Nephrologist

A nephrologist is a doctor who has specialized in nephrology. Nephrology (from the Greek nephros – kidneys) is a branch of medicine that deals with the diagnosis, treatment and prevention of diseases of the urinary system, in particular the kidneys. Interestingly, in translation from Greek, nephro also means hidden feelings, an impulse to make a decision.

The impetus for the separation of nephrology into a separate specialty, which happened quite recently, was the emergence of such a research method as a kidney biopsy. The biopsy method allows you to take a piece of kidney tissue and see under a microscope what is really happening in the kidneys and make a reliable diagnosis. It should be noted an important feature of the kidneys: it is an incredibly silent and patient organ, kidney diseases often develop slowly, hidden, without obvious signs. It is not uncommon for people to see a nephrologist at an advanced stage of renal failure. A timely visit to a nephrologist can save your health or the health of your child!

What complaints should be addressed to a nephrologist

In addition to the formation of urine and the elimination of toxins and metabolic products, kidney fluids regulate blood pressure levels, are involved in the activation of vitamin D, and produce a hormone that stimulates the formation of red blood cells. Accordingly, complaints that are not obviously related to the kidneys, such as increased blood pressure or anemia, may be the reason for contacting. Let’s take a closer look at this.

You have every reason to think about consulting a nephrologist if you have the following complaints:

1. Pain, discomfort, chilliness in the lower back, unilateral or bilateral, can sometimes radiate to the inguinal region. Spread (irradiation) to the buttocks or thigh is not typical.
2. Increased urination at night is a quiet, early, and classic sign of kidney dysfunction. Sometimes it can be associated with an adenoma or prostatic hyperplasia.
3. Thirst and increased amount of urine.
4. Decrease in the amount of urine against the background of edema and increased blood pressure.
5. Changing the color of urine, the appearance of blood in the urine. Sometimes it can be related to food or medications.
6. Increased blood pressure.
7. Persistent anemia, weakness, pallor, earthy odor and acetone breath.
8. Changes in urine tests in the form of the appearance of red blood cells, protein.

Sometimes a consultation with a nephrologist is needed, even if there are no complaints: chronic kidney diseases, such as viral hepatitis C or even HIV infection, may not make themselves felt for many years, and they can only be identified by passing a medical examination, passing urine and blood tests. If left untreated, this can lead to kidney failure, where the kidneys are no longer able to perform vital functions. The only method of treatment in the late stage of renal failure is replacement therapy, that is, hemodialysis (artificial blood purification). It is possible to transplant or transplant a kidney, however, firstly, the kidney does not always take root, and secondly, after transplantation, it is necessary to take immunosuppressants for life. The number of people in the world requiring hemodialysis is doubling every 10 years.

You also need to consult a nephrologist if you have been diagnosed with arterial hypertension, diabetes mellitus, because these diseases lead to kidney damage over time.

How is the appointment with a nephrologist

When you come for a consultation, the nephrologist will ask you questions about your general health, the presence of other diseases, your complaints, the health of your close relatives. Bad habits, frequent use of painkillers, increased pressure – you will be asked about this. After the conversation, the doctor will conduct a general examination, measure blood pressure. After that, the specialist will prescribe an additional examination and invite you to a second appointment.

How to prepare for a doctor’s appointment

A few simple rules will help you get the most out of your visit to the doctor, and help the specialist make a diagnosis faster.

1. Write down your questions in clear handwriting in advance on a piece of paper. Give the leaflet to the doctor at the reception. This will help you remember to ask questions that are important to you and get answers from a professional.
2. Prepare and take with you all the tests and examinations, make bookmarks in the medical record with colored stickers so that they are easier to find during the consultation.
3. Before the visit, it is better to keep a diary of blood pressure and pulse for several days, take the diary with you to the consultation.
4. Write a separate list of all the medicines that you take with the dosages and take it with you to the appointment.

What diseases does a nephrologist treat?

It is important to distinguish between primary kidney diseases, that is, developing as independent diseases, and secondary nephropathies, when kidney damage is only a consequence of other diseases. Independent kidney diseases are rare and most kidney diseases are complications of diseases such as diabetes mellitus and arterial hypertension. The prevalence of these diseases among the population is high and continues to grow.

A nephrologist treats the following diseases:

1. Pyelonephritis is an infectious inflammation of the kidneys.
2. Glomerulonephritis is an immune and autoimmune inflammation of the kidneys, independent and as part of other diseases, for example, glomerulonephritis in systemic lupus erythematosus.
3. Hypertensive nephropathy – damage to the kidneys as a result of arterial hypertension.
4. Diabetic nephropathy is kidney damage due to diabetes mellitus.
5. Acute renal failure is a condition of impaired renal function against the background of poisoning, severe inflammation, trauma.
6. Chronic renal failure is a persistent impairment of kidney function.
7. Anomalies in the development of the kidneys, including polycystic.
8. Hereditary and congenital nephropathies.
9. Condition after kidney transplantation.

Pediatric nephrologists deal less with the consequences of diabetes and hypertension, but much more with anomalies in the development of the urinary system and hereditary tubulopathies. Tubulopathies are a group of diseases that are based on damage to the tubules of the nephron. Hereditary tubulopathies include:

• de Toni-Debre-Fanconi disease;
• renal diabetes insipidus;
• phosphate-diabetes;
• renal glucosuria;
• Liddle syndrome;
• Dent syndrome;
• metabolic acidosis of the first type;
• alkaptonuria.

Anomaly de Toni-Debre-Fanconi is a genetic pathology of damage to the tubules, as a result of which the absorption (reabsorption) of water and important macro- and microelements is disturbed. This leads to damage to the skeleton and nervous system. Phosphate diabetes – a genetic defect leads to impaired phosphate reabsorption, which also leads to their loss and the development of rickets. With Liddle’s syndrome, due to increased reabsorption (reabsorption) of sodium, persistent arterial hypertension, mental and mental retardation develop. Renal diabetes insipidus is caused by a mutation that prevents the tubules of the kidneys from reabsorbing water, leading to dehydration and seizures.

Hereditary nephritis with deafness or Alport syndrome is manifested by symptoms such as blood and protein in the urine, hearing loss, low blood pressure. The first signs develop in childhood and they are manifested by increased pallor of the skin, hypotension (low blood pressure), periodic hematuria (blood in the urine). Hearing loss gradually develops, there is a decrease in memory and intelligence. The final diagnosis is made only after a kidney biopsy.

Drug-induced kidney injury

Drugs that can cause kidney toxicity are called nephrotoxic drugs. Drug nephritis is a big problem that is gaining momentum, associated primarily with the abuse of painkillers grouped as NSAIDs or non-steroidal anti-inflammatory drugs. Other nephrotoxic drugs include: antibiotics – aminoglycosides, sulfonamides, first-generation cephalosporins, amphotericin B, lithium preparations, non-steroidal anti-inflammatory drugs – nise, ketonal, ibuprofen; antiviral drugs – acyclovir, anticancer drugs – methotrexate, cyclosporine.

How is the examination carried out?

The nephrologist always uses laboratory tests to diagnose and monitor the effectiveness of treatment.

• general urine analysis – reaction, density, protein, glucose and formed elements – according to these indicators, the doctor evaluates the quality of urine, which means the work of the kidneys;
• urinalysis according to Nechiporenko reflects the number of erythrocytes, leukocytes in the urine;
• complete blood count to detect inflammation and anemia;
• a biochemical blood test to determine creatinine (the main indicator of kidney function), urea, uric acid;
• functional renal tests (Zimnitsky and Rehberg).

The results of functional tests allow us to draw conclusions about how well the kidneys perform the main function – they purify the blood and remove metabolic products.

Urologist or nephrologist?

Both of these specialists deal with kidney diseases: a nephrologist and a urologist. So which one should you contact? Urology is a surgical specialty, so urologists deal primarily with diseases that may require surgical treatment – tumors, urolithiasis, anomalies in the development of the urinary system, kidney tuberculosis, etc. Nephrology is a branch of therapy, therefore, the area of ​​interest of nephrologists is kidney disease, requiring a therapeutic approach and conservative treatment. The division into nephrological and urological diseases is not entirely appropriate, since urolithiasis in the early stages can be treated by a urologist, a nephrologist, and a local therapist: with a special diet and stone-dissolving drugs. But with large stones and the ineffectiveness of conservative treatment, frequent pyelonephritis, a urologist is needed to crush or remove stones.

At the same time, the preservation of kidney function in urological diseases and nephroprotective therapy is one of the most important areas of work for a nephrologist. The nephrologist determines the need for renal replacement therapy (dialysis or transplantation). In some cases, part of the tasks of the nephrologist can be taken over by the therapist.

How to save the kidneys – the basics of nephroprotective therapy

Treatment of kidney diseases consists of two directions: universal or nephroprotective and specific treatment, which is aimed at eliminating or alleviating the underlying disease. In severe kidney failure, dialysis is used.

Normal and stable body weight, blood pressure, blood sugar and cholesterol levels are simple and effective ways to prevent kidney disease. This will help a balanced diet, rich in vegetables and fruits, and physical activity. Hypothermia, abuse of painkillers and diuretics, some antibiotics (gentamicin), and even severe stress can trigger the development or exacerbation of kidney disease. Smoking is very bad for kidney health.

It is important to observe a sufficient drinking regime – drink more fluids, 2-3 liters, especially in the hot season: fresh water, green tea, kidney herbal teas, natural fruit drinks, compotes.

With regard to nutrition, strict salt restriction (less than 5 g of sodium chloride per day) is the universal principle of dietary therapy for patients with chronic kidney disease. In case of intolerance to a strict salt-free diet, it is allowed to slightly salt the prepared dishes on a plate (on the tip of a knife). Ideally, this means cooking without salt and not adding salt on the table.

Outside of exacerbation, you can use kidney herbal teas. For example: bearberry, or lingonberry leaf – 2 parts, St. John’s wort – 1 part, chamomile – 1 part. Mix and brew in a teapot 2 teaspoons of the mixture with one glass of boiling water. Drink 1 glass 2-3 times a day.

Hemodialysis is a method that has no contraindications (except for the unwillingness of the patient, severe psychiatric illness, the inability to form a vascular access to connect the “artificial kidney” device). Effective blood purification usually requires 3 sessions of hemodialysis per week on an outpatient basis, lasting 4 hours each.

In no case should you be treated with diuretics (furosemide, hypothiazide) without a medical examination and doctor’s recommendations in order to lose weight and remove swelling. This leads to a violation of the water and electrolyte balance, thrombosis, heart rhythm disturbance, convulsions. In addition, kidney dependence develops – the kidneys “sit down” on diuretics and drug nephritis develops.

Today, the nephroprotective properties of certain drugs have been proven, which can slow down the development of kidney failure. These are angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and others). They should be prescribed by a nephrologist. On the one hand, these drugs are indicated for most patients with chronic kidney disease in terms of reducing proteinuria and maintaining function. On the other hand, there is an important exception – ischemic kidney disease with bilateral narrowing of the renal arteries, in which these drugs are contraindicated. In addition, the further kidney disease has progressed, the higher the risk of side effects of these drugs (a sharp increase in creatinine and potassium in the blood). Therefore, only a specialist doctor can prescribe drugs for kidney diseases after examination and observation.