What Is a Nephrologist?

Nephrologists are doctors who specialize in conditions that affect the kidney. Kidney issues are on the rise around the world, with millions of people each year undergoing treatments for kidney injury or chronic kidney disease (CKD). In fact, kidney disease ranks as the 12th leading cause of death globally and the 9th leading cause in the United States.

In the United States, 15% of adults are believed to have chronic kidney disease. Though 90% of them don't realize it or don't visit a nephrologist until the disease has become serious and expensive. 

Having your kidneys malfunction is even more likely than having your liver malfunction, primarily due to the chronic health conditions that develop at the same time. Kidney disease can develop from existing health issues like diabetes, obesity, heart disease, and high blood pressure. It can also cause high blood pressure and heart disease to develop, even if you didn't have these conditions before.

Chronic kidney disease can also lead to health complications like anemia, osteoporosis, a weakened immune system, or an irregular heartbeat. This cause-and-effect relationship shows how important it is to have healthy kidneys, and to be proactive in seeing a nephrologist who can treat and manage any kidney issues you have.

Nephrologists can develop a management plan that helps you overcome low-functioning kidneys. In some cases, your kidney damage may even be reversible if caught and treated early. 

What Does a Nephrologist Do?

Sometimes called renal medicine, nephrology is a specialty within the internal medicine field related to kidney care. It is often connected with hypertension or high blood pressure. 

Nephrologists are medical professionals who diagnose, treat, and manage acute and chronic kidney problems and diseases. They also treat associated issues like high blood pressure, fluid retention, and electrolyte and mineral imbalances. In addition, these specialists are in charge of kidney dialysis treatment — both hemodialysis and peritoneal dialysis — and kidney transplants and their follow-up care. 

Nephrologists are experts in renal health, and they work to identify issues with your kidneys to help you maintain good health. Your kidneys are important because they filter your blood to remove waste and toxins, and they monitor and balance the water, acid-base, and mineral ratios in the body. 

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Without proper filtering of the blood and balanced amounts of fluids and nutrients, your body can become an unhealthy environment. Having low-kidney function can put you at risk for chronic kidney disease, kidney failure, or end-stage renal disease, where you require dialysis regularly. 

Seeing a nephrologist for your care puts you in the hands of experts who can recommend the best treatment plan. They stay up-to-date on medical advancements for your kidney condition to ensure that you have the most accurate and comprehensive care.  

Education and Training

Nephrologists are specialized medical doctors who have received advanced training in the field of nephrology. These doctors complete medical school and a fellowship with board certification in their specialty. 

This process involves completing:

  • Four years of medical school to earn a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)
  • A three-year residency in internal medicine
  • A two- to three-year fellowship in nephrology, with the option for an additional year-long fellowship in interventional nephrology or transplant nephrology
  • A certification exam from the American Board of Internal Medicine to be board certified in nephrology

Reasons to See a Nephrologist

Most people don't go to a nephrologist without a referral from their primary care doctor. Typically, seeing a nephrologist means that you have kidney-related symptoms from an unknown cause or that you have health issues only a renal specialist knows how to treat. You might be referred to a nephrologist if you have the following signs or symptoms: 

Chronic Urinary Tract Infections

If you get a lot of urinary tract infections (UTI), which are typically bladder infections, you are at greater risk for the infection to travel up to your kidneys. This also puts you more at risk of developing kidney disease, permanent kidney damage, or even kidney failure. Chronic UTI symptoms, especially blood in the urine, fever, and fatigue, can also indicate the early stages of bladder or kidney cancer. 

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Recurring Kidney Stones

Kidney stones are mineral- or salt-based deposits inside your kidneys, and they cause a lot of pain when passing through your urinary tract. If you get a lot of kidney stones, your kidneys are likely not filtering waste properly and are letting deposits accumulate. 

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You can also develop kidney stones that begin to block glomerular filtration (part of the urination process) and lower the filtration rate. Any obstructions can begin to damage your kidneys and lead to chronic kidney disease.

Foamy Urine

Foamy or bubbly urine means there is protein in your urine. This condition, called proteinuria, can happen from a number of causes, some being relatively harmless and others more likely to cause kidney damage. Your urine normally has a bit of protein waste in it, but this protein will pass unnoticed. Only when you have high amounts of protein do you begin to see foam or bubbles in the urine. 

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This protein spillover can accompany other symptoms like muscle cramping, shortness of breath, and tiredness, and may indicate more moderate stages of chronic kidney disease or early kidney failure. Your nephrologist will likely do a series of blood tests, such as blood urea nitrogen, serum creatinine, and protein-creatinine ratio, to check your blood and kidney health. 

Itchy Skin and Joint or Bone Pain

If you're experiencing bone and joint pain along with itchy skin, you might have a condition called renal bone disease, also known as mineral and bone disorder. This condition can occur alongside kidney disease, and it happens when the kidneys can't maintain the amount of calcium and phosphorus your bones need. If untreated, this condition can lead to weakened bones, and heart and blood vessel problems.

Talk to your doctor if you’re experiencing these symptoms, as a referral to a nephrologist may be necessary.

WebMD Medical Reference

Sources

SOURCES:

American Cancer Society: “Kidney Cancer Signs and Symptoms.”

American College of Physicians: “Nephrology.”

American Medical Association: “Nephrology Specialty Description.”

Bulletin of the World Health Organization: “The global burden of kidney disease and the sustainable development goals.”

Centers for Disease Control and Prevention: “Chronic Kidney Disease: Common - Serious - Costly.”

Centers for Disease Control and Prevention: “Chronic Kidney Disease in the United States, 2019.”

Cleveland Clinic: “Proteinuria.”

Mayo Clinic: “Creatinine test.”

Mayo Clinic: “End-stage renal disease.”

Mayo Clinic: “Kidney stones.”

National Institute  of Diabetes and Digestive and Kidney Diseases: “Mineral & Bone Disorder in Chronic Kidney Disease.”

National Institute of Diabetes and Digestive and Kidney Diseases: “Your Kidneys & How They Work.”

Primary Care: “Chronic Kidney Disease and Its Complications.”

The University of Chicago: “Kidney Stones, Kidney Function, Kidney Disease.”

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