1. Who is a Nephrologist?

A nephrologist is a doctor who specializes in diagnosis, treatment, and management of kidney diseases and electrolyte and fluid imbalances of the body. To become a nephrologist, after graduating from medical school, a doctor completes a residency program in internal medicine followed by a fellowship in nephrology.

Nephrologists provide diagnosis, treatment, prevention, and management of kidney diseases such as glomerulonephritis, interstitial nephritis, pyelonephritis, nephrolithiasis (kidney stones), obstructive uropathy, acute kidney injury (from toxins, medications, or other causes), kidney cancer, as well as chronic kidney disease and kidney failure (end-stage renal disease) associated with systemic conditions such as diabetes, hypertension, chronic infections, cancer, or autoimmune diseases. Nephrologists also perform kidney biopsies and manage a number of therapeutic procedures such as hemodialysis, peritoneal dialysis, plasmapheresis, renal replacement therapy, and kidney transplantation.

2. When should I see a Nephrologist?
Your primary care provider will usually refer you to a nephrologist. You may need to see a nephrologist for managing kidney complications of diabetes, high blood pressure, chronic infections, lupus, or other diseases and for certain genetic diseases such as polycystic kidney disease or sickle cell anemia. You may also need to a see a nephrologist or consult a nephrologist online if you have symptoms such as:

• Changes in urine including hematuria (blood in the urine), proteinuria (protein in the urine, urine may become foamy), or glycosuria (sugar in urine)
• Excessive or insufficient urination
• Swelling of feet or puffy eyes
• Weight gain
• Pale skin
• Lower back or lower abdominal pain
• Excessive thirst
• Fatigue
• Appetite loss
• Fever or chills
• Nausea and vomiting
• Muscle twitching or spasms
• Bad breath (halitosis)
• Bad (metallic) taste in the mouth
• Sleepiness, confusion, or coma
• Itchiness
• High blood pressure

3. What tests does a Nephrologist perform or recommend?

The nephrologist may request several blood or urine tests, including:

• Complete blood count
• Urine tests including urine total protein, creatinine, urinary albumin-to-creatinine ratio, uric acid, glucose, urine culture, or others
• Blood tests including urea nitrogen (BUN), creatinine, total protein, glycemia, myoglobin, and others
• Clearance tests, such as inulin or creatinine clearance
• Immunologic tests such as antinuclear antibody (ANA), complement, or antineutrophil cytoplasmic antibodies (ANCA)
• Serum and urine electrolytes
• Blood gases (ABG) and pH
• Calcium and phosphorus
• Parathormone (PTH)
• Erythropoietin
• Imaging tests such as abdominal ultrasonography, CT scan, MRI, intravenous pyelogram, or others
• Kidney biopsy

4. What procedures does a Nephrologist perform or recommend?

A nephrologist may perform, recommend, or manage the following procedures:

• Kidney biopsy
• Hemodialysis (dialysis using a dialyzer)
• Peritoneal dialysis (dialysis within the body using a special solution)
• Arteriovenous fistula or dialysis catheter placement for hemodialysis
• Plasmapheresis (filtration of blood to remove harmful antibodies)
• Renal cyst drainage
• Kidney transplantation
• Thrombectomy, angioplasty, or stenting
• Renal replacement therapy (RRT)

5. What questions should I ask a Nephrologist?

You may want to ask a kidney specialist /nephrologist the following type of questions:

• What is the diagnosis? What caused my condition? What are the complications of the disease?
• What is the extent of damage to my kidneys? Can treatment stop or reverse this damage?
• What are my treatment options? Are there any side effects of the treatment?
• What are the risks and complications of the recommended procedure?
• Are there any alternatives to this treatment?
• What can I expect as my disease progresses?
• Do I need to change any of the medicines I take for other health conditions, such as hypertension and diabetes?
• What lifestyle modifications can I make to improve my outlook?
• Are there any dietary guidelines I need to follow?
• How often do I need dialysis? Do I need surgery? Will I need kidney transplant in future?
• What are the emergency signs and symptoms I need to watch out for?
• Where can I learn more about my condition?
• How often should I see you?