Located just below your ribcage are your two kidneys on either side of the spine. The kidneys perform several key functions, namely,
Being a specialty of internal medicine, nephrology concentrates on conditions and subsequent treatment that affect the kidneys.
What is Nephrology?
‘Nephros’ is a Greek word that denotes ‘kidney’ which has been combined with the suffix ‘logy’, meaning ‘the study of’. A branch of internal medicine and paediatrics, nephrology is concerned with the kidneys in the body, its normal day-to-day functioning, related kidney conditions, the overall preservation of the health of the kidneys followed by treating kidney related conditions through medications and diet along with dialysis and ultimately renal or kidney transplant.
Studying systematic disorders that impact the kidney, for example, diabetes and autoimmune conditions falls under the purview of nephrology. In addition to that, any systematic conditions that develop as a result of a kidney disorder, like, renal osteodystrophy and hypertension is also an area of care under nephrology.
A nephrologist is an expert medical practitioner who has received additional training and specialised in this branch of medicine of caring and treating disorders of the kidney. With advanced skills, nephrologists are able to offer diagnosis and treatment to patients without kidney issues too. They are able to work under additional areas of medicine such as internal or general medicine, transplant medicine, immunosuppression management, intensive care medicine, clinical pharmacology, perioperative medicine, or paediatric nephrology.
Supplementary sub-specialties in nephrology is also available in domains such as dialysis, kidney transplantation, chronic kidney disease, cancer-related kidney diseases or onconephrology, procedural nephrology or even non-nephrology areas.
Causes of nephrological disorders and the severity of its impact on the kidneys are investigated by the nephrologist who may prescribe treatment plans including drugs, dietary modifications or even perhaps dialysis. If none of these treatments are successful in controlling the condition, then a renal or kidney transplant may have to be performed by a transplant surgeon.
Symptoms of Nephrological Conditions
The type of kidney condition affecting the patient determines the symptoms that he or she may experience. If bacterial infection is the cause of the disorder, the most common sign for that:
Other common signs of nephrological diseases are:
These symptoms may indicate towards nephrogenic diabetes insipidus which is a kidney disorder where the kidneys are not able to remove adequate quantities of water from the urine, making the urine more concentrated.
In the majority of mild to moderate kidney related diseases, there are often very little or no symptoms that are distinctively visible. If, however, it is a case or uremia or ERSD, toxins in the patient’s blood tend to accumulate, thus, manifesting itself through these symptoms:
• If the patient has puffy eyes, hands and feet, also known as edema
• If the patient has high blood pressure
• If the patient feels exhausted frequently
• If the patient is experiencing a shortness of breath
• If the patient notices a sudden loss in appetite
• If the patient feels nauseous and has a tendency to vomit often
• If the patient is frequently thirsty
• If the patient has a bad taste in the mouth
• If the patient observes bad breath
• If the patient undergoes a sudden loss in weight
• If the patient’s skin feels itchy
• If the patient notices cramping or muscle twitching
• If the patient notes a yellowish tint to the skin
• If the patient is passing urine that is tea-coloured
Causes of Nephrological Conditions
The common reasons behind the development of nephrological conditions are:
• High blood pressure
• Hardening of the arteries that causes impairments to the blood vessels in the kidney
However, some nephrological disorders may be caused by:
• If there is swelling or inflammation of the kidneys, a condition known as nephritis as a result of an infection or an autoimmune reaction to the body’s immune system which in turn attacks and causes damage to the kidneys
Conditions such as polycystic kidney develop due to:
• If the size or shape of the kidneys are problematic, a condition referred to as anatomic disorders
• If there is interference with the inner workings of the kidneys, also known as metabolic disorders
Causes behind kidney failure may be due to:
• Specific medicines that may be toxic to the kidney tissue
• If there are blockages of the system that drains the kidneys, which can also be the result of prostate issues
A broad spectrum of disorders and conditions fall under the areas of care in nephrology. The list includes:
• Acute Kidney Injury: Disturbances in the electrolyte and acid-bases may result in acute kidney injuries where the kidney quickly loses its ability to function
• Glomerular Disease: The kidney blood filters are affected in this case, in spite of being a rare condition. The accepted cause of the condition is related to the presence of protein in the urine, known as proteinuria or blood in the urine, referred to as hematuria
• Chronic Kidney Disease: These are typically kidney related conditions which are long-term
• End stage Kidney Disease: Kidney failure is an end stage kidney disease where renal or kidney transplant is the only treatment option left in order to restore kidney function
• High Blood Pressure or Advanced Hypertension and Kidney stones: These are also common nephrological conditions
Additional nephrological disorders include:
Acute kidney failure
Intrinsic kidney diseases
Anaemia, associated to kidney disorders
Bone disease, also related to kidney conditions
Fluid and Electrolyte disorders
• Polycystic kidney disease
• Hemolytic uremic syndrome
• Renal artery stenosis
• Nephrotic syndrome
• Kidney infections
In order to diagnose the nephrological condition, your nephrologist may recommend a number of diagnostic tests and screenings including:
Multiple screenings may be prescribed to arrive at an accurate conclusion about the functioning of your kidneys through a series of blood tests and urine samples.
Blood tests that may be suggested, include:
• Glomerular filtration rate or GFR: This is a blood test that is used to measure if your kidneys are properly filtering your blood. If there is a kidney disease present in the body, the GFR starts to reduce below the acceptable levels.
• Serum creatinine: A waste product, the presence of creatinine at more than the required levels indicates kidney dysfunction
• Blood urea nitrogen or BUN: Just like creatinine, increased levels of BUN, which is also a waste product point towards a kidney dysfunction
Urine tests may also be prescribed by your nephrologist, including:
• Urinalysis: A dipstick may be used to test the collected urine sample for the presence of any abnormal amount of blood, sugar, protein or bacteria along with checking the pH balance
• Albumin/creatinine ratio or ACR: Measuring the quantity of protein albumin in the urine is the objective of the test. The presence of albumin is a possible indication of a kidney dysfunction
• 24-hour urine collection: This is a procedure where a special container is used in order to collect all the urine produced in a 24 hour cycle. Additional tests are carried out on this collected urine sample.
• Creatinine clearance: The creatinine from the 24 hours urine sample and the blood sample is measured which is then used to calculate the creatinine that has exited the blood and progressed to the urine.
• 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.
Specific procedures may be proposed by your nephrologist, post receiving the outcomes of the laboratory tests – blood and urine. The procedures are:
• Imaging tests of the kidneys
• Dialysis which may also comprise of placing the dialysis catheter
• Kidney biopsies
• Kidney transplants
Some types of nephrological conditions are treatable depending on their underlying cause. However, chronic kidney disease, does not have a cure.
Treatment plans mostly comprise of methods to assist in managing the symptoms of the condition, minimising their impact, limiting the possibility of further complications and moving towards a slow advancement of the disease. Once you approach the stage wherein the kidneys are severely damaged, then you will need to undergo end stage kidney disease treatment.
Treating the cause
The objective of your nephrologist will be to slow down and control the cause that is triggering the progression of the kidney condition. While treatment options are variable, conditions such as high blood pressure have been known to worsen the condition of the kidney leading to severe damage.
Treating complications with Medications
Some common methods of treating complicated kidney conditions include:
Medicines for High Blood Pressure: Patients diagnosed with kidney conditions may also experience high blood pressure which could possibly worsen due to the kidney condition. Medicines may be prescribed in order to control the blood pressure and also to preserve proper functioning of the kidneys. Frequent blood tests may also be recommended to monitor your condition as medicines for blood pressure tend to reduce kidney function and modify electrolyte levels.
Medicines to lower cholesterol levels: Medicines that can lower cholesterol levels are recommended as patients with chronic kidney disease along with high cholesterol are at an increased risk of a heart disease.
Medicines to treat anaemia: Supplements may be suggested which in turn are able to instigate the production of red blood cells. This, in due course of time, is able to relieve exhaustion and weakness related to anaemia.
Medicines to relieve inflammation: There is a tendency to retain fluids if you are suffering from chronic kidney disease. Inflammation in the legs as well as increase in blood pressure are side effects. Medicines prescribed to relieve the swelling also helps to regulate and balance the fluids in the body.
Medicines to protect the bones: Calcium and Vitamin D supplements may be suggested to prevent weakening of the bones and lowering the possibility of fractures.
Treatment with Low Protein Diet
Your doctor may recommend a low protein diet in order to reduce waste products in the body. This also reduces the pressure on the kidneys that must filter the waste products out of the body.
Treatment for end-stage kidney disease
If the kidney has reached the stage where it is not able to keep up with clearing the fluid and waste products on its own, this situation may lead to near total or total kidney failure. The following end stage treatments may be recommended:
Dialysis: Your waste products and additional fluid in the body is artificially removed from the blood as the kidneys are no longer capable of performing this function. There are two types of dialysis procedures, namely:
Kidney transplant: This is a surgical operation performed by a transplant surgeon where a healthy kidney from a donor replaces the damaged kidney in the patient’s body.
About the Department
The Department of Nephrology at Fortis Hospital in Chennai has a team of specialists who collaborate together offering the highest standards of care to our patients. The experts, through a multi-disciplinary approach are able to provide accurate diagnosis and treatment along with clinical consultation in all aspects of kidney disease, water and electrolyte metabolism, disturbances of bone and mineral metabolism, hypertension, transplantation, onconephrology, glomerulonephritis, and immunosuppression.
The mission at Fortis, Chennai is to foster the adaption of new technologies in advanced kidney disease treatments along with personalised care for our patients experiencing chronic kidney diseases, end stage renal disease and kidney failures. With cutting-edge research and generating new knowledge, our specialists at Fortis, Chennai are studying new ways to understand and treat chronic kidney disease.