Nephrology

Your Health. Your Hospital

Our kidneys are vital for life because they filter our blood of its waste products and excess water with the help of a complex network of blood vessels and intricate network of tubes and tubules. The kidneys maintain the fluid, electrolyte, and acid-base regulation that are altered by several disease conditions as well as drugs and toxins.

Full Spectrum Care

We offer a full continuum of care for patients with acute and chronic kidney disease

Nephrology is a medical specialty that involves the study of normal kidney function, kidney problems, the treatment of kidney problems and renal replacement therapy (dialysis and kidney transplantation). A nephrologist is a physician who studies and deals with nephrology. The nephrologist usually works in conjunction with urologists who deal with the surgical aspects of kidney disease and diseases of the bladder and urethra.

The diseases that come under the scope of nephrology include:

  • acid base imbalances
  • autoimmune diseases (autoimmune vasculitis, lupus)
  • cancers of the kidneys, bladder, and urethra
  • dialysis: hemodialysis and peritoneal dialysis
  • effects of diseases like diabetes and high blood pressure on kidneys
  • glomerular disorders
  • hydronephrosis
  • ill effects of drugs and toxins on the kidneys
  • kidney and bladder stones
  • kidney infections
  • nephrotic syndrome and nephritis
  • polycystic kidneys diseases
  • renal failure (sudden, acute, long term or chronic)
  • renal vascular diseases
  • tubulointerstitial diseases
  • urine abnormalities

The steps taken to diagnose damage and diseases of the kidneys include:

  • physical examination
  • blood tests
  • urine analysis
  • glomerular filtration rate (GFR)
  • ultrasound scanning
  • other imaging studies
  • MR angiography
  • renal biopsy
  • intravenous urography (IVU)
  • scintigraphy
  • renal arteriography

Physical Examination

History and physical examination are central to the diagnostic workup in nephrology. This may include:

  • inquiries regarding family history
  • general medical history
  • occupation
  • medication use
  • drug use
  • diet

During your physical examination, your physician will assess your volume state, blood pressure, skin, joints, abdomen and flank.

Blood Tests

  • reveal raised or altered levels of urea, creatinine and electrolytes including sodium, potassium, calcium, magnesium, phosphates, blood urea nitrogen and others
  • Your blood may also be tested for various organisms that may damage the kidneys including hepatitis B, hepatitis C, AIDS
  • blood levels of antibodies to special antigens can help detect lupus, amyloidosis and multiple myeloma

Urine Analysis

Urine analysis is very useful in diagnosing kidney issues, as it may reveal:

  • excess proteins that are being excreted from the body in the urine (kidney damage that is especially seen in diabetic nephropathy or in long term kidney diseases)
  • total protein excretion in a day, with 24 hour urine samples or urine collected over a period of 24 hours (indicator of chronic kidney disease)
  • kidney and urinary tract infections with microscopic analysis, culture and sensitivity studies

Glomerular Filtration Rate (GFR)

  • measured by studying the clearance of a substance, which is freely filtered through the filtering units of the kidneys called glomerulus e.g. inulin
  • creatinine clearance is used to calculate GFR in clinical practice
  • clearance is a measure of volume of plasma cleared by the kidneys per time unit
  • it is the product of urine concentration of creatinine and urine flow rate
  • normal creatinine clearance in adult male is 90 -150 ml/minute

Ultrasound Scanning

  • one of the commonest and most used non-invasive imaging studies for kidneys diseases and damage
  • diseases such as hydronephrosis, polycystic kidney disease and kidney stones are detected using ultrasound examination

Other Imaging Studies

  • Computed Tomography scans (CT scan) and Magnetic Resonance Imaging (MRI) scans are used to detect structural or other abnormalities of the kidneys
  • can help detect renal tumors and cancer

MR Angiography

  • used to detect abnormalities in the blood vessels within the kidneys
  • a radio-contrast dye is injected into a vein in the arm and MRI images are taken as the dye passes through the kidneys
  • this gives a clear picture of the blood vessel network and their abnormalities within the kidneys

Renal Biopsy

  • a small amount of renal tissue may be taken from the kidney if a lesion is detected on the kidney
  • the doctor uses long thin hollow needles under the guidance of ultrasound or other imaging studies
  • the tissues are then examined under the microscope for abnormal pathologies

Intravenous Urography (IVU)

  • during this test, an iodinated contrast dye is injected into the veins of the person
  • the dye is imaged using X-rays or other imaging studies
  • its goal is to detect the flow of the blood and formation of urine in the kidneys, as well as its outflow as it traverses through the kidneys

Scintigraphy

  • uses radioactive isotopes that help detect abnormal functions of the kidney

Renal Arteriography

  • a thin catheter is inserted into the femoral artery and under guidance through an imaging study
  • a dye is injected into the aorta above the renal arteries and images of the blood vessels within the kidneys are obtained

Most kidney conditions are chronic conditions and so long term follow-up with a nephrologist is usually necessary. Treatment of kidney diseases depends on their cause and pathology. Treatments in nephrology can include:

  • medication
  • blood products
  • surgical interventions (urology, vascular or surgical procedures)
  • renal replacement therapy (dialysis or kidney transplantation)
  • plasma exchange

Chronic Kidney Disease

Impaired kidney function has systemic effects on the body. Chronic kidney disease is typically managed with:

  • treatment of causative conditions (such as diabetes)
  • avoidance of substances toxic to the kidneys (nephrotoxins: radiologic contrast and non-steroidal anti-inflammatory drugs)
  • antihypertensives
  • diet and weight modification
  • planning for end-stage renal failure

Auto-Immune and Inflammatory Kidney Disease

Vasculitis or transplant rejection may be treated with immunosuppression.  Newer, so-called "biologic drugs" or monoclonal antibodies, are also used in these conditions. Blood products including intravenous immunoglobulin and a process known as plasma exchange can also be employed.

End-Stage Renal Failure

End-stage renal failure occurs when the kidneys are no longer able to sustain the demands of the body. Without renal replacement therapy, death from renal failure will eventually result. Dialysis is an artificial method of replacing some kidney function to prolong life.

Currently, renal transplantation is the most effective treatment for end-stage renal failure although its world-wide availability is limited by lack of availability of donor organs. By inserting into the body a healthier kidney from an organ donor and inducing immunologic tolerance of that organ with immunosuppression kidney function will be restored.

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Frequently Asked Questions

Hematuria is a term used to indicate the presence of blood in the urine, while proteinuria indicates the presence of abnormal amounts of protein in the urine.

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The kidneys are important because they filter our blood, prevent the accumulation of waste in our body, maintain the level of electrolytes and produce hormones.

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Common kidney disorders include – acute renal failure, chronic kidney disease (CKD), nephrolithiasis or kidney stones, and pyelonephritis.

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The treatment options for kidney failure include hemodialysis, peritoneal dialysis, and kidney transplantation.

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In order to asses and monitor the kidney functions imaging tests such as ultrasound, MRI or CT scans may be advised, as well as blood tests and urine tests.

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