Nephrologists: Caring for Patients at the Dialysis Center

What is a nephrologist?

A nephrologist is a doctor who specializes in the study of kidneys and the diseases and conditions that can affect the kidneys. This area of study is called nephrology.

Nephrology is a branch of internal medicine. A doctor must complete a two-year residency in internal medicine and pass the internal medicine board certification exam before he can be accepted into a nephrology program. This two- to three-year program will further train the doctor and prepare him to take the board certification exam in nephrology.

Nephrologists can specialize in helping adults or children. A nephrologist who specializes in treating children is called a pediatric nephrologist.

What do nephrologists do?

Nephrologists diagnose and treat people with kidney problems, also known as renal problems. Patients are often referred to a nephrologist by their general physician. Ask your doctor to refer you to a nephrologist, if you are feeling symptoms of chronic kidney disease, such as:

• A metallic taste in the mouth or ammonia breath
• Nausea and vomiting
• Loss of appetite
• Protein aversion (no longer wanting to eat meat)
• Difficulty concentrating
• Itchiness (pruritis)
• Swelling in the face, feet or hands
• Shortness of breath (from fluid in the lungs)
• Making more or less urine than usual
• Urine that is foamy or bubbly (may be seen when protein is in the urine)
• Blood in the urine (typically only seen through a microscope)
• Fatigue
• Weakness
• Feeling cold all the time
• Shortness of breath
• Mental confusion

If you are referred to a nephrologist, your nephrologist will go over your medical history and note any conditions that may affect your kidneys. Health issues like diabetes and high blood pressure can damage the kidneys and put you at risk for chronic kidney disease (CKD). Your nephrologist will perform tests to see if your kidneys are functioning well. If the test results indicate that your kidneys are not working as well as they should, the nephrologist will help diagnose the cause and prescribe a treatment plan.

Some of the most common conditions nephrologists treat are:

• Chronic kidney disease
• Polycystic kidney disease (PKD)
• Acute renal failure
• Cancer of the kidneys
• Kidney stones

Many patients seen by nephrologists have chronic kidney disease. CKD destroys kidney function over time. If you have CKD, your nephrologist will determine what stage of kidney disease you are in and plan your treatment accordingly. Also, your nephrologist will refer you to other specialists who will assist in your treatment, such as renal dietitians and renal nurses.

If your kidneys become damaged to the point where dialysis or a kidney transplant becomes necessary, this is called Stage 5 CKD or end stage renal disease (ESRD). Your nephrologist will help you determine what type of dialysis is best suited for your condition, either peritoneal dialysis (PD) or hemodialysis. If you opt for peritoneal dialysis, your nephrologist will refer you to a renal nurse who will instruct you and your caregiver on performing manual exchanges or operating a cycler, a machine that automatically performs the exchanges. If you opt for hemodialysis, your nephrologists will refer you to a dialysis facility. You may also be referred to a kidney transplant center, if your nephrologist feels you are a good candidate for transplant surgery.

What to talk about with your nephrologist

Your nephrologist is able to answer questions about your specific condition and the treatment involved. You can ask your nephrologist about the tests you are undergoing and about any recommended treatment plans.

If you are feeling unwell, or wish to explore different treatment options, speak with your nephrologist first. Changes to your treatment without your nephrologist’s knowledge can affect your health. If you are feeling tired and ill, your nephrologist may order new tests to determine if your treatment is effective and make any adjustments needed.

If you have other health conditions that can impact your kidneys, such as diabetes or high blood pressure, you can ask your nephrologist about ways to manage these conditions. Your nephrologist will work with your other doctors to help you manage these conditions so that you can stay as healthy as possible.

It’s important to ask your nephrologist’s advice before you try over-the-counter medicines, herbal remedies or dietary supplements. Feel free to talk to your nephrologist about issues regarding your quality of life. If you’d like to start an exercise plan, stop smoking or make other lifestyle changes, ask your nephrologist for guidance. If you are having trouble with restless leg syndrome, skin problems or sexual performance issues, your nephrologist may be able to help you with these conditions, as they can be a result of kidney disease.