A Nephrologist's Daily Schedule

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.

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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.

The Daily Schedule Of A Nephrologist

Nephrologists will consult with their hospital patients on a daily basis and will manage them until they are ready to be discharged home or to rehabilitation hospitals so that they can receive dialysis, for example.

Nephrologists will be consulted by other physicians and surgeons when they have patients who need specialist kidney care. This happens quite often since the kidneys are organs that don't fair well once they are damaged. Patients with poor renal functioning will need these specialists to care for them as they may have to optimize these patients when, for example, they go for an urgent surgical procedure.

Nephrologist's offices are usually based in the hospital as it is easier to get to their admitted patients and to patients who need a nephrological consultation in the wards or the emergency rooms. These specialists will also have to provide on call services after hours and on weekends. Emergency cases such as acute renal failure and acute poisoning cases that will need dialysis are example of cases that would need to be managed by these specialists.

Monday

Mondays are usually used to manage non-clinical and administrative issues such as confirming and attending meetings with hospital staff, management and medical representatives as well as dealing with the financial aspects of a private practice.

Once these issues have been dealt with, the nephrologist will then start consulting with patients. The specialist will manage these patients conservatively by prescribing medication or referring to other healthcare personnel, sending the patients for further investigations which will be followed up and feedback will be given or they will admit patients to the ward for further tests and treatment to be given.

Tuesday

The nephrologist may use the morning to consult with patients and the afternoon to perform procedures such as the mentioned kidney and bone biopsies.

Wednesday

The nephrologist will use this day to consult with patients who need dialysis or kidney transplantation as well as counsel their family members. The latter is done so that the family members are aware that they will need to offer support to these patients, seeing that a lot of patients on dialysis are diabetic who will have other complications such as poor eyesight or amputated limbs. As an example, haemodialysis patients need to be dialysed 3 times a week and will have to travel to the nearest dialysis centre/hospital in order to do so. Peritoneal dialysis patients will need to perform the dialysis at home 3-4 times a day and may need family to help them perform this procedure.

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Other duties on this day will include filling in of and repeating or adjusting chronic prescriptions for the patients in the dialysis unit, consulting with these patients where needed and discussing possible kidney transplant patients with their donors (if there's an individual willing to donate a kidney and there's a match) and the urologist who will be performing the procedure.

Thursday

The nephrologist will continue to consult with and manage outpatients, and the day may also be used for providing training to undergraduate medical students and postgraduate physicians.

Fridays

The specialist will consult with patients again and any unresolved administrative issues will be finalised before the work week is concluded.