View source for Nephrology

{{dablink|See the article on the [[kidney]] for the anatomy and function of healthy kidneys and a list of diseases involving the kidney.}}
[[Image:Kidney section.jpg|thumb|250px|A drawing of the human [[kidney]] from ''[[Gray's Anatomy]]''.]] 
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'''Editor-In-Chief:''' Vijay Lapsia, M.D. <small>Assistant professor of Medicine/Nephrology, Medical Director, Mount Sinai Kidney Center.</small> [mailto:vijay.lapsia@mssm.edu]

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'''Nephrology''' is the branch of [[internal medicine]] dealing with the study of the function and diseases of the [[kidney]]. The word ''nephrology'' is derived from the [[Greek language|Greek]] word ''nephros,'' which means "kidney," and the suffix ''-ology,'' signifying "study of."

== Scope of the specialty ==
Nephrology concerns itself with the diagnosis and treatment of kidney diseases including [[electrolyte disturbance]]s and [[hypertension]], and the care of those requiring [[renal replacement therapy]], including [[dialysis]] and [[renal transplant]] patients. Many diseases affecting the kidney are not limited to the organ itself, but are systemic disorders, and may require not only a whole patient approach, but also special treatment, such as systemic vasculitides or other autoimmune diseases, such as [[Lupus erythematosus|lupus]].

== Who sees a nephrologist? ==
Patients are referred to nephrology specialists for various reasons, such as:
* [[Acute renal failure]], a sudden loss of renal function
* [[Chronic kidney disease]], declining [[renal function]], usually with an inexorable rise in [[creatinine]]. 
* [[Hematuria]], blood loss in the urine
* [[Proteinuria]], the loss of [[protein]] especially [[human serum albumin|albumin]] in the [[urine]]
* [[Kidney stone]]s, usually only recurrent stone formers.
* [[Chronic disease|Chronic]] or recurrent [[urinary tract infection]]s
* [[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

[[Urology|Urologists]] are surgical specialists of the [[urinary tract]] - see [[Urology]]. They are involved in renal diseases that might be amenable to [[surgery]]:
* Diseases of the [[Urinary bladder|Bladder]] and [[prostate]] such as malignancy, stones, or obstruction of the urinary tract.

== Diagnosis ==
As with the rest of [[medicine]], important clues as to the cause of any symptom are gained in the history and physical examination.

Laboratory tests are almost always aimed at: [[urea]], [[creatinine]], [[electrolyte]]s, and [[urinalysis]]-- which is frequently the key test in suggesting a diagnosis. 

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 and 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 and 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.;
* [[Medical ultrasonography|Ultrasound]] scanning of the urinary tract and occasionally examining the renal blood vessels;
* [[Computed axial tomography|CT scanning]] when mass lesions are suspected or to help diagnosis [[nephrolithiasis]];
* [[Scintigraphy]] ([[nuclear medicine]]) for accurate measurement 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 vessel]]s might be affected

== Therapy ==
Many kidney diseases are treated with [[medication]], such as [[steroid]]s, [[DMARD]]s (disease-modifying antirheumatic drugs), [[antihypertensive]]s (many kidney diseases feature [[hypertension]]). Often [[erythropoietin]] and [[vitamin D]] treatment is required to replace these two hormones, the production of which stagnates in chronic renal disease.

When symptoms of [[renal failure]] become too severe, [[dialysis]] might be required. ''Please refer to [[dialysis]] for a comprehensive account of this treatment.''

If patients proceed to [[renal transplant]], nephrologists often monitor the [[immunosuppressive]] regimen and the [[infection]]s that can occur at this stage.

==See Also==

* [[Abderhalden-Kaufmann-Lignac syndrome]]
* [[Acute renal failure]]
* [[Alport syndrome]]
* [[Aminoaciduria]]
* [[Analgesic nephropathy]]
* [[Azotemia]]
* [[Balkan nephropathy]]
* [[Bright's disease]]
* [[Chronic kidney disease]]
* [[Chronic renal failure]]
* [[Danubian endemic familial nephropathy]]
* [[Dent's disease]]
* [[Diabetic nephropathy]]
* [[Fanconi syndrome]]
* [[Fibromuscular dysplasia]]
* [[Focal segmental glomerulosclerosis]]
* [[Galloway Mowat syndrome]]
* [[Glomerulonephritis]]
* [[Glycosuria]]
* [[Goodpasture's syndrome]]
* [[HIV associated nephropathy]]
* [[Horseshoe kidney]]
* [[Hypercalcemia]]
* [[Hypertensive nephropathy]]
* [[Hyponephrosis]]
* [[Hypophosphatemia]]
* [[IgA nephropathy]]
* [[Interstitial nephritis]]
* [[Kidney stone]]
* [[Lupus nephritis]]
* [[Medullary cystic kidney disease]]
* [[Minimal change disease]]
* [[Multicystic dysplastic kidney]]
* [[Nephritis]]
* [[Nephropathy]]
* [[Nephroptosis]]
* [[Nephrotic syndrome]]
* [[Nutcracker syndrome]]
* [[Papillorenal syndrome]]
* [[Phosphate nephropathy]]
* [[Polycystic kidney disease]]
* [[Post-streptococcal glomerulonephritis]]
* [[Pyonephrosis]]
* [[Rapidly progressive glomerulonephritis]]
* [[Rebound diuresis]]
* [[Renal agenesis]]
* [[Renal artery stenosis]]
* [[Renal cell carcinoma]]
* [[Renal osteodystrophy]]
* [[Renal papillary necrosis]]
* [[Renal tubular acidosis]]
* [[Secondary hypertension]]
* [[Tetracapsuloides bryosalmonae]]
* [[Thin basement membrane disease]]
* [[Uremia]]
* [[Wilms' tumor]]

== Pioneers in Nephrology==

*Dr. [[Joseph W. Eschbach]], nephrologist whose research lead to the treatment of [[anemia]].
*Dr. [[Georg Haas]], preformed the first human [[hemodialysis]] treatment.
*Dr. [[Willem Johan Kolff]], is a pioneer in the development of the [[hemodialysis]] machine as well as in the field of other artificial organs.
*Dr. [[Arthur Arnold Osman]], was the first [[nephrologist]].
*Dr. [[Belding H. Scribner]], one of the pioneers of [[kidney dialysis]].

==External links==
*[http://journalreview.org/spage.php?specialty_id=11&sdesc=Nephrology On-line Nephrology Journal Club (via JournalReview.org)]
*[http://www.bjrm.co.uk British Journal of Renal Medicine]
*[http://www.nature.com/ncpneph/index.html Nature Clinical Practice Nephrology]

{{Nephrology}}
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[[Category:Nephrology| ]]
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