Nephrology is the study of kidney function and its associated diseases. Its goal is the preservation of kidney health and the treatment of kidney disease, from diet and medication to renal replacement therapy such as dialysis and kidney transplantation. Common systemic conditions that affect the kidneys include diabetes and autoimmune diseases like lupus. Systemic diseases may also occur as a result of a problem with the kidneys, such as renal osteodystrophy and hypertension.
To become a nephrologist in Australia typically requires the completion of a medical degree (Bachelor of Medicine, Bachelor of Surgery of 4–6 years), internship (1 year), Basic Physician Training (3 years minimum), successful completion of the Royal Australasian College of Physicians written and clinical examinations, and Advanced Physician Training in Nephrology (2–3 years). The training pathway is overseen and accredited by the Royal Australasian College of Physicians. Increasingly, nephrologists may additionally complete of a post-graduate degree (usually a PhD) in a nephrology research interest (3–4 years). Finally, all Australian nephrologists participate in career-long professional and personal development through the Royal Australasian College of Physicians and other bodies such as the Australian and New Zealand Society of Nephrology and the Transplant Society of Australia and New Zealand.
A medical history and physical examination are central to the diagnostic process in nephrology. This history typically will include the present illness, family history, general medical history, diet, medication use, drug use, and occupation. The physical examination typically includes an assessment of volume state, blood pressure, heart, lungs, peripheral arteries, joints, abdomen and flank.
Examination of the urine (urinalysis) allows a direct assessment for possible kidney problems, which may be suggested by appearance of blood in the urine (haematuria), protein in the urine (proteinuria), pus cells in the urine (pyuria), cancer cells in the urine, or abnormal levels of sugar in the urine.
Basic blood tests can be used to check the concentration of hemoglobin, platelets, sodium, potassium, chloride, bicarbonate, urea, creatinine, calcium, magnesium or phosphate in the blood. All of these may be affected by kidney problems.
Structural abnormalities of the kidneys are identified with imaging tests. These may include Medical ultrasonography/ultrasound, computed axial tomography (CT), scintigraphy (nuclear medicine), angiography or magnetic resonance imaging (MRI). Where definitive diagnosis is required, a biopsy of the kidney (renal biopsy) may be performed. This typically involves the insertion, under local anaesthetic and ultrasound or CT guidance, of a core biopsy needle into the kidney to obtain a small sample of kidney tissue. The kidney tissue is then examined under a microscope, allowing direct imaging of the changes occurring within the organ.
When the kidneys are no longer able to sustain the demands of the body, end-stage kidney failure is said to have occurred. Without renal replacement therapy, death from kidney failure will eventually result. Dialysis is an artificial method of replacing some kidney function to prolong life. Renal transplantation replaces kidney function by inserting into the body a healthier kidney from an organ donor and inducing immunologic tolerance of that organ with immunosuppression. At present, renal transplantation is the most effective treatment for end-stage kidney failure although its worldwide availability is limited by lack of availability of donor organs.
Most kidney conditions are chronic and so long term follow-up with a nephrologist is usually necessary.
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Experts in the field of nephrology can be called upon to provide evidence in medical cases that require opinion on conditions, treatment, surgery, complications, diseases, or injury of the kidneys, whether short term or chronic.
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