors to control blood pressure, diuretics to control swelling by increasing your kidneys' fluid output, statins to lower cholesterol levels, blood thinners to decrease your blood's ability to clot and immune system-suppressing medications. 

Interstitial Nephritis

Interstitial Nephritis is a kidney disease marked by inflammation in between the kidney tubules. This inflammation can cause a number of kidney symptoms that range from mild to severe. A nephrologist is a specialist with expertise in the management of interstitial nephritis. 

Symptoms of Interstitial Nephritis
Symptoms include decrease in the amount of urination, fever, blood in the urine, exhaustion, confusion, fatigue, nausea, vomiting, rash, water retention, swelling, weight gain from water retention, feeling bloated, elevated blood pressure. 

Treatment of Interstitial Nephritis
Treatment for interstitial nephritis depends on the cause. If it is caused by a drug allergy, the only treatment needed may be drug removal. In other cases, a nephrologist may prescribe anti-inflammatory medications. Dialysis may be needed in extreme cases. 

IgA Nephropathy

IgA nephropathy, commonly known as Berger's disease, is a kidney disease that occurs when an antibody called immunoglobulin A (IgA) affects your kidneys. A nephrologist is a specialist with expertise in the management of IgA nephropathy.

Symptoms of IgA nephropathy
Symptoms include tea-coloured urine, repeated episodes of tea-coloured urine, pain in the sides of your back below your ribs, swelling in your hands and feet and high blood pressure.

Treatment of IgA nephropathy
A nephrologist may prescribe various medications to treat IgA nephropathy including angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), fish oil supplements, immunosuppressants and cholesterol-lowering medications.  

Lupus Nephritis

Lupus Nephritis is a condition in which your immune system begins attacking different areas of your body, especially the kidneys. A nephrologist is a specialist with expertise in the management of lupus nephritis.

Symptoms of Lupus Nephritis
Symptoms include dark urine, blood in urine, foamy, frothy urine, having to urinate often, especially at night, puffiness in the feet, ankles, and legs that worsens over the course of the day, gaining weight and high blood pressure.

Treatment of Lupus Nephritis
A nephrologist may reduce your intake of protein and salt, prescribe blood pressure medication, steroids to reduce swelling and inflammation and medicines to suppress your immune system such as prednisone. 

Hematuria (Blood in urine)

Hematuria refers to a presence red blood cells in the urine. It is usually caused by urinary tract infection, kidney stones, kidney or bladder tumour, or traumatic injury to any part of the urinary tract. A nephrologist is a specialist with expertise in the management of hematuria.  

Symptoms of Hematuria
Symptoms include pink, red or cola-coloured urine. 

Treatment of Hematuria
A nephrologist may prescribe antibiotics to clear a urinary tract infection, medication to shrink an enlarged prostate, or shock wave therapy to break up bladder or kidney stones.

Diabetic Nephropathy

Diabetic nephropathy is a form of progressive kidney disease that may occur in people having type 1 and type 2 diabetes. It is also called diabetic kidney disease. A nephrologist is a specialist with expertise in the management of diabetic nephropathy.

Symptoms of diabetic nephropathy
Symptoms include dark urine, blood in urine, foamy, frothy urine, having to urinate often, especially at night, puffiness in the feet, ankles, and legs that worsens over the course of the day, weight gain, and high blood pressure.

Treatment of diabetic nephropathy
A nephrologist may prescribe angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), medicines to control high blood sugar, lower high cholesterol, and calcium supplements. In severe cases, dialysis or kidney transplant may be required. 

Amyloidosis

Amyloidosis refers to as a group of dangerous conditions caused by deposits of abnormal protein, called amyloid in tissues and organs throughout the body. A nephrologist is a specialist with expertise in the management of amyloidosis.

Symptoms of amyloidosis
Symptoms include feeling lightheaded or fainting, particularly after standing or sitting up, numbness or a tingling feeling in the hands and feet, frothy urine, an irregular heartbeat, chest pain, erectile dysfunction, diarrhoea or constipation, blood spots on the skin, carpal tunnel syndrome or an enlarged tongue.

Treatment of amyloidosis
A nephrologist may suggest kidney transplant in people suffering from kidney failure, although the underlying bone marrow disorder will need to be suppressed by chemotherapy to prevent build-up of amyloid in the new kidney.

Urinary Tract Infection

A urinary tract infection is a form of infection affecting primarily your kidneys, ureters, bladder and urethra. Women are at greater risk of developing this disease than men. A nephrologist is a specialist with expertise in the management of urinary tract infection.

Symptoms of urinary tract infection
Symptoms include persistent urge to urinate, burning sensation when urinating, passing frequent, small amounts of urine, urine that appears cloudy, urine that appears red, bright pink, strong-smelling urine, pelvic pain in women.

Treatment of urinary tract infection
A nephrologist may prescribe medicines such as sulfamethoxazole, fosfomycin, nitrofurantoin, ciprofloxacin, levofloxacin, cephalexin, ceftriaxone, azithromycin and doxycycline.

Glomerulosclerosis

Glomerulosclerosis is a condition which occurs when there is scarring or hardening of the blood vessels located in the kidneys. Glomerulosclerosis can affect children and adults. A nephrologist is a specialist with expertise in the management of glomerulosclerosis.

Symptoms of Glomerulosclerosis
Symptoms include fluid retention in the hands, feet, legs, abdomen, foamy or bubbly urine, caused by proteinuria, high blood pressure and high cholesterol. 

Treatment of Glomerulosclerosis
A nephrologist may prescribe angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs), steroids such as prednisone, statins to control cholesterol, anticoagulants to prevent blood clots, diuretics, etc. 

Diabetes Insipidus

Diabetes insipidus refers to an imbalance of water in the body which leads to intense thirst even after drinking fluids and excretion of large amounts of urine. A nephrologist is a specialist with expertise in the management of diabetes insipidus.

Symptoms of Diabetes insipidus
Symptoms include extreme thirst, excretion of an excessive amount of diluted urine, trouble sleeping, fever, vomiting, diarrhoea, and weight loss. 

Treatment of Diabetes insipidus
For central diabetes insipidus, a nephrologist may prescribe a synthetic hormone called desmopressin for nephrogenic diabetes insipidus, a nephrologist may prescribe a low-salt diet and for gestational diabetes insipidus, a nephrologist may prescribe a synthetic hormone desmopressin.

Goodpasture Syndrome

Goodpasture syndrome is a potentially life-threatening autoimmune disease in which your immune system mistakenly attacks the tiny filtering units in your kidneys. A nephrologist is a specialist with expertise in the management of goodpasture syndrome.

Symptoms of Goodpasture syndrome
Symptoms include fatigue, weakness, or lethargy, nausea or vomiting, loss of appetite, unhealthy, pale appearance.

Treatment of Goodpasture syndrome
A nephrologist may prescribe immunosuppressive or cytoxic drugs to keep your immune system from making the antibodies that damage your kidneys and corticosteroids, such as prednisone. 

Hyperoxaluria

Hyperoxaluria refers to a condition in which there is too much oxalate in your urine. Hyperoxaluria can be genetic disorder or caused by an intestinal disease or eating too many oxalate-rich foods. A nephrologist is a specialist with expertise in the management of hyperoxaluria.

Symptoms of Hyperoxaluria
Symptoms include sudden back pain, pain in the area below the ribs on the back, blood in the urine, frequent urge to urinate, pain when urinating, chills or fever.

Treatment of Hyperoxaluria
To reduce the amount of calcium oxalate crystal formation in your kidneys, a nephrologist may prescribe doses of vitamin B-6, high fluid intake along with making subtle dietary changes. In severe cases, a kidney transplant or kidney and liver transplant may be required. 

Renal Artery Stenosis

Renal artery stenosis is a condition in which there is narrowing of one or more arteries that carry blood to your kidneys. A nephrologist is a specialist with expertise in the management of renal artery stenosis.

Symptoms of renal artery stenosis
Symptoms include high blood pressure that's difficult to treat, a whooshing sound as blood flows through a narrowed vessel, high protein levels in the urine, worsening kidney function, swelling in your body's tissues. 

Treatment of renal artery stenosis
Medications commonly prescribed by a nephrologist to treat high blood pressure associated with renal artery stenosis include angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs), diuretics, beta blockers and calcium channel blockers. When uncontrolled high blood pressure leads to worsening kidney function, a nephrologist may suggest renal angioplasty and stenting, renal artery bypass surgery and renal endarterectomy.  

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