Department Of Nephrology

NEPHROLOGY

Nephrology deals with the study of the normal working of the kidneys as well as their diseases. The kidneys are vital for life with their complex network of blood vessels and intricate network of tubes and tubules that filter the blood of its waste products and excess water. The kidneys maintain the fluid, electrolyte, and acid-base regulation that are altered by several disease conditions as well as drugs and toxins.  A physician who has undertaken additional training and becomes certified in nephrology is called a nephrologist.

The conditions and diseases of nephrology include:

• Glomerular disorders that affect the tiny filtering systems of the kidneys called the glomerulus
• Urine abnormalities such as excess excretion of protein, sugar, blood, casts, crystals, ls, etc.
• Tubulointerstitial diseases affect the tubules in the kidneys
• Renal vascular diseases affecting the blood vessel networks within the kidneys
• Renal failure that can be sudden or acute or long term or chronic
• Kidney and bladder stones
• Kidney infections
• Cancers of the kidneys, bladder, and urethra
• Effects of diseases like diabetes and high blood pressure on kidneys
• Acid-base imbalances
• Nephrotic syndrome and nephritis
• Ill effects of drugs and toxins on the kidneys
• Dialysis and its long-term complications - dialysis includes hemodialysis as well as peritoneal dialysis
• Autoimmune diseases including autoimmune vasculitis, lupus, etc.
• Polycystic kidneys diseases where large cysts or fluid-filled sacs are formed within the kidney impairing its functions - this is congenital and inherited or genetic condition
• Hydronephrosis

Diagnostic tests under Nephrology include:

1. Blood tests reveal the raised or altered levels of urea, creatinine, and electrolytes including sodium, potassium, calcium, magnesium, phosphates, blood urea nitrogen, etc
2. Urine analysis may reveal excess proteins that are being excreted from the body in the urine. This is a sign of kidney damage that is especially seen in diabetic nephropathy or long-term kidney diseases.
3. Glomerular Filtration Rate (GFR) is measured by studying the clearance of a substance that is freely filtered through the filtering units of the kidneys called glomerulus e.g., inulin.
4. Ultrasound scanning is one of the commonest and most used non-invasive imaging studies for kidney diseases and damage. Ultrasound uses high-frequency sound waves to create images of the abdominal organs. Diseases such as hydronephrosis, polycystic kidney disease, kidney stones, etc. are detected using ultrasound examination.
5. MR Angiography is used to detect abnormalities in the blood vessels within the kidneys. In this test, a radio-contrast dye is injected into a vein in the arm and MRI images are taken as the dye passes through the kidneys. This gives a clear picture of the blood vessel network and its abnormalities within the kidneys.

Treatments under Nephrology include:

1.     Continuous Renal Replacement Therapy (CRRT)
2.     Peritoneal Dialysis (CPD)
3.     Plasma Dialysis (Plasmapheresis)
4.     Liver Dialysis (MARS Therapy)
5.     Kidney Transplant
6.     Combined Kidney & Liver Transplant and Kidney Biopsy

The most important primary treatment is Dialysis:

Dialysis is the process of removing excess water, solutes, and toxins from the blood in those kidneys that can no longer perform these functions naturally. This is referred to as renal replacement therapy. Dialysis is needed during the end-stage kidney failure, loss of about 85 to 90 % of kidney function, and having a GFR of less than 15.

When the kidneys fail, dialysis keeps the body in balance by removing waste, salt, and extra water to prevent them from building up in the body. Dialysis keeps a safe level of certain chemicals in the blood, such as potassium, sodium, and bicarbonate. This procedure also helps to control blood pressure.