Nephrologist

What is a nephrologist?

A nephrologist is a medical 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. These leave your body as urine (pee).

A nephrologist (neh-FRAH-leh-jist) diagnoses and treats kidney conditions and kidney failure. They also recognize how conditions affect other parts of your body. This includes:

• Autoimmune diseases
• Cardiovascular diseases
• High blood pressure

Nephrologists can also get additional training in transplant nephrology, interventional nephrology and other specialized areas.

Transplant nephrology specializes in kidney and pancreas transplants. This includes providing care for people who receive the organs.

Interventional nephrology specializes in treating and maintaining access to blood vessels for dialysis. These specialists also perform kidney biopsies.

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, which is continued training in which they learn from doctors and develop skills
• Two to three years of a fellowship that focuses on nephrology (you may also need another year to get additional training in transplant nephrology or interventional nephrology)
• Licensing/certification (in the U.S., 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 are common conditions that a nephrologist treats?

Some of the most common conditions that a nephrologist may treat include:

• Diabetes
• High blood pressure
• Kidney failure
• Cystic kidney disease
• Kidney stones
• Nephrotic syndrome
• Kidney failure
• Hemolytic uremic syndrome
• Urinary tract infections (UTIs)
• Kidney infections
• Hyponatremia and other electrolyte disorders
• Toxic overdoses that require dialysis
• Glomerulonephritis (GN)

What types of tests and procedures do they perform?

Common tests and procedures that nephrologists perform may include:

• Imaging tests: These may include X-rays, CT scans and ultrasounds.
• Kidney function tests: These tests determine how well your kidneys are working. They include blood and pee tests.
• Dialysis: When your kidneys don’t work properly, dialysis performs their functions. It filters waste products and excess fluid from your blood.
• Kidney biopsy: Your nephrologist will take a small tissue sample from your kidneys to help diagnose a kidney condition.
• Kidney transplant care: During a kidney transplant, your transplant surgeon inserts a healthy kidney from a donor into a space in your pelvis. Your nephrologist will work with your surgeon to help prepare you for the procedure, and to support your follow-up care and recovery.
• Urinalysis: Your nephrologist examines a pee sample for signs of infection, diabetes, kidney disease or other conditions.

When should I see a nephrologist?

You should see a nephrologist if you have any symptoms of kidney disease. These symptoms may include:

• Changes in your pee: Changes in your peeing habits or how your pee looks may indicate a problem with your kidneys. Signs may include peeing more often or less often, foamy pee or pee that’s darker in color.
• Brain fog: Brain fog may be a symptom of kidney disease. It isn’t a medical condition. But your provider may use the term if you’re easily confused, forgetful or unable to focus.

The two diseases that most commonly cause kidney disease are:

• Diabetes: Diabetes can damage your kidneys. If you have it, you’re at a higher risk of kidney failure.
• High blood pressure: Your kidneys use blood vessels to help filter waste and excess fluids from your blood. High blood pressure can make your blood vessels tighten. This reduces blood and oxygen flow to your kidneys. This can cause kidney failure.

If you have diabetes and high blood pressure, ask your healthcare provider if you need kidney disease tests.

It’s also a good idea to see a nephrologist if you have a biological family history of kidney disease. If one of your blood relatives has a kidney disease, you may be at a greater risk of having it, too. A nephrologist can help prevent it or treat its earliest stages.

At what stage of kidney disease should you see one?

It helps to first understand how healthcare providers stage kidney diseases. They use a blood test to figure out your estimated glomerular filtration rate (eGFR). Your eGFR tells them how well your kidneys filter your blood (kidney function). A normal eGFR is about 100. That means there aren’t any problems with your kidneys. The lowest eGFR is 0. That means your kidneys don’t function at all.

The stages include:

• Stage I: Your eGFR is 90 or higher. But your urine has an elevated protein concentration. At this stage, your kidneys have mild damage. But they still function normally.
• Stage II: Your eGFR may be as low as 60 or as high as 89. You have more damage to your kidneys than in stage I. But they still function well.
• Stage III: Your eGFR may be as low as 30 or as high as 59. You may have mild or severe loss of kidney function.
• Stage IV: Your eGFR may be as low as 15 or as high as 29. You have severe loss of kidney function.
• Stage V: Your eGFR is below 15. Your kidneys are nearing or at complete failure.

Primary care providers (PCPs) often check your eGFR at an annual checkup. If they detect any kidney damage, they’ll refer you to a nephrologist. It’s important to see a nephrologist at the earliest stages of kidney disease. The sooner you get treatment, the more likely it is that they can slow down or stop kidney disease from getting worse.

What do they do on a first visit?

During your first visit with a nephrologist, they’ll:

• Look over your medical records
• Ask about your symptoms
• Ask about any prescribed and over-the-counter medicines you take
• Perform a physical exam
• Recommend blood tests, pee tests and imaging tests

How do I prepare for a nephrology appointment?

It’s helpful to prepare for your first appointment with a nephrologist. It’s a good idea to do the following:

• Fill out any forms they give you before the appointment.
• Keep a diary of your symptoms, including the day and time they occurred and how long they lasted.
• Learn about your biological family’s medical history.
• Bring copies of any test results or lab work that another healthcare provider ordered.
• Include names and contact information for your current primary care provider and any other providers you see regularly.
• If you check your blood pressure at home, bring your monitor. It may also be helpful to bring several days’ worth of home blood pressure readings.
• Bring a list of all current medications you take. Include prescription medications, over-the-counter (OTC) medications, vitamins and supplements.
• Bring your current insurance cards.

Some people also find it helpful to bring a trusted family member or friend with them. They can help take notes, ask questions, schedule tests and remind you about follow-up appointments.