Nephrology is a specialty of medicine and pediatrics that concerns itself with the function of the kidneys and kidney disease (CKD). This includes the preservation of kidney health, treatment of kidney disease, diet and medication for kidney health and renal replacement therapy.
The general management of the patient with CKD (Chronic Kidney Disease) involves the following issues:
Treatment of or recommendations for treatment of reversible causes of renal failure/AKI.
Nephrologist management and treatment of the complications of renal failure/ CKD
- Metabolic bone disease
- Volume control
Preventing or slowing the progression of renal disease or proteinuria related to diabetes, hypertension, etc.
Adjustments of drug doses when appropriate to optimize the patient’s kidney function and improve or stabilize estimated glomerular filtration rate (eGFR)
Identification and adequate preparation of the patient in whom renal replacement therapy (dialysis) will be required
Patients who would benefit from a nephrology referral:
- AKI or abrupt sustained fall in GFR
- Progression of CKD
- Consider for patients if eGFR < 60
- Urine microalbumin/ Crea ratio > 300 mg/g or urine protein/ Crea ratio > 0.5 g/g
- Uncontrolled hypertension
- Recurrent nephrolithiasis/stone prevention
- Fluid management – ‘resistant’ to diuretics, with or without a diagnosis of CHF
- Patients who are known to have only one kidney (congenital, acquired solitary kidney)
- Hereditary kidney disease