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Description

Nephrology (from Greek nephros “kidney”, combined with the suffix -logy, “the study of”) is a specialty of medicine and pediatrics that concerns itself with the kidneys: the study of normal kidney function and kidney disease, the preservation of kidney health, and the treatment of kidney disease, from diet and medication to renal replacement therapy (dialysis and kidney transplantation).

 

Nephrology also studies systemic conditions that affect the kidneys, such as diabetes and autoimmune disease; and systemic diseases that occur as a result of kidney disease, such as renal osteodystrophy and hypertension. A physician who has undertaken additional training and become certified in nephrology is called a nephrologist. The term “nephrology” was first used in about 1960. Before then, the specialty was usually referred to as “kidney medicine.”

 

Nephrology concerns the diagnosis and treatment of kidney diseases, including electrolyte disturbances and hypertension, and the care of those requiring renal replacement therapy, including dialysis and renal transplant patients. Many diseases affecting the kidney are systemic disorders not limited to the organ itself, and may require special treatment. Examples include acquired conditions such as systemic vasculitides (e.g. ANCA vasculitis) and autoimmune diseases (e.g., lupus), as well as congenital or genetic conditions such as polycystic kidney disease. Patients are referred to nephrology specialists after a urinalysis, for various reasons, such as acute kidney failure, chronic kidney disease, hematuria, proteinuria, kidney stones, hypertension, and disorders of acid/base or electrolytes. History and physical examination are central to the diagnostic workup in nephrology. The history typically includes the present illness, family history, general medical history, diet, medication use, drug use and occupation. The physical examination typically includes an assessment of volume state, blood pressure, heart, lungs, peripheral arteries, joints, abdomen and flank.

 

Examination of the urine (urinalysis) allows a direct assessment for possible kidney problems, which may be suggested by appearance of blood in the urine (haematuria), protein in the urine (proteinuria), pus cells in the urine (pyuria) or cancer cells in the urine. A 24-hour urine collection can be used to quantify daily protein loss (see proteinuria), urine output, creatinine clearance or electrolyte handling by the renal tubules. Basic blood tests can be used to check the concentration of hemoglobin, platelets, sodium, potassium, chloride, bicarbonate, urea, creatinine, calcium, magnesium or phosphate in the blood. All of these may be affected by kidney problems. The serum creatinine concentration can be used to estimate the function of the kidney, called the creatinine clearance or estimated glomerular filtration rate (GFR). More specialized tests can be ordered to discover or link certain systemic diseases to kidney failure such as infections (hepatitis B, hepatitis C), autoimmune conditions (systemic lupus erythematosus, ANCA vasculitis), paraproteinemias (amyloidosis, multiple myeloma) and metabolic diseases (diabetes, cystinosis).

 

Structural abnormalities of the kidneys are identified with imaging tests. These may include Medical ultrasonography/ultrasound, computed axial tomography (CT), scintigraphy (nuclear medicine), angiography or magnetic resonance imaging (MRI). In certain circumstances, less invasive testing may not provide a certain diagnosis. Where definitive diagnosis is required, a biopsy of the kidney (renal biopsy) may be performed. This typically involves the insertion, under local anesthetic and ultrasound or CT guidance, of a core biopsy needle into the kidney to obtain a small sample of kidney tissue. The kidney tissue is then examined under a microscope, allowing direct visualization of the changes occurring within the kidney. Additionally, the pathology may also stage a problem affecting the kidney, allowing some degree of prognostication. In some circumstances, kidney biopsy will also be used to monitor response to treatment and identify early relapse.

Scope of Research

Renal Failure Peritoneal Dialysis
Chronic Kidney Disease Drug-Induced Renal Failure
Poly Cystic Kidney Disease Ischemic Nephropathy
Diabetic Nephropathy Nephrolithiasis
Renal Transplantation Glomerular Disease
Haemodialysis Tubulo Interstitial Disease

 

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