KIDNEY DISEASE

What Is a Nephrologist?

Nephrologists are medical doctors who focus on the health of the kidneys. They can help diagnose kidney conditions and provide treatment and management.

The name “nephrologist” comes from the Greek word ”nephros," meaning kidneys.

Nephrologists can work in hospitals or clinics, or have their own (private) practice.

What Conditions Can a Kidney Doctor Treat?

Nephrologists help people with many different kinds of kidney problems, including:1

• Acute kidney injury: Acute kidney disease develops quickly and can be temporary. It could be related to a medical condition like shock (where there is less blood flow to the kidneys), dehydration, kidney problems related to surgery, or poor drainage from the urinary tract (ureter, bladder, prostate, urethra).

• Chronic kidney failure: Chronic kidney disease (CKD) typically involves kidney damage that progresses gradually and is permanent.2 Many people have mild symptoms or no symptoms at all when they are diagnosed. Chronic kidney disease is described by five stages based on the severity of the disease. Grade 1 kidney failure refers to a mild disease, while grade 5 renal failure usually means that dialysis or a kidney transplant will be needed for a person to survive. 

Kidney vs. Renal Disease

Kidney disease is sometimes called renal disease. Renal is a medical word that refers to the kidneys.3

Other medical problems can also affect the kidneys. Some of the common conditions that can lead to kidney problems or kidney failure include:1

• Diabetes (diabetic nephropathy), which is the leading cause of kidney failure in the United States

• Kidney disease related to high blood pressure and heart disease (cardiorenal syndrome)

• Obesity

• Chronic kidney infections

• Kidney stones (which can get stuck and cause a lot of pain, even becoming infected) 

• Kidney problems present at birth (congenital) such as horseshoe kidney

• Glomerulonephritis (inflammation of the kidneys which can be caused by a number of different processes, including the bacteria that causes strep throat)

• Kidney disease related to lupus (lupus nephritis)

• Polycystic kidney disease (a hereditary condition that varies in how severe it is and at what age a person develops it) 

• Autoimmune diseases (e.g., IgA nephropathy)

• Kidney failure secondary to liver disease (hepatorenal syndrome)

In addition to managing kidney problems, kidney doctors can help people manage the symptoms of kidney diseases, such as electrolyte disturbances (especially potassium levels) and high blood pressure.

Nephrologist vs. Urologist

Urologists and nephrologists are different kinds of healthcare providers that can treat kidney problems. Urologists are surgeons of the urinary tract who can remove cancers of the kidneys, open up blockages in the ureters from stones, or help drain the bladder better.4

When to See a Kidney Doctor

Usually your primary healthcare provider will help you decide when to see a nephrologist based on your symptoms, the results of tests, and the stage of your condition.

It's important to see a nephrologist at an early stage if you have kidney problems. Multiple medical studies have shown that patients who are referred to a nephrologist at a late stage of disease are more likely to progress to dialysis or even more likely to die.567

Signs and Symptoms of Kidney Disease 

The early symptoms of kidney disease can be general and vague, so it’s easy to confuse them for more common conditions. Some early warning signs include:8

• Feeling tired but having trouble sleeping

• Dry skin

• Urinating frequently (especially at night)

• Blood in your urine 

• Foamy urine

• Swelling and puffiness especially around your eyes and in your feet and ankles 

• Muscle cramps

• Lack of appetite 

• A metallic taste in your mouth 

Can Kidney Disease Cause No Symptoms?

Early on with kidney disease, and sometimes even with advanced kidney disease, people may have few symptoms. It's very common for people with kidney disease to have no symptoms.9

Risk Factors for Kidney Disease

Kidney disease can get serious before you ever have symptoms. Your provider will talk to you about your risk factors for kidney disease and may recommend taking certain steps to try to prevent kidney disease or at least catch it early, should it develop.10

Kidney Injuries

Your kidneys are located on your flanks near your spine. If your back or the side of your body below your diaphragm is injured, your kidneys could also be hurt.

You might be at a higher risk of developing kidney failure if you have:

• Diabetes

• Long-standing high blood pressure

• Heart diseases such as coronary artery disease, or congestive heart failure

• Other vascular diseases such as cerebrovascular disease (strokes) and peripheral vascular disease (such as aortic aneurysms)

• A family history of kidney disease

• Prolonged use of medications filtered through the kidneys like non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen)

Tests and Procedures

There are several tests a nephrologist can do to screen for kidney disease and check how it's progressing. 

Blood tests a nephrologist might use to diagnose kidney problems include:11

• BUN (blood urea nitrogen): Measures your blood's level of urea nitrogen, a waste product made when your body breaks down protein in food

• Serum creatinine: Measures creatinine, a waste product that comes from your muscles

• GFR (glomerular filtration rate): Measures how well your kidneys filter your blood

Urine tests a nephrologist might use include those that check the urine for:

• Protein

• Blood

• Signs of infection

Imaging tests a nephrologist might do of the kidneys include:

• CT

• MRI

• Renal ultrasound

Treatments

Most early kidney issues can be treated with medications or changes in what you are drinking (fluids). In advanced stages, nephrologists may need to put you on dialysis. This will be the only way that your body will be able to remove toxins and balance electrolytes, since your kidneys have failed and cannot do that job anymore.12

What to Expect at Your First Visit

Your primary care provider may give you a referral to see a nephrologist if you have elevated Cr (stage 4) or a GFR of less than 30. Some people should see a kidney doctor much sooner. 

Since timely consultation with a nephrologist is correlated with survival, it's best to err on the side of seeing one of these healthcare providers earlier rather than later.

When you have your first visit, your nephrologist will go over your medical records and ask you about your health. They will look at any tests that have already been done and explain what they mean. 

They may talk to you about what other tests or procedures they’d like to do, and whether they think your current treatment is working. If not, they might recommend you try changing your treatment or starting something new.

If you have any questions or do not understand what your nephrologist is talking about, be sure to speak up. It’s important that you feel like you can advocate for your health. 

How to Find a Nephrologist

Your primary care provider may recommend a nephrologist to you or give you a referral. If not, you can ask them if they would recommend someone.

You can check your local healthcare systems to see if any nephrologists they employ are taking new patients. You can also look for practices that are within a reasonable traveling distance. 

Before you call a provider’s office to ask about appointments for a consultation, check with your health insurance provider (if you have it) to see if the provider is in-network for coverage and whether they need a referral.