Nephrology

 Nephrology 

Nephrology is the medical specialty, branch of internal medicine, concerned with the study of kidney structure and function, both in health and disease, including the prevention and treatment of kidney diseases. The word nephrology derives from the Greek word νεφρός (nephrós), which means kidney, and from the suffix -logy (study, treatise).

Definition

 Nephrology can be defined as the clinical specialty that deals with the study of the anatomy, physiology, pathology, health promotion, prevention, clinical, therapeutic and rehabilitation of diseases of the urinary system in its entirety, including the urinary tract that affects the renal parenchyma. Unlike urology, this is not a surgical specialty.

 The doctor specializing in nephrology is called a nephrologist. Nephrology should not be confused with urology, which is the surgical specialty of the urinary system and the male genital system.

Scope of the specialty

 Nephrology refers to the diagnosis of kidney disease and its treatment, both with medications and renal replacement therapy (including the follow-up of kidney transplant patients). Additionally, nephrologists are experts in the care of electrolyte disorders and hypertension. Most kidney conditions are chronic.

 Diseases that nephrology deals with

•  Patients are referred to nephrology specialists for different reasons, such as the following.

•  Kidney failure is the condition in which the kidneys stop working properly:

•  Acute kidney failure, a sudden loss of kidney function.

•  Chronic kidney failure, another doctor has detected symptoms of decline in kidney function, often a rise in creatinine, that persists for more than 3 months.
• Hematuria, blood loss through urine.

•  Proteinuria, the loss of protein, especially albumin, in the urine.

•  Kidney stones.

•  Cancer in the kidney, especially renal carcinoma, but this is generally the domain of the urologist.

•  Chronic or recurrent urinary tract infections.

•  Hypertension that has failed to respond to multiple forms of antihypertensive medication or may have a secondary cause.

•  Hydroelectrolyte alterations or acid-base imbalance.

•  People who need to start renal replacement therapy such as kidney transplant, hemodialysis and peritoneal dialysis.

•  Glomerulonephritis. Directly affecting the glomerulus, a fundamental part of the Nephron, which is responsible for preventing certain substances in the body from being excreted abnormally through urine.

•  Nephritic syndrome. Nephrological syndrome characterized by loss of protein in urine in a range of less than 3.5 g/24 h, macro or microscopic hematuria, and arterial hypertension.

•  Nephrotic syndrome. Nephrological syndrome characterized by loss of protein in urine in a range greater than 3.5 g/24 h, edema, hypoalbuminemia, dyslipedmia, lipiduria.

•  Patients on renal replacement therapies such as:

•  Peritoneal dialysis: Start, placement of percutaneous Tenckhoff catheter, monitoring of the patient on dialysis, management of complications, mainly peritonitis.

•  Hemodialysis: Initiation, management and placement of temporary and definitive vascular access, monitoring of the patient on hemodialysis, as well as diagnosis and treatment of its complications.

•  Kidney transplant: Start of the protocol, both for the living and cadaveric donors, follow-up, surveillance of the surgical event, immediate, medium and late post-surgical follow-up, management of immunosuppression.

Diagnosis

 As with all medicine, important clues as to the cause of any symptoms come from the patient's history and physical examination.

 Laboratory tests almost always address urea, creatinine, electrolytes, blood count, and urinalysis, which is often the dominant test in suggesting a diagnosis.

 Specialized tests may be ordered to detect or link certain systemic diseases to kidney failure, such as hepatitis B or hepatitis C serologies, or lupus, paraproteinemias such as amyloidosis, multiple myeloma, or other systemic diseases that lead to kidney failure. kidney. Collecting a 24-hour urine sample can give valuable information about the filtering capacity of the kidney and the amount of protein loss in some forms of kidney disease. However, in the chronic kidney disease scene, 24-hour urine samples have recently been replaced by the urine point ratio of protein and creatinine.

 Other tests often performed by nephrologists are:

•  Kidney biopsy, to obtain a tissue diagnosis of a disorder when the nature or exact stage remains uncertain.

•  Ultrasound scan of the urinary tract and occasionally examine the renal blood vessels.

•  Computed axial tomography when mass lesions are suspected or to aid in the diagnosis of nephrolithiasis.

•  Scintigraphy (nuclear medicine) for accurate measurement of kidney function (rarely done), diagnosis of renal artery disease, or 'split function' of each kidney.

•  Nuclear magnetic resonance angiography when blood vessels may be affected.

Treatments in nephrology

 Many kidney diseases are treated simply with medication, such as diuretics, corticosteroids, immunosuppressants, antihypertensives, and others. Treatment with erythropoietin and vitamin D is often required to replace these two hormones, the production of which is decreased in chronic kidney disease.

 When the symptoms of kidney failure become too severe, renal replacement therapy is required. The technique of choice is kidney transplantation. This is carried out by the urologist, and in some cases by the general surgeon. However, the nephrologist is responsible for selecting the transplant recipient as well as monitoring and treating complications (especially rejection and infections resulting from immunosuppressive treatment).

 In cases where transplantation is not indicated or is not possible, there are other techniques, generically called kidney dialysis. Among these, it is worth highlighting hemodialysis, hemofiltration, hemodiafiltration and peritoneal dialysis.

Other medical specialties

 In cases with CKD, it is important to control and prevent dehydration-acidosis: if adequate water intake is not possible in these patients, they can quickly lead to dehydration, decreased renal perfusion and progressive deterioration of renal function.

 In chronic kidney disease, metabolic acidosis is a product of the inability of the kidneys to excrete sufficient hydrogen ions and to reabsorb bicarbonate. Consumption of high protein diets can contribute to acidosis, and this in turn leads to a series of adverse effects: anorexia, nausea, vomiting, lethargy, weakness, muscle wasting and weight loss.