Nephrology is a specialty of internal medicine that focuses on the treatment of diseases that affect the kidneys.
You have two kidneys. They’re located below your ribcage on either side of your spine. The kidneys have several vital functions, including:
- removing waste and excess fluid from the blood
- maintaining your body’s electrolyte balance
- releasing hormones with functions such as managing blood pressure
A nephrologist is a type of doctor that specializes in treating diseases of the kidney. Not only do nephrologists have expertise on diseases that specifically affect the kidney, but they’re also very knowledgeable about how kidney disease or dysfunction can affect other parts of your body.
Although your primary care doctor will work to help prevent and treat early stages of kidney disease, a nephrologist may be called in to help diagnose and treat more severe or complex kidney conditions.
In order to start on the path to becoming a nephrologist, you must first complete medical school. Medical school lasts four years and requires a prior bachelor’s degree.
After receiving your medical degree, you’ll need to complete a three-year residency that focuses on internal medicine. A residency allows new doctors to receive further training and education in a clinical setting and under the supervision of more senior clinicians.
Once certified in internal medicine, you must then complete a two-year fellowship in the nephrology specialty. This fellowship further hones the knowledge and clinical skills required for the specialty. After you complete your fellowship, you may take an exam to become board-certified in nephrology.
Nephrologists can work with you to help diagnose and treat the following conditions:
- blood or protein in urine
- chronic kidney disease
- kidney stones, although a urologist may also treat this
- kidney infections
- kidney swelling due to glomerulonephritis or interstitial nephritis
- kidney cancer
- polycystic kidney disease
- hemolytic uremic syndrome
- renal artery stenosis
- nephrotic syndrome
- end-stage kidney disease
- kidney failure, both acute and chronic
A nephrologist can also be involved when other factors cause kidney disease or dysfunction, including:
If you’re visiting a nephrologist, they may be involved in performing a variety of tests and procedures or interpreting the results.
A wide range of tests can be used to assess the function of your kidneys. These tests are typically performed on either a blood or urine sample.
- Glomerular filtration rate (GFR). This test measures how well your kidneys are filtering your blood. GFR begins to decrease below normal levels in kidney disease.
- Serum creatinine. Creatinine is a waste product and is present at higher levels in the blood of people with kidney dysfunction.
- Blood urea nitrogen (BUN). As with creatinine, finding high levels of this waste product in the blood is a sign of kidney dysfunction.
- Urinalysis. This urine sample can be tested with a dipstick for pH as well as the presence of abnormal amounts of blood, glucose, protein, or bacteria.
- Albumin/creatinine ratio (ACR). This urine test measures the amount of the protein albumin in your urine. Albumin in the urine is a sign of kidney dysfunction.
- 24-hour urine collection. This method uses a special container to collect all of the urine that you produce during a 24-hour period. Further testing can be performed on this sample.
- Creatinine clearance. This is a measure of creatinine from both a blood sample and a 24-hour urine sample that’s used to calculate the amount of creatinine that’s exited the blood and moved to the urine.
In addition to reviewing and interpreting the results of your laboratory tests, a nephrologist may also perform or work with other specialists on the following procedures:
- imaging tests of the kidneys, such as ultrasounds, CT scans, or X-rays
- dialysis, including placement of the dialysis catheter
- kidney biopsies
- kidney transplants
The fields of nephrology and urology share some overlap because they can both involve the kidneys. While a nephrologist focuses on diseases and conditions that affect the kidney more directly, a urologist focuses on diseases and conditions that can affect the male and female urinary tract.
The urinary tract includes the kidneys, but also several other parts such as the ureters, bladder, and urethra. A urologist also works with the male reproductive organs, such as the penis, testes, and prostate.
Conditions that a urologist may treat can include:
Your primary care doctor can help prevent and treat the early stages of kidney disease. However, sometimes these early stages may not have any symptoms or may have nonspecific symptoms such as fatigue, sleep problems, and changes in the amount you urinate.
Regular testing can monitor your kidney function, particularly if you’re at risk for kidney disease. These groups include people with:
- high blood pressure
- heart disease
- a family history of kidney problems
Testing can detect signs of decreasing kidney function, such as a decreasing GFR value or an increase in the level of albumin in your urine. If your test results indicate rapid or continuing deterioration of kidney function, your doctor may refer you to a nephrologist.
Your doctor may also refer you to a nephrologist if you have any of the following:
If you need to see a nephrologist, your primary care doctor should be able to refer you to one. In some cases, your insurance company may require that you have a referral from your primary care doctor before you can visit a specialist.
If you choose not to get a referral from your primary care doctor, check with your insurance company for a list of nearby specialists covered in your insurance network.
A nephrologist is a type of doctor that specializes in diseases and conditions that affect the kidneys. They work to treat conditions such as chronic kidney disease, kidney infections, and kidney failure.
Your primary care doctor will likely refer you to a nephrologist if you have a complex or advanced kidney condition that requires the care of a specialist.
It’s important to remember that if you have specific concerns about kidney problems, you should be sure discuss them with your doctor and request a referral, if necessary.