Nephrology is the branch of internal medicine dealing with the study of the function र diseases of the kidney. The word nephrology is derived from the Greek word nephros, which means "kidney", र the suffix -ology, or "study of".
Scope of the specialty[सम्पादन गर्ने]
Most diseases affecting the kidney are not limited to the organ itself, but are systemic disorders. Nephrology concerns itself with the diagnosis of kidney disease र its treatment (medication, dialysis), र follow-up of renal transplant patients. Additionally, most nephrologists consider themselves to be expert in the care of electrolyte disorders र hypertension. Given that most renal conditions are chronic, nephrologists "grow with their patients".
Who sees a nephrologist?[सम्पादन गर्ने]
Patients are referred to nephrology specialists for various different reasons, such as :
- Acute renal failure, a sudden loss of renal function
- Chronic renal failure; another doctor has detected symptoms of declining renal function, often a rise in creatinine.
- Hematuria (blood loss in the urine)
- Proteinuria the loss of protein especially albumin in the urine
- Kidney stones
- Cancer of the kidney, mostly renal cell carcinoma but this is usually the domain of the urologist
- Chronic or recurrent urinary tract infections
- 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
As with the rest of medicine, important clues as to the cause of any symptom are gained in the history र physical examination.
More specialized tests can be ordered to discover or link certain systemic diseases to kidney failure such as hepatitis b or hepatitis c, 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 र 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 However, 24-hour urine samples have recently, in the setting of chronic renal disease, been replaced by spot urine ratio of protein र creatinine.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.;
- Ultrasound scanning of the urinary tract र occasionally examining the renal blood vessels;
- CT scanning when mass lesions are suspected or to help diagnosis nephrolithiasis;
- Scintigraphy (nuclear medicine) for accurate measurment of renal function (rarely done), diagnosis of renal artery disease, or 'split function' of each kidney;
- Angiography or Magnetic resonance imaging angiography when the blood vessels might be affected
Many kidney diseases are treated with medication, such as steroids, DMARDs (disease-modifying antirheumatic drugs), antihypertensives (many kidney diseases feature hypertension). Often erythropoietin र vitamin D treatment is required to replace these two hormones, the production of which stagnates in chronic renal disease.