Nephrology 22028 226046446 2008-07-16T16:17:08Z 70.91.178.185 /* Training */ rm nonsense word "thics", could possibly be "ethics" typo? {{dablink|See the article on the [[kidney]] for the anatomy and function of healthy kidneys and a list of diseases involving the kidney.}} [[Image:Kidney section.jpg|thumb|250px|A drawing of the human [[kidney]] from ''[[Gray's Anatomy]]''.]] '''Nephrology''' (from Greek: ''nephros'', "[[kidney]]"; and λόγος, ''[[logos]]'', "speech" lit. "to talk about kidney") is a branch of [[internal medicine]] and [[pediatrics]] dealing with the study of the function and diseases of the [[kidney]].<ref>[http://www.asn-online.org/facts_and_statistics/faq.aspx American Society of Nephrology | Facts and Statistics | FAQ]</ref> == Scope of the specialty == Nephrology concerns itself with the diagnosis and treatment of kidney diseases, including [[electrolyte disturbance]]s 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 systemic vasculitides and [[autoimmune diseases]] such as [[Lupus erythematosus|lupus]]. == Training == A nephrologist is a [[physician]] who has been trained in the diagnosis and management of [[kidney disease]], by regulating [[blood pressure]], regulating [[electrolytes]], balancing fluids in the body, and administering [[dialysis]]. Nephrologists treat many different kidney disorders including acid-base disorders, electrolyte disorders, nephrolithiasis ([[kidney stones]]), hypertension (high blood pressure), acute kidney disease and end-stage renal disease. Nephrology is a subspecialty of [[internal medicine]]. In the [[United States]], after [[medical school]] nephrologists complete a three year [[residency (medicine)|residency]] in [[internal medicine]] followed by a two year (or longer) [[fellowship (medicine)|fellowship]] in nephrology. Knowledge of [[internal medicine]] is required to obtain certification. To become a nephrologist requires many years of school and training. Nephrologists also must be approved by the board. To be approved, the physician must fulfill the requirements for education and training in nephrology in order to qualify to take the board's examination. If a physician passes the examination, then he or she can become a nephrology specialist. Typically, nephrologists also need two to three years of training in an ACGME accredited program in nephrology. Things that a nephrologist learns in training are fluid and acid base and electrolyte physiology, medical management of acute and chronic [[renal failure]], glomerular and casuclar disorders, tubular/interstitial disorders, mineral [[metabolism]], clinical [[pharmacology]], hypertension, epidemiology, and nutrition. Procedures a nephrologist may learn in a training program include native and transplant kidney biopsies, ultrasound guidance, placement of temporary dialysis catheters, placement of tunneled [[hemodialysis]] catheters and placement of peritoneal dialysis catheters. Nearly all programs train nephrologists in continuous renal replacement therapy; fewer than half train in the provision of plasmapheresis.<ref>http://www.ncbi.nlm.nih.gov/pubmed/18417748 Clin J Am Soc Nephrol. 2008 Apr 16</ref> Once training is satisfactorily completed, the physician is eligible to take the ABIM nephrology examination. Only [[pediatric]] trained physicians are able to train in pediatric nephrology, and internal medicine (adult) trained physicians may enter general (adult) nephrology fellowships. Physicians that achieved training in both medicine and pediatrics may subspecialize in both adult and pediatric nephrology. == Who sees a nephrologist? == Patients are referred to nephrology specialists for various reasons, such as: * [[Acute renal failure]], a sudden loss of renal function * [[Chronic kidney disease]], declining [[renal function]], usually with an inexorable rise in [[creatinine]]. * [[Hematuria]], blood loss in the urine * [[Proteinuria]], the loss of [[protein]] especially [[human serum albumin|albumin]] in the [[urine]] * [[Kidney stone]]s, usually only recurrent stone formers. * [[Chronic disease|Chronic]] or recurrent [[urinary tract infection]]s * [[Hypertension]] that has failed to respond to multiple forms of anti-hypertensive [[medication]] or could have a secondary cause * [[Electrolyte]] disorders or acid/base imbalance [[Urology|Urologists]] are surgical specialists of the [[urinary tract]] - see [[Urology]]. They are involved in renal diseases that might be amenable to [[surgery]]: * Diseases of the [[Urinary bladder|Bladder]] and [[prostate]] such as malignancy, stones, or obstruction of the urinary tract. == Diagnosis == As with the rest of [[medicine]], important clues as to the cause of any symptom are gained in the history and physical examination. Laboratory tests are almost always aimed at: [[urea]], [[creatinine]], [[electrolyte]]s, and [[urinalysis]]-- which is frequently the key test in suggesting a diagnosis. More specialized tests can be ordered to discover or link certain systemic diseases to kidney failure such as [[hepatitis b]] or [[hepatitis c]], [[Lupus nephritis|lupus]] serologies, paraproteinemias such as [[amyloidosis]] or [[multiple myeloma]] or various other systemic diseases that lead to kidney failure. Collection of a 24-hour sample of [[urine]] can give valuable information on the filtering capacity of the kidney and the amount of [[protein]] loss in some forms of kidney disease. However, 24-hour urine samples have recently, in the setting of chronic renal disease, been replaced by spot urine ratio of protein and creatinine. Other tests often performed by nephrologists are: * Renal [[biopsy]], to obtain a ''tissue diagnosis'' of a disorder when the exact nature or stage remains uncertain.; * [[Medical ultrasonography|Ultrasound]] scanning of the urinary tract and occasionally examining the renal blood vessels; * [[Computed axial tomography|CT scanning]] when mass lesions are suspected or to help diagnosis [[nephrolithiasis]]; * [[Scintigraphy]] ([[nuclear medicine]]) for accurate measurement of renal function (rarely done), and [[MAG3 scan]]s for diagnosis of renal artery disease or 'split function' of each kidney; * [[Angiography]] or [[Magnetic resonance imaging]] angiography when the [[blood vessel]]s might be affected == Therapy == Many kidney diseases are treated with [[medication]], such as [[steroid]]s, [[DMARD]]s (disease-modifying antirheumatic drugs), [[antihypertensive]]s (many kidney diseases feature [[hypertension]]). Often [[erythropoietin]] and [[vitamin D]] treatment is required to replace these two hormones, the production of which stagnates in chronic kidney disease. When [[chronic kidney disease]] progresses to stage five, [[dialysis]] or [[renal transplant|transplant]] is required. ''Please refer to the main articles [[dialysis]] and [[renal transplant]] for a comprehensive account of these treatments.'' If patients proceed to [[renal transplant|transplant]], nephrologists will continue to follow patients to monitor the [[immunosuppressive]] regimen and watch for the [[infections|infection]] that can occur post transplant. == Notable nephrologists == <!--Attempts to add Gregory House will be reverted; this has been discussed extensively--> {{Expand list}} *[[Morrell Avram]], among the first in the United States to use the [[artificial kidney]] to treat patients with kidney failure. *[[Hugh R. Brady]], President of [[University College Dublin]], [[Ireland]] *[[William Bright]], one of the initial physicians to realize that the microscopic presence of blood and protein in the urine indicated [[kidney damage]], known today as [[glomerulonephritis]]. *[[Joseph W. Eschbach]], nephrologist whose research lead to the treatment of [[anemia]] in renal patients. *[[Georg Haas]], performed the first human [[hemodialysis]] treatment. *[[Steven C. Hebert]], made major contributions to medicine, notably in the cloning of genes that mediate or regulate the transport of sodium, potassium, and calcium across cell membranes. His work won him election to the National Academy of Sciences (NAS) in 2005 and was the basis for a new class of drugs used to treat hyperparathyroidism, a hormonal disorder that affects many of the more than 1 million patients worldwide with end-stage kidney disease. *[[Willem Johan Kolff]], is a pioneer in the development of the [[hemodialysis]] machine as well as in the field of other artificial organs. *[[Arthur Arnold Osman]], was the first doctor to call himself a [[nephrologist]]. *[[Belding H. Scribner]], one of the pioneers of ongoing [[kidney dialysis]]. ==Organizations== In the USA, the [[National Kidney Foundation]] is a national organization representing patients and professionals who treat kidney diseases. The [[American Society of Nephrology]] (ASN) is a not-for-profit organization of 11,000 physicians and scientists dedicated to the study of nephrology and committed to providing a forum for the promulgation of information regarding the latest research and clinical findings on kidney diseases. In the United Kingdom, the [[National Kidney Federation]] represents patients, and the [[Renal Association]] represents renal physicians and works closely with the [[National Service Framework]] for kidney disease. The [[Renal Support Network]] (RSN) is a nonprofit, patient-focused, patient-run organization that provides non-medical services to those affected by chronic kidney disease (CKD). The [[American Association of Kidney Patients]] (AAKP) is a non-profit, patient-centric group focused on improving the health and well-being of CKD and [[dialysis]] patients. ==References== <references/> ==External links== *[http://www.asn-online.org American Society of Nephrology] {{Nephrology}} {{Medicine}} [[Category:Nephrology| ]] [[Category:Subjects taught in medical school]] [[bn:বৃক্কবিদ্যা]] [[ca:Nefrologia]] [[ceb:Neprolohiya]] [[de:Nephrologie]] [[et:Nefroloogia]] [[es:Nefrología]] [[eu:Nefrologia]] [[fr:Néphrologie]] [[gl:Nefroloxía]] [[id:Nefrologi]] [[it:Nefrologia]] [[he:נפרולוגיה]] [[pam:Nephrology]] [[la:Nephrologia]] [[lt:Nefrologija]] [[hu:Nefrológia]] [[nl:Nefrologie]] [[ne:मृगौलाशास्त्र]] [[ja:腎臓学]] [[pl:Nefrologia]] [[pt:Nefrologia]] [[ro:Nefrologie]] [[ru:Нефрология]] [[sr:Нефрологија]] [[fi:Nefrologia]] [[sv:Nefrologi]] [[tr:Nefroloji]] [[zh:腎臟科]]