Nephrology is a subspecialty of internal medicine. It is concerned with the diagnoses, treatment and management of kidney functions and renal (kidney) replacement therapy, such as dialysis and kidney transplantation. Although your primary care doctor will work to help prevent and treat early stages of kidney disease, a nephrologist may be called in to help diagnose and treat more severe or complex kidney conditions.
Glomerulonephritis can develop in an acute (sudden, rapid onset) or a chronic (slow) form, and is caused by a painless inflammation of the glomerulus (the kidney filter). Glomeruli remove excess fluid, electrolytes and waste from your bloodstream and pass them into your urine. It can occur by itself or as part of a more general problem such as diabetes or systemic lupus erythematosus (SLE). Severe or prolonged inflammation associated with glomerulonephritis can damage your kidneys.
Many patients with glomerulonephritis will simply need follow-up each year in an outpatient setting. Others may need treatment with specific drugs to reduce inflammation.
Hypertensive Kidney Disease
High blood pressure, also called hypertension, can damage the kidneys and lead to chronic kidney disease (CKD). Blood pressure measures the force of blood against the walls of the blood vessels. Extra fluid in the body increases the amount of fluid in blood vessels and raises blood pressure even higher.
Narrow, stiff, or clogged blood vessels can also raise blood pressure. In this case hypertension can result from normal fluid levels, but blood flow is minimized due to plaque buildup on the inner walls of the arteries.
High blood pressure makes the heart work harder and, over time, can damage blood vessels throughout the body. If the blood vessels in the kidneys are damaged, they may stop removing wastes and extra fluid from the body. The extra fluid in the blood vessels may then raise blood pressure even more.
IgA Nephropathy (also known as Berger’s disease), is a kidney disease that occurs when an antibody called immunoglobulin A (IgA) builds up in your kidneys. This results in local inflammation that can hamper your kidneys’ ability to filter waste from your blood.
Since IgA Nephropathy usually progresses slowly and often does not cause symptoms in the early stages, it can go unnoticed for years. It varies from person to person. Some people leak blood in their urine without developing problems, some eventually achieve complete remission and others develop end-stage kidney failure.
No cure exists for IgA Nephropathy, but certain medications can slow its course.
Nephrotic Syndrome is a kidney disorder that causes your body to excrete too much protein in your urine (often making the urine “frothy”). It is not a single underlying disease, but develops alongside other processes such as glomerulonephritis or diabetes. It usually causes damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood.
The condition often causes swelling since the excess water in the blood stream instead passes into the tissues, particularly in your feet and around the eyes.
Treatment is by restricting fluid intake, using diuretics and perhaps aspirin and cholesterol lowering drugs. A kidney biopsy will be done to determine the exact nature of the problem and to decide if treatment with steroids or other drugs is needed.
Polycystic Kidney disease
Polycystic Kidney disease is a very common genetic problem leading to the development and growth of multiple cysts within the kidneys. These cysts can also develop in other organs, such as the liver and the pancreas. Polycystic kidney disease can cause pain, urinary infections, blood in the urine and abnormal kidney function.
Treatment varies depending on the symptoms and complications present.
Systemic Lupus Erythematosus (SLE) with Nephritis
Lupus nephritis is a frequent complication in people who have systemic lupus erythematosus (SLE). Lupus is an inflammatory disease resulting from an abnormality in the body’s immune system regulation. It causes your immune system to produce proteins (called autoantibodies) that attack your own tissues and organs. It is an unpredictable disease, varying a great deal from one case to another. SLE affects women much more often than men. In some people, SLE can produce potentially life-threatening complications, including kidney failure.
Your Nephrologist will recommend other treatments based on the type and severity of organ involvement.
Hypertension (or high blood pressure) is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. It includes the following classifications:
- Essential Hypertension: Essential hypertension (also known as idiopathic hypertension) by definition has no identifiable cause. It tends to be familial and it likely the result between environmental and genetic factors. It is the most common type of hypertension.
- Secondary Hypertension: In about 10% of people, high blood pressure is caused by another disease. If that is the case, it is called secondary hypertension. Oftentimes when the root cause is controlled, blood pressure returns to healthy levels or is significantly lowered.
- Ambulatory Blood Pressure Problems: Ambulatory blood pressure occurs when a patient’s blood pressure is elevated due to nervousness or anxiety (such as being in a clinical environment). It can also be the reverse (called masked hypertension) when a patient exhibits normal blood pressure during an examination but uncontrolled blood pressure at home.
- Refractory or Complicated Hypertension: In simple terms, refractory or complicated hypertension refers to resistant high blood pressure. By definition, high blood pressure can be considered refractory if it cannot be reduced despite treatment compliance.
- Renovascular Hypertension: Renovascular hypertension is a condition in which high blood pressure is caused by the kidneys’ hormonal response to narrowing of the arteries supplying blood to the kidneys. It is a form of secondary hypertension.