Renal medicine
Nephrologists (doctors in renal medicine) diagnose and treat diseases of the kidneys.
Nature of the work
General nephrology includes the management of patients with diseases which affect the kidney.
Diseases that affect the kidney include:
- auto-immune disorders (where the body attacks its own tissues) such as systemic lupus erythematosus (causing inflammation of the connective tissue) or vasculitis (inflammation of the blood vessels)
- diabetes
- hypertension (high blood pressure)
Nephrologists also see patients with acute kidney injury (AKI) when only the kidney is affected (for example, following certain drug reactions) and also AKI as part of multi-system failure resulting, for example, from septicaemia (blood poisoning).
They also manage patients with end-stage kidney failure either by dialysis or by kidney transplantation.
Nephrologists manage acutely ill patients and those with a chronic disease requiring long term care with the help of colleagues in a multidisciplinary team. A patient, for example, may progress to renal failure and require dialysis and subsequently a renal transplant over a period of 10 to 20 years.
They generally work in renal units based in district general hospitals or university teaching hospitals. The renal services in these two types of hospital are broadly similar, with the exception that renal transplantation mostly takes place in university teaching hospitals. Many renal units also manage satellite haemodialysis units, either in other hospitals or in community-based facilities.
More renal medicine specialists will be needed in future to cope with the predicted increase in chronic kidney disease in the UK.
Nephrologists treat conditions such as:
- congenital and genetic disorders, eg autosomal dominant inherited polycystic kidney disease (an inherited condition in whuch fliud-filled cysts develop and grow in both kidneys) and familial nephropathy (inherited kidney disease)
- autoimmune disorders, eg acute glomerulonephritis (inflammation of the glomeruli, the filtering units of the kidneys)
- malfunctions caused by impaired blood supply, eg acute tubular necrosis (a condition causing the death of kidney tissue cells)
- resistant hypertension
- kidney infections
- metabolic disorders, eg cystinuria (an inherited disorder leading to the formation of stones in the kidneys, ureters and bladder)
- tumours of the kidney
- renal failure due to external factors, eg crushing accidents
Common procedures/interventions
These include:
- renal biopsy
- the insertion of temporary vascular (vein) access for haemodialysis (the removal of waste material from the blood of a patient with renal failure, using an artificial kidney)
- the insertion of tunnelled catheters (thin flexible tube) for haemodialysis vascular access
- the insertion of peritoneal dialysis catheters (thin flexible tube that allows dialysis fliud to enter the abdominal cavity and then drain back again)
Sub-specialties
Many nephrologists develop sub-specialty interests such as:
- haemodialysis
- peritoneal dialysis
- transplantation
- academic nephrology
- vasculitis
- acute kidney injury (AKI)
- hypertension
Want to learn more?
Find out about:
- the working life of someone in renal medicine
- the entry requirements and about training and development needed