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Nephrology (From: Nephros "
Nephrology (From: Nephros "
Training[edit]
India
To become a nephrologist in India, one has to complete an MBBS (5 and 1/2 years) degree,
followed by an MD/DNB (3 years) either in medicine or paediatrics, followed by a DM/DNB (3 years)
course in either nephrology or paediatric nephrology.
Australia and New Zealand[edit]
Nephrology training in Australia and New Zealand typically includes completion of a medical degree
(Bachelor of Medicine, Bachelor of Surgery: 4–6 years), internship (1 year), Basic Physician Training
(3 years minimum), successful completion of the Royal Australasian College of Physicians written
and clinical examinations, and Advanced Physician Training in Nephrology (2–3 years). The training
pathway is overseen and accredited by the Royal Australasian College of Physicians. Increasingly,
nephrologists may additionally complete of a post-graduate degree (usually a PhD) in a nephrology
research interest (3–4 years). Finally, all Australian and New Zealand nephrologists participate in
career-long professional and personal development through the Royal Australasian College of
Physicians and other bodies such as the Australian and New Zealand Society of Nephrology and
the Transplant Society of Australia and New Zealand.
United Kingdom[edit]
In the United Kingdom, nephrology (often called renal medicine) is a subspecialty of general
medicine. A nephrologist has completed medical school, foundation year posts (FY1 and FY2)
and core medical training (CMT), specialist training (ST) and passed the Membership of the Royal
College of Physicians (MRCP) exam before competing for a National Training Number (NTN) in
renal medicine. The typical Specialty Training (when they are called a registrar, or a ST) is five years
and leads to a Certificate of Completion of Training (CCT) in both renal medicine and general
(internal) medicine. In those five years, they usually rotate yearly between hospitals on a region
(known as a deanery). They are then accepted on to the Specialist Register of the General Medical
Council (GMC). Specialty trainees often interrupt their clinical training to obtain research degrees
(MD/PhD). After achieving CCT, the registrar (ST) may apply for a permanent post as Consultant in
Renal Medicine. Subsequently, some Consultants practice nephrology alone. Others work in this
area, and in Intensive Care (ICU) , or General (Internal) or Acute Medicine.
United States[edit]
Nephrology training can be accomplished through one of two routes. The first pathway is through an
internal medicine pathway leading to an Internal Medicine/Nephrology specialty, and sometimes
known as "adult nephrology". The second pathway is through Pediatrics leading to a speciality in
Pediatric Nephrology. In the United States, after medical school adult nephrologists complete a
three-year residency in internal medicine followed by a two-year (or longer) fellowship in nephrology.
Complementary to an adult nephrologist, a pediatric nephrologist will complete a three-year pediatric
residency after medical school or a four-year Combined Internal Medicine and Pediatrics residency.
This is followed by a three-year fellowship in Pediatic Nephrology. Once training is satisfactorily
completed, the physician is eligible to take the American Board of Internal Medicine (ABIM)
or American Osteopathic Board of Internal Medicine (AOBIM) nephrology examination.
Nephrologists must be approved by one of these boards. To be approved, the physician must fulfill
the requirements for education and training in nephrology in order to qualify to take the board's
examination. If a physician passes the examination, then he or she can become a nephrology
specialist. Typically, nephrologists also need two to three years of training in
an ACGME or AOA accredited fellowship in nephrology. Nearly all programs train nephrologists
in continuous renal replacement therapy; fewer than half in the United States train in the provision
of plasmapheresis.[5] Only pediatric trained physicians are able to train in pediatric nephrology, and
internal medicine (adult) trained physicians may enter general (adult) nephrology fellowships.
History and physical examination are central to the diagnostic workup in nephrology. The history
typically includes the present illness, family history, general medical history, diet, medication use,
drug use and occupation. The physical examination typically includes an assessment of volume
state, blood pressure, heart, lungs, peripheral arteries, joints, abdomen and flank. A rash may be
relevant too, especially as an indicator of autoimmune disease.
Examination of the urine (urinalysis) allows a direct assessment for possible kidney problems, which
may be suggested by appearance of blood in the urine (hematuria), protein in the urine (proteinuria),
pus cells in the urine (pyuria) or cancer cells in the urine. A 24-hour urine collection used to be used
to quantify daily protein loss (see proteinuria), urine output, creatinine clearance or electrolyte
handling by the renal tubules. It is now more common to measure protein loss from a small random
sample of urine.
Basic blood tests can be used to check the concentration of hemoglobin, white count, platelets,
sodium, potassium, chloride, bicarbonate, urea, creatinine, albumin, calcium, magnesium,
phosphate, alkaline phosphatase and parathyroid hormone (PTH) in the blood. All of these may be
affected by kidney problems. The serum creatinine concentration is the most important blood test as
it is used to estimate the function of the kidney, called the creatinine clearance or
estimated glomerular filtration rate (GFR).
It is a good idea for patients with longterm kidney disease to know an up-to-date list of medications,
and their latest blood tests, especially the blood creatinine level. In the United Kingdom, blood tests
can monitored online by the patient, through a website called RenalPatientView.
More specialized tests can be ordered to discover or link certain systemic diseases to kidney failure
such as infections (hepatitis B, hepatitis C), autoimmune conditions (systemic lupus
erythematosus, ANCA vasculitis), paraproteinemias (amyloidosis, multiple myeloma) and metabolic
diseases (diabetes, cystinosis).
Structural abnormalities of the kidneys are identified with imaging tests. These may include Medical
ultrasonography/ultrasound, computed axial tomography (CT), scintigraphy (nuclear
medicine), angiography or magnetic resonance imaging (MRI).
In certain circumstances, less invasive testing may not provide a certain diagnosis. Where definitive
diagnosis is required, a biopsy of the kidney (renal biopsy) may be performed. This typically involves
the insertion, under local anaesthetic and ultrasound or CT guidance, of a core biopsy needle into
the kidney to obtain a small sample of kidney tissue. The kidney tissue is then examined under a
microscope, allowing direct visualization of the changes occurring within the kidney. Additionally, the
pathology may also stage a problem affecting the kidney, allowing some degree of prognostication.
In some circumstances, kidney biopsy will also be used to monitor response to treatment and
identify early relapse. A transplant kidney biopsy may also be performed to look for rejection of the
kidney.