A nephrologist is a medical consultant who specializes in diseases and disorders relating to the kidneys and renal system. Kidney disease can be acute (immediate, often short-term illness), or chronic (long-term).
Nephrology – the study and care of the kidneys – sometimes overlaps with urology, the medical discipline relating to the bladder and urinary tract. As the kidneys are so closely linked with other body systems, nephrologists work closely with physicians from all areas of medicine and surgery.
Sometimes when a person’s kidneys are seriously compromised, either in the short or long term, they may need to have renal dialysis; a process which mimics the function of the kidneys to filter waste products from the blood. There are several different methods of dialysing or filtering the blood, and the nephrology specialist will make the decision about which is best for each patient on an individual basis.
Dialysis can be a short-term solution to acute kidney problems or a long-term ‘destination therapy’, where the patient is expected to have frequent regular dialysis (sometimes several times a week, for several hours) for the rest of their lives. It can also be a therapeutic intervention provided while the patient waits for a kidney transplant. People who need kidney transplants can sometimes wait for a long time before a suitable donor can be found. Kidney transplants are unusual in that a kidney can be taken from a live donor with relatively few side effects to the donor. Transplantable kidneys can also be taken from deceased organ donors.
People who have had a kidney transplant will need to be on immunosuppressant medication for life to stop their body from rejecting the donor's kidney. Kidney transplant recipients will have some input from a kidney specialist for the rest of their lives, partly because the medication they have to take requires careful monitoring.
Nephrologists become involved in the care of patients with kidney problems. Some kidney disease requires a high amount of input from specialist nephrologists, and their patients will generally be referred to them by other doctors, including general practitioners, when kidney problems first become apparent. Some kidney problems can be identified or monitored by routine blood tests, urine sample analysis, or physical examination.
Nephrology is usually a hospital-based discipline because of the potentially high dependency of the patient, and because the equipment a nephrologist uses is often very high tech. Nephrologists use modern imaging techniques such as ultrasound and MRI as well as basic observations and examinations, biopsies (tissue samples) and reported patient histories to assess, diagnose and treat kidney problems.
Kidney function can be impaired by some medication, and people who take essential medication which is known to have an effect on the kidneys will need regular monitoring. Doctors from other disciplines who discover problems with their patients’ kidneys can consult and liaise with kidney specialists. For example, diuretics (water tablets) prescribed by cardiologists for heart failure are known to impact on kidney function and if this becomes a problem then a nephrologist may become involved.