Nephrology is the medical specialty focused on kidney function, kidney diseases, and their treatment, including medical management, dialysis, and transplantation; nephrologists diagnose, prevent, and treat disorders that affect fluid, electrolyte, and acid–base balance.
What is a nephrologist?
A nephrologist is a physician trained in internal medicine who then completes additional fellowship training focused on the kidneys and urinary system, making them experts in how the kidneys filter blood, regulate electrolytes and acid–base balance, control blood pressure, and influence red blood cell production. Nephrologists diagnose and treat acute kidney injury (AKI), chronic kidney disease (CKD), glomerular diseases, electrolyte abnormalities, and complications of systemic illnesses such as diabetes and hypertension, and they interpret specialized tests including urinalysis, urine protein quantification, estimated glomerular filtration rate (eGFR), renal imaging, and kidney biopsy to guide management. When conservative measures are insufficient, nephrologists coordinate renal replacement therapies—hemodialysis, peritoneal dialysis, and kidney transplantation—and they work closely with surgeons, dialysis teams, dietitians, and social services to optimize outcomes and quality of life. Beyond procedural care, nephrologists emphasize prevention and risk‑factor control: slowing CKD progression through blood pressure and glycemic control, medication review to avoid nephrotoxins, and lifestyle counseling. They also manage complex metabolic issues such as hyperkalemia, metabolic acidosis, fluid overload, and anemia of kidney disease, tailoring drug dosing to reduced renal function and advising on vascular access planning when dialysis is anticipated.
What does a nephrologist do?
A nephrologist focuses on the kidneys’ role in filtering waste, regulating blood pressure, balancing electrolytes and acid–base status, and supporting red blood cell production, and they apply this expertise across acute and chronic conditions. In clinical practice a nephrologist evaluates abnormal kidney function using laboratory tests (serum creatinine and estimated glomerular filtration rate), urinalysis and urine protein quantification, imaging, and when needed, kidney biopsy to identify glomerular or interstitial disease. They manage acute kidney injury (AKI) in hospitalized patients—stabilizing fluids, correcting electrolytes, and deciding when dialysis is required—and they oversee long‑term care for chronic kidney disease (CKD) by treating underlying causes (hypertension, diabetes), adjusting medications for reduced renal clearance, and addressing complications such as anemia, bone‑mineral disorders, and metabolic acidosis. Nephrologists also counsel patients about lifestyle, diet, and medication changes to slow progression, and they plan for renal replacement when appropriate: arranging hemodialysis or peritoneal dialysis, creating vascular access, and coordinating kidney transplantation with surgical and transplant teams.
What conditions does a nephrologist treat?
A nephrologist manages disorders that directly affect the kidneys and those systemic problems that impair renal function, including acute kidney injury (AKI), which requires rapid assessment of causes and often temporary renal support; chronic kidney disease (CKD) at all stages, where slowing progression and treating complications is central; and glomerular diseases (such as glomerulonephritis and nephrotic syndrome) that present with proteinuria and hematuria and frequently need biopsy‑guided diagnosis and immunomodulatory therapy. They treat electrolyte and acid–base disorders (notably hyperkalemia, hyponatremia, and metabolic acidosis), manage fluid overload and hypertension that both cause and result from kidney dysfunction, and address metabolic consequences like anemia of CKD and bone‑mineral disorders. Nephrologists also care for patients with recurrent kidney stones, congenital or structural renal abnormalities, and complications of systemic diseases—especially diabetes and poorly controlled hypertension, the leading causes of CKD. When conservative measures are insufficient, nephrologists coordinate renal replacement therapies: initiating and managing hemodialysis or peritoneal dialysis, planning vascular or peritoneal access, and arranging kidney transplantation and post‑transplant immunosuppression and follow‑up. They advise other clinicians on drug dosing in renal impairment, interpret specialized testing (eGFR, urine protein quantification, renal imaging, and kidney biopsy), and participate in multidisciplinary care to reduce cardiovascular risk and improve quality of life for patients with kidney disease.
When should I see a nephrologist?
See a nephrologist when you have persistent abnormal kidney tests, significant proteinuria, a rapid decline in kidney function, or complications such as resistant hypertension or recurrent stones—early referral improves outcomes and allows timely planning for dialysis or transplant.
You should consider nephrology referral for persistent eGFR decline (especially eGFR <30 mL/min/1.73 m²), marked albuminuria or proteinuria (for example urine albumin:creatinine ratio in the nephrotic range), abrupt or rapidly progressive loss of kidney function, treatment‑resistant hypertension, visible red blood cell casts or unexplained hematuria, recurrent or extensive kidney stones, suspected hereditary kidney disease (such as polycystic kidney disease), or CKD‑associated anemia and electrolyte disturbances that are difficult to manage.
Conclusion
Nephrology is a medical specialty dedicated to preserving kidney health, diagnosing and treating kidney diseases, and managing the complex systemic consequences of renal dysfunction; it spans prevention, medical therapy, acute care for kidney injury, and coordination of life‑sustaining treatments like dialysis and transplantation. Early detection, risk‑factor control (blood pressure, diabetes, avoidance of nephrotoxins), and timely collaboration between patients, primary care, and nephrology improve outcomes and reduce complications.
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