Nephrologist: Key Differences / When to See One

Nephrologist: Key Differences / When to See One. A nephrologist is a medical doctor who specializes in diagnosing and treating kidney conditions. You should see a nephrologist if you have any signs of kidney disease or other conditions that may damage your kidneys. During your appointments, your nephrologist will examine your medical history, order tests and treat your condition.

What is a nephrologist?

A nephrologist (neh-frah-leh-jist) is a doctor with expertise in the care of kidneys. Your kidneys are part of your urinary system. They’re bean-shaped organs that filter your blood and remove waste, excess water and electrolytes, which leave your body as urine (pee).

What is a pediatric nephrologist?

A pediatric nephrologist is a doctor who specializes in kidney care and treatment in newborns, children, adolescents and young adults.

What does a nephrologist do?

A nephrologist diagnoses and treats kidney conditions and kidney failure. In addition, they also recognize how kidney conditions affect other parts of your body, including:

• Autoimmune diseases.
• Cardiovascular disease.
• High blood pressure (hypertension).

How do you become a nephrologist?

To become a nephrologist, doctors must complete:

• Four years of college.
• Four years of medical school.
• Three years of residency (continued training concentrating on the field of internal medicine or pediatrics).
• Two to three years of a fellowship (concentrating on the field of nephrology). You may also add another year to your fellowship to get additional training in transplant nephrology or interventional nephrology.
• Licensing/certification. In the United States, nephrologists must pass a board certification exam in internal medicine and nephrology by the American Board of Internal Medicine or the American Osteopathic Association.

What is transplant nephrology?

Transplant nephrology specializes in kidney and pancreas transplants as well as caring for kidney and pancreas transplant recipients.

A nephrologist’s education and training

Nephrologist: Key Differences / When to See One. To start on the path to becoming a nephrologist, you must first complete medical school. Medical school lasts 4 years and requires a prior bachelor’s degree.

After receiving your medical degree, you’ll need to complete a 3-year residency in internal medicine. A residency allows new doctors to receive further training and education in a clinical setting and under the supervision of more senior clinicians.

Once certified in internal medicine, you must complete a 2-year fellowship in nephrology. This fellowship further hones the knowledge and clinical skills required for the specialty.

After you complete your fellowship, you must pass an exam to become board certified in nephrology.

Conditions a nephrologist treats

Nephrologists can work with you to help diagnose and treat the following conditions:

• blood or protein in urine
• chronic kidney disease
• inflammation of the kidneys due to glomerulonephritis or interstitial nephritis
• kidney stones, although a urologist may also treat this condition
• kidney infections
• kidney cancer
• polycystic kidney disease
• hemolytic uremic syndrome
• renal artery stenosis
• nephrotic syndrome
• end-stage kidney disease
• kidney failure, both acute and chronic

A nephrologist can also be involved when other factors cause kidney disease or dysfunction, including:

• high blood pressure
• diabetes
• heart disease
• autoimmune conditions, such as lupus
• medications

Tests and procedures a nephrologist might perform or order

If you visit a nephrologist, they may perform the following tests and procedures and also interpret the results.

Laboratory tests

A wide range of tests can help assess kidney function. A healthcare professional typically performs these tests on a blood or urine sample.

Blood tests

• Glomerular filtration rate (GFR): This test measures how well your kidneys filter your blood. In kidney disease, GFR begins to drop below normal levels.
• Serum creatinine: Creatinine is a waste product and is present at higher levels in the blood of people with kidney dysfunction.
• Blood urea nitrogen: As with creatinine, finding high levels of this waste product in the blood is a sign of kidney dysfunction.

Urine tests

• Urinalysis: A doctor can use a dipstick to test a urine sample for pH and the presence of abnormal amounts of blood, glucose, protein, or bacteria.
• Albumin/creatinine ratio: This urine test measures the amount of the protein albumin in your urine. Albumin in the urine can be a sign of kidney dysfunction.
• 24-hour urine collection: This method uses a special container to collect the urine you produce during a 24-hour period. A doctor can use this sample for further testing.
• Creatinine clearance: This is a measure of creatinine from both a blood sample and a 24-hour urine sample used to calculate the amount of creatinine that has exited the blood and moved to the urine.

Differences between nephrology and urology

The fields of nephrology and urology share some overlap because they can both involve the kidneys. While a nephrologist focuses on diseases and conditions that affect the kidney more directly, a urologist focuses on those that can affect the male and female urinary tract.

The urinary tract includes the kidneys, as well as the ureters, bladder, and urethra. A urologist also works with the male reproductive organs, such as the penis, testes, and prostate.

Conditions that a urologist may treat can include:

• kidney stones
• bladder infections
• bladder control issues
• erectile dysfunction
• enlarged prostate

When to see a nephrologist

Your primary care doctor can help prevent and treat the early stages of kidney disease. However, sometimes these early stages may not have symptoms or may have nonspecific symptoms such as fatigue, sleep problems, and changes in the amount you urinate.

Regular testing can monitor your kidney function, particularly if you’re at risk for kidney disease. These groups include people with:

• high blood pressure
• diabetes
• heart disease
• a family history of kidney problems

Testing can detect signs of decreasing kidney function, such as a decreasing GFR value or an increase in the level of albumin in your urine. If your test results indicate rapid or continuing deterioration of kidney function, your doctor may refer you to a nephrologist.

Your doctor may also refer you to a nephrologist if you have any of the following:

• advanced chronic kidney disease
• large amounts of blood or protein in your urine
• recurring kidney stones, though your doctor may refer you to a urologist for this condition
• high blood pressure that’s still high even though you’re taking medications
• a rare or inherited cause of kidney disease.

How to find a nephrologist

If you need to contact a nephrologist, your primary care doctor should be able to refer you. In some cases, your insurance company may require a referral from your primary care doctor before you can visit a specialist.

If you choose not to get a referral from your primary care doctor, check with your insurance company for a list of nearby specialists covered in your insurance network.

Who should see a nephrologist?

A person may be referred to a kidney doctor if he or she is experiencing:

• Acute renal failure
• Stage 4 or 5 chronic kidney disease
• Accelerated decline in kidney function
• Chronic urinary tract infections
• Repeat urinary tract infections
• High blood pressure that does not respond to medication
• A glomerular filtration rate (GFR) of 30 or lower
• Repeat kidney stones
• Blood loss in the urine
• Protein loss in the urine

What types of tests and procedures does a nephrologist perform?

Common tests and procedures that nephrologists perform include:

• Imaging tests. Kidney imaging tests may include X-rays, CT scans and ultrasounds.
• Kidney function tests. Kidney function tests determine how well your kidneys are working. These tests include blood tests and urine tests.
• Dialysis. If your kidneys don’t work properly, dialysis performs the functions of your kidney. During dialysis, a machine removes your blood, filters out waste products and excess fluid and returns your blood to your body.
• Kidney biopsy. Your nephrologist will take a small tissue sample from your kidneys to help diagnose a kidney condition.

Kidney transplantcare. During a kidney transplant, your transplant surgeon inserts a healthy kidney from a donor into a space in your pelvis. Your own kidneys almost always remain with you even after they fail. Your nephrologist will work with your transplant surgeon to help prepare you for the procedure and help with follow-up care and recovery.

What is the difference between a nephrologist and a urologist?

The differences between a nephrologist and a urologist may be confusing because their areas of expertise overlap a little.

Nephrologists specialize in conditions that affect your kidneys. A nephrologist is the best doctor to treat you if you have a condition that affects your kidneys or kidney function.

A urologist is a doctor who specializes in diagnosing and treating conditions that affect your urinary system. Your urinary system includes your bladder, urethra, ureters and kidneys. They also specialize in conditions, symptoms and treatments that affect the male and female reproductive systems. A urologist is the best doctor to treat you if you have a condition affecting your urinary system or reproductive system.

Another key difference between a nephrologist and a urologist is that urologists have surgical training. Urologists only take care of kidney diseases that may require an intervention, like kidney cancer or kidney stones. Nephrologists don’t do surgery.