Complete Guide on Nephrology
Nephrology is the branch of internal medicine's subspecialty that deals with the diagnosis and treatment of kidney-related diseases. A human body has two kidneys; they are the bean-shaped organs located on either side in the retroperitoneal space. Kidneys are responsible for removing waste products and excess fluid from the body. They are also critical for retaining fluid intake and maintaining electrolyte concentrations that may be subjected to change due to numerous conditions or medicines.
Several kidney complications are systematic disorders, i.e. they are not only confined to the organ itself. These conditions need specialized treatment and medical care.
The Nephrology Division at Narayana Health Hospitals offers comprehensive care to patients suffering from a spectrum of chronic and acute kidney diseases. We are one of the best kidney hospitals in India renowned for using advanced facilities and treatment options. The Nephrology experts at NH consistently invest time, effort, and expertise to help people maintain their kidney health through various non-invasive procedures.
Our team of experienced Nephrologists is acclaimed for its rare clinical skills and for providing top-notch treatment to all classes of people ranging from children to adults. We at NH boast an adroit team of professionals including kidney transplant specialists, nephrologists, urologists, and other nursing staff.
Diseases Treated Under the Branch of Nephrology
Nephrology focuses on ensuring the normal functioning of kidneys by treating conditions that hinder its processes. The various conditions that fall under the scope of nephrology include:
- Urine abnormalities such as excess excretion of protein, sugar, blood, casts, and crystals
- Glomerular complications that affect the tiny filtering systems of the kidneys known the glomerulus
- Cancers of the kidneys, bladder, and urethra
- Acute, sudden, long-term or chronic Renal failure
- Kidney infections
- Effects of diseases like diabetes and hypertension on the kidneys
- Acid-base fluctuations.
- Kidney and bladder stones
- Ill effects of toxins and drugs on the kidneys
- Nephrotic syndrome and nephritis
- Renal vascular diseases that disturb the blood vessel networks within the kidneys.
- Tubulointerstitial diseases affecting the kidneys tubules
- Autoimmune diseases including lupus and autoimmune vasculitis
- Dialysis and its associated long-term complications - hemodialysis as well as peritoneal dialysis
- Renal Transplantations
- Polycystic kidneys diseases in which large cysts or fluid-filled sacs grow within the kidney damaging its normal functioning – this may be congenital, inherited or genetic.
- Anemia related to kidney disease.
- Bone disease related to kidney disease
The Nephrology team at NH specializes in offering evaluation and treatment for a wide range of kidney-related complications including:
- Amyloidosis: This disease is characterized by abnormal growth of protein known as amyloids in different parts of the body.
- Diabetic kidney disorder: The long-standing complications of diabetes contribute to kidney diseases. It is one of the prominent causes of kidney failure. Around one-third of people having diabetes are exposed to the risk of developing diabetic nephropathy.
- Electrolyte disorders: This condition results from an abnormal imbalance of minerals in the body that results in potentially harmful damage to vital organs including the brain and muscles.
- Glomerulonephritis: This is a kind of disease that develops due to inflammation in tiny kidney organs called glomeruli. The glomeruli are important structures that are responsible for removing extra fluid and waste from your bloodstream.
- Hypertension (chronic hypertension): This refers to high blood pressure, a condition wherein arteries are exposed to a consistent increase in blood pressure levels. This condition affects different body organs and results in illnesses involving kidney failures, heart failure, aneurysm, and stroke.
- Kidney disease: Kidney diseases comprise a wide range of damages to the organ that results in its system failure. These complications make kidneys inefficient to remove waste and excess fluid from the body.
- Kidney failure: Also referred to as a renal failure, this is a medical condition in which kidneys become incapable of filtering out waste products from the blood.
- Lupus nephritis: This is a condition in which inflammation of kidneys occurs due to systemic lupus erythematosus (SLE), an autoimmune disease.
- Nephrotic syndrome: This is a kind of kidney disorder that occurs due to damage in small blood cells of the kidney. This syndrome results in excretion of excessive protein in your urine.
- Pyelonephritis: This is a kind of bacterial infection that leads to inflammation of substances of the kidney.
- Polycystic kidney disorder: It is a genetic disorder that leads to the development of a cluster of cysts within kidneys and results in high blood pressure and kidney failure.
- Renal insufficiency: This is a medical condition in which blood flow to kidneys reduces significantly due to renal artery diseases and leads to poor kidney functioning.
Signs and symptoms of Nephrology Diseases
Some common signs and symptoms that indicate the risk of severe kidney complication include:
- Frequent swelling in the legs, ankles, or feet
- Consistent headaches
- Dry and itchiness in the skin
- Reduced sense of taste and appetite
- Less energy and trouble concentrating
- Unexplained confusion, memory problems, or trouble focusing
- Pain, fluid in the joints, or stiffness
- Unexplained blood pressure problems
- Muscle cramps, numbness, or weakness
- Exhaustion during the day but problems sleeping at night
- Blood in the urine (hematuria)
- Reduced urine output not related to dehydration
- Abnormal weight loss
Treatments Available for Nephrology Diseases
The state-of-the-art dialysis units with modern equipment and facilities for nephrology treatment operates 24/7 at full capacity across all multispecialty hospitals of Narayana Health. Different services offered by the nephrology department include-
- Continuous Renal Replacement Therapy (CRRT)
- Peritoneal Dialysis (CPD)
- Plasma Dialysis (Plasmapheresis)
- Liver Dialysis (MARS Therapy)
- Kidney Transplant
- Combined Kidney & Liver Transplant and Kidney Biopsy
Continuous Renal Replacement Therapy (CRRT)
Patients who are critically ill tend to have a high metabolic rate as their bodies are trying to recover from the disease. They need vasoactive drugs and continuous waste elimination while also simultaneously receiving large volumes of fluid in the form of nutritional and inotropic agents and drug infusions. Therefore, CRRT or continuous renal replacement therapy is followed so that wastes and water can be gently removed without causing hypotension.
CRRT is a slow form of haemodialysis, where the blood is removed and pumped through a hemofilter.
Peritoneal Dialysis (CPD)
During peritoneal dialysis, a fluid known as dialysate is put into the peritoneal or abdominal cavity with the help of a catheter. The dialysate is allowed to sit there for several hours while waste products pass from the capillaries into the liquid. The dialysate is then drained out.
Liver Dialysis (MARS Therapy)
The Molecular Adsorbent Recirculating System or MARS therapy is based on the concept of albumin dialysis and quite effectively eliminates the protein-bound and water-soluble toxins. The treatment procedure could facilitate liver regeneration and stabilisation of vital organ functions.
Patients with kidney failure have to go for dialysis or a kidney transplant. Dialysis takes time, and patients have to visit a dialysis centre frequently for treatments. But with a liver transplantation, they don’t have to depend on a dialysis machine and can have a chance at leading a better quality of life.
Combined Kidney & Liver Transplant and Kidney Biopsy
Combined kidney and liver transplantation are usually done in patients with cirrhosis and other kidney diseases associated with it.
During a kidney biopsy, the doctor will collect samples of the kidney to check them in great detail under special microscopes. It can be done either through percutaneous biopsy or open biopsy. In a percutaneous biopsy, a needle is advanced through the skin over the kidney and guided to the required place by ultrasound.
In an open biopsy, the sample is taken from the kidney during surgery.
Other treatment options available are:
- Full range dialysis services and chronic dialysis on an outpatient basis.
- Chronic peritoneal dialysis care, including continuous cycling peritoneal dialysis (CCPD) or continuous ambulatory peritoneal dialysis (CAPD).
- Real-time ultrasound guidance for Percutaneous needle biopsy of native kidneys and kidney transplants.
- Percutaneous cannula placement through ultrasound guidance
- Dialysis and transplant services for patients with end-stage renal complications.
- Therapies to all end-stage renal disease, including kidney transplantation, hemodialysis, and peritoneal dialysis.
- Continuous renal replacement therapy, including citrate anticoagulation for critically ill patients.
Common Medical Procedures Used in Nephrology
There are several medical procedures that your Nephrologists may use for diagnosing, monitoring, and treating kidney diseases. Some of the most common ones are:
Ultrasound: Ultrasound is an imaging test that uses high-frequency sound waves to capture internal images of your kidneys. This test helps in the identification of abnormalities in kidneys such as a change in size and position. Moreover, it can detect the presence of obstructions involving the formation of cysts or tumors.
CT scan: As known as computed tomography, a CT scan allows doctors to capture cross-sectional images of kidneys. Sometimes the process may also be performed using intravenous contrast dye. This test can identify obstruction in organs in a more precise manner.
Biopsy: A biopsy involves removing tiny samples of tissues by inserting a thin needle. These cells from your body help healthcare professionals examine the condition in laboratories.
You doctor may conduct a biopsy for some specific reasons including:
- Assessing kidney damage
- Identifying disease processes and checking its response to treatment
- Analyzing the complications associated with transplantation
Hemodialysis: Hemodialysis is a specialized process that uses an artificial kidney machine called hemodialyzer for extracting extra waste, fluid, and chemicals from the blood before returning it to the body. After purification blood is returned to the body through a catheter or port, in leg, arm, or neck.
This procedure is usually used for patients who have reached the end stage of kidney failure. At this stage, 85–90% functioning of kidneys is lost and during this a patient requires around 4 hours of hemodialysis sessions three times a week.
Kidney transplant: Transplantation is a surgical procedure that involves removing a particular section or the entire of the damaged kidney and replacing it with a matching donor organ.
A nephrologist is a doctor who is certified in nephrology and specializes in diagnosing and treating kidney diseases. Nephrologists study internal medicine and then go into more specialized training to treat patients with kidney disorders. They commonly deal with the treatment of chronic kidney disease, acute renal failure, kidney stones, etc. and are quite knowledgeable about kidney transplantation and dialysis. A nephrologist is usually consulted to deal with severe and complex kidney conditions.
If your kidneys are in the early stages of a disease, a general care doctor may be able to help to prevent and treat them. However, in many cases, kidney diseases occur without any or non-specific symptoms that are hard to detect. Some of them include fatigue, changes in the urine amount, and sleep troubles.
Therefore, people who are at a higher risk for kidney diseases must go through regular tests to monitor their kidney health and functioning. Individuals with diabetes, heart disease, high blood pressure, and a family history of kidney problems should be cautious.
Regular tests will help you detect any signs of declining kidney function like an increase in albumin level in urine or a decrease in GFR value. If the tests show that your kidney functions are rapidly or continually deteriorating, it's time to see a nephrologist.
Some of the common reasons why your doctor may refer you to a nephrologist are mentioned below.
- Sudden loss of kidney functions or acute renal failure
- CKD (chronic kidney disease) with a long-term decline in kidney functions
- Cystitis or bladder infections and Pyelonephritis or kidney infection
- Recurring kidney stone formation
- Presence of blood, crystals, proteins or casts in the urine
- Acid-base imbalance or electrolyte disorders
- Diabetic nephropathy
- Hypertensive nephrosclerosis (kidney damage from high blood pressure)
- Atheroembolic kidney disease (kidney damage from atherosclerosis)
- Autoimmune diseases such as lupus, autoimmune vasculitis, etc.
- Drugs or toxins that may have caused kidney damage
Though Urology and Nephrology deal with kidney problems, they are reasonably different. A urologic surgeon or urologist is a surgical specialist who treats kidney diseases caused by physical reasons, such as
- kidney stones
- prostate enlargement
- bladder infections and bladder control issues
- cancer of the urinary tract
- hydronephrosis or swelling of the kidney occurring due to the blockage in the passage of urine
- other defects like cysts and deformed kidneys, etc.
They also focus on other parts of the urinary tract, including the ureters, bladder, and urethra.
On the other hand, a nephrologist's area of expertise is focused on treating the functional issues of the kidney. They prescribe non-surgical medical treatments if your kidney function is impaired by:
- kidney failure
- blood or protein leakage in your urine
- advanced chronic kidney disease
- hypertension or high blood pressure
- inherited kidney disease
- a chemical imbalance in the blood (can occur from high or low sodium and potassium levels in the blood)
A nephrologist conducts several tests and procedures to determine various conditions and disorders of the kidney.
The laboratory tests are usually performed on the blood or urine sample of the patient. Again, there are many tests that a nephrologist can perform to check the functioning of the kidneys.
- GFR or Glomerular filtration rate: The GFR test tells whether your kidneys are functioning well to filter the blood. If you have a disease, your GFR goes below the normal levels.
- Serum creatinine: This test measures the level of creatinine in the blood. Individuals with kidney dysfunction will have a higher creatinine level in the blood.
- BUN or Blood urea nitrogen: Like creatinine, urea nitrogen is a waste product. High levels of BUN indicate kidney dysfunction.
- Urinalysis: Here, a urine sample is tested for the presence of abnormal levels of blood, glucose, bacteria, or protein.
- ACR or Albumin/creatinine ratio: It determines the level of the protein albumin in the urine.
- 24-hour urine collection: In this method, all of the urine that the patient produces is collected for 24 hours. Samples collected are sent for further testing.
- Creatinine clearance: Here, a blood sample and a 24-hour urine sample are put through the test to calculate the amount of creatinine that left the blood and moved to the urine.
A nephrologist sees patients with problems and conditions related to the kidneys or specific type of metabolic disorders. They conduct blood and urine tests to determine how well their kidneys are functioning. In some cases, they may also order an ultrasound or a kidney biopsy to get a better idea of the conditions.
However, nephrologists don’t typically perform surgeries. Operations and surgeries for the treatment of various kidney conditions are usually performed by urologists.
Dialysis is needed by a patient when he/she reaches the end stage of kidney failure. Usually, at this level a person loses around 85 to 90 percent of kidney functioning and his/her GFR becomes less than 15.
Dialysis ensures the normal functioning of the body by:
- Removing waste, extra liquid and salt to prevent it from clogging up in the body
- Maintain a proper level of chemicals in the blood, like sodium, potassium, and bicarbonate
- Controlling blood pressure levels
Nephrologists are doctors specializing in the care and treatment of kidney or renal related diseases. Disorders that are treated by nephrologists include kidney cancers, blood pressure, autoimmune disorders, diabetic nephropathy, and other related complications.
This is subjected to vary depending upon certain factors which include:
- Effectiveness of kidney function
- Type of dialyzer being used
- Bodyweight and build of a patient
- Fluid weight gained between treatments
Diabetes and high blood pressure are the two major causes responsible for kidney disease. Apart from this, other factors may include inherited kidney disorders like lupus or polycystic kidney disease.
High blood pressure, also called hypertension, results in damage to blood vessels in your vital body organs such as the heart, brain, and kidneys. However, if you already have kidney disease then it can worsen the situation for high blood pressure, making it critically dangerous.