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A nephrologist is a specialist physician who deals with diseases and disorders of the kidneys and renal replacement therapy. This article will discuss the training that these specialists receive and their daily schedules.

Nephrologists are physicians who focus on the diagnosis and management of conditions that affect the renal (kidney) system of the body. These specialists are also involved with renal replacement therapy which involves dialysis of the kidneys and kidney transplantation. The latter isn't performed by a nephrologist but rather a urologist to whom the physician will refer the patient to once they fulfill the criteria that is needed to receive a kidney transplant.

Training

In order for a doctor to become a nephrologist they have to complete their undergraduate medical degree that takes 5-6 years to accomplish, 1-2 years of internship training where they are exposed to the various medical and surgical disciplines, a 4 year residency programme in internal medicine which is a postgraduate degree to become a physician and then finally a 2-3 year fellowship training programme in nephrology. It can therefore take between 12-15 years for a doctor to become a nehrologist.

The following are sub-specialty areas that a nephrologist can further specialise in, and these are accomplished by completing a further 1-2- year fellowship programme in these disciplines.

  • Chronic kidney disease.
  • Renal dialysis.
  • Kidney transplantation.
  • Renal cancer disease called onconephrology.
  • Interventional or procedural nephrology.
  • Non-nephrological areas such as intensive care medicine, immunosuppression management, peri-operative medicine and clinical pharmacology.

Diagnostic tools used by a Nephrologist

The most important diagnostic tools that any doctor can use are taking a proper history from the patient and performing a thorough clinical examination. From these important measures a doctor can compile a differential diagnosis of what may be the concern with the patient. From there, the nephrologist will either perform or request further investigations to help narrow down the differential diagnosis, or ultimately diagnose the patient so that they can be managed further.

The investigations that can be requested by a nephrologist to aid them further include the following:

  • Urine tests - the urine is checked for the presence of blood, proteins, pus and cancer cells to exclude certain conditions. A 24-hour collection of the urine can also be done to determine the amount of protein being excreted, the creatinine levels in the urine, the daily urine output and if there are electrolytes being excreted. 
  • Blood tests - haemoglobin, platelet levels and kidney function tests such as electrolyte levels including sodium, potassium, calcium, magnesium and phosphorus as well as urea and creatinine can be requested to exclude certain conditions.
  • Infective, metabolic and autoimmune conditions - blood can also be drawn to check for sources that can link certain systemic diseases to kidney failure such as autoimmune diseases (ANCA vasculitis and lupus), metabolic diseases (diabetes) and infections (hepatitis B and C).  
  • Abnormalities of the kidneys can be viewed via diagnostic imaging techniques such as ultrasound, angiograms, scintigraphy, CT scans and MRIs.
  • Where the above-mentioned tests fail to give a conclusive diagnosis, invasive procedures such as kidney biopsies are done, under local anaesthesia and with the guidance of ultrasound or CT imaging, to analyze the renal tissue.

Procedures performed by a Nephrologist

The following are procedures that can be performed by a nephrologist:

  • Taking biopsies of native or transplanted kidneys.
  • Accessing areas for insertion of dialysis lines including tunneled vascular access lines, temporary vascular access lines and peritoneal dialysis access lines.
  • Management of fistulas via angiography, angioplasty or surgical fistulogram. The fistulas, done for haemodialysis access, are performed by vascular surgeons.
  • Bone biopsy.
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