Nephrology In A Nutshell

By Sagar Gupta, M.D.

Nephrology – Study of Kidney

Nephrology (​Nephros ​= ​kidney, ​the suffix -logy​ = ​​the study of) is ​a branch of medicine specializing in the diagnosis and treatment of kidney diseases. A Nephrologist is a doctor that specializes in treating conditions affecting the functioning of kidneys.

What are the diseases treated by a nephrologist?​

Some of the medical conditions that a nephrologist specializes in are:

​- Chronic kidney disease: Impairment in kidney function/ structure or urine composition that has persisted for more than three months

​- ​ Acute kidney injury: new stress on functioning of the kidneys

​- Patients on dialysis (hemodialysis: dialysis is done through blood OR peritoneal dialysis: dialysis is done through the abdomen)

​- Critically sick patients admitted in ICU needing dialysis support

– Hypertension (high blood pressure)

​- D​iabetic nephropathy​(people whose kidneys have been damaged by diabetes)

​- Glomerular diseases​/ Glomerulonephritis (Inflammation of the glomeruli – the filtering units inside the kidneys leading to the passage of blood, inflammatory cells and protein in urine)

– Kidney Transplant recipients: managing their medications and overall health

​​-​ Genetic problems like ADPKD (Polycystic kidney disease, medullary sponge kidney, nephrocalcinosis)

– Kidney stones (especially patients with recurrent kidney stones where a medical cause can be found and treated to halt the process) 

What role do kidneys play inside our bodies?

Kidneys are two beans shaped filtering units approximately 3-4 inches in length placed on each side of the spine. Their primary function is to filter the blood and get rid of toxins, drugs, and other waste materials with water and salts in the form of urine.

Also, kidneys play an essential role in maintaining a lot of other bodily functions:

  • Regulating blood pressure
  • Controlling the level of electrolytes like sodium, potassium, and chloride in the blood
  • Regulating the amount of fluid in the body
  • Help maintain acid-base balance
  • Production of a hormone called erythropoietin that helps in making blood
  • Maintaining bone health by regulating calcium and phosphorous
  • Controlling blood sugar levels

When kidneys are affected by any disease process, some of these functions are disturbed, leading to various signs and symptoms.  

​​What is chronic kidney disease or CKD?

CKD or chronic kidney disease is the medical condition when there is longstanding (more than three months) impairment in the functioning of kidneys.

Eventually, it may lead to kidney failure (or end-stage renal disease), necessitating initiation of renal replacement therapy in the form of dialysis or kidney transplantation.

What are the leading causes and risk factors for CKD?

Diseases that can damage the kidneys in the long run and cause CKD to include the following:

  • Diabetes Mellitus (high blood sugars, Type 1 or type 2)
  • Hypertension (high blood pressure)
  • Taking too many painkillers of the class NSAIDs (Non-steroidal anti-inflammatory drugs) like ibuprofen/naproxen/diclofenac/ketorolac
  • Glomerulonephritis (inflammation of the glomeruli – the filtering units inside the kidneys leading to the passage of blood, inflammatory cells and protein in the urine
  • Interstitial nephritis
  • Genetic conditions like Polycystic kidney disease
  • Obstructive nephropathy: Partial or complete but prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones, and some cancers
  • Congenital (present from birth) states like VUR (Vesicoureteral reflux – a condition that causes urine to backflow into your kidneys from the urinary bladder
  • Recurrent urinary tract and kidney infections

Factors that may increase the risk of contracting chronic kidney disease include:

  • Longstanding and poorly controlled blood sugars (Diabetes mellitus)
  • Longstanding and poorly controlled high blood pressure (Hypertension)
  • Cardiovascular diseases like heart failure
  • Smoking
  • Obesity
  • Individual races are genetically more predisposed to getting kidney diseases like African-American, Native American or Asian-American
  • Family history of kidney diseases
  • Older age

What are the symptoms of kidney diseases?

Unfortunately, many kidney diseases can be “silent killers” because most patients are relatively asymptomatic early in their course of illness with little or no symptoms.

With advanced kidney disease, patients may develop:

  • Fatigue (lack of energy, feeling tired all the time)
  • Swelling over face (especially around eyes, often worse in mornings)
  • Swelling over legs (pedal edema) and hands due to water retention
  • Shortness of breath with exertion
  • Fluid in the lungs
  • Pallor (due to low hemoglobin levels)
  • Weight loss
  • Loss of appetite
  • Nausea and vomiting
  • Disturbed sleep patterns
  • Itchy skin
  • Decreased mental sharpness
  • Muscle twitches and cramps
  • High blood pressure (hypertension) that’s difficult to control
  • Blood in the urine (hematuria)
  • Excessive frothing of urine (due to protein spillage)
  • Excessive peeing at night (nocturia)

Many of these are non-specific to kidney diseases and can occur in a variety of medical conditions.

When do you need to see a Nephrologist?

​One should see a Nephrologist if the blood test comes back with elevated levels of creatinine, derangement of electrolytes like potassium, sodium, calcium, or urine tests contains protein, blood, or pus cells. Multiple research studies have confirmed that patients who see a nephrologist earlier in their course of chronic kidney disease have a slower progression of their condition, delay initiating dialysis, and have better overall outcomes, including a lower death rate.

How are kidney diseases managed/treated?

During the early stages of chronic kidney disease (stage 1-4), your nephrologist, along with taking note of your medical history and doing a physical examination, may run a battery of tests (blood and urine) to determine the cause of kidney disease. The kidney doctor will then prescribe you medicines to treat the symptoms and complications that arise from CKD. They will also ensure to do everything to slow down the rate of progression of kidney disease.

Once the chronic kidney disease has progressed to stage 5 or a point where medicines can no longer keep you healthy enough, you will need to initiate RRT (Renal Replacement therapy) in the form of dialysis or get a kidney transplant.

Other diseases of the kidney may warrant doing a kidney biopsy. A kidney biopsy involves taking a few tiny pieces (samples) of your kidney to look at under the microscope. Special microscopes make it possible to see the kidney tissue in great detail using special techniques. Few conditions when patients need a kidney biopsy include:

  • Blood in the urine (hematuria) or
  • Protein in the urine (proteinuria)
  • Abnormal blood test results
  • Acute or chronic kidney disease with no apparent cause
  • Nephrotic syndrome and
  • Glomerular disease (Glomerulonephritis)
  • Transplanted kidney dysfunction
  • Allergic reaction in kidney
  • Prognostication

You can watch this YouTube educational video on kidney biopsy to learn more: https://youtu.be/1axAUPa91tA

Why take a second opinion in nephrology?

Nephrology encompasses a broad spectrum of diseases ranging from high blood pressure, impairment in kidney function, dialysis, kidney transplantation, and many more. Given the complexity of problems and heterogeneity in treatment protocols, the management of many kidney diseases can be challenging for expert physicians. 

This blog was written by Dr. Sagar Gupta, a specialist in Nephrology, Hypertension, and Kidney Transplantation. He is board certified by the American Board of Internal Medicine in Internal Medicine and Nephrology. He has also done a one-year fellowship in Kidney and Pancreas Transplantation accredited by the AST (American Society of Transplantation).

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