Nephrology

Nephrology is the medical specialty focused on the kidneys, their function, and their diseases. Nephrologists evaluate and treat conditions that affect kidney structure and physiology, including disorders of filtration, fluid and electrolyte balance, acid-base homeostasis, and hormone production. The specialty covers diagnostic evaluation, medical management, and when needed renal replacement therapy.

Kidney functions include filtering blood to remove waste, regulating volume and composition of body fluids, maintaining acid-base balance, producing hormones such as erythropoietin and renin, and activating vitamin D. The kidneys also participate in calcium and phosphate homeostasis and in controlling blood pressure.

Common conditions include chronic kidney disease, acute kidney injury, kidney stones, glomerulonephritis, nephrotic and nephritic syndromes, and polycystic kidney disease. Risk factors commonly associated with nephrological disease include diabetes, hypertension, smoking, autoimmune diseases, and recurrent infections. Nephrology care spans both pediatric and adult patients, addressing disease-specific needs.

Diagnosis relies on laboratory and imaging studies. Key tests include serum creatinine and estimated glomerular filtration rate (eGFR), urinalysis for proteinuria or hematuria, urine albumin-to-creatinine ratio, renal ultrasound, and, when indicated, kidney biopsy to assess histology.

Treatment varies by condition but often includes blood pressure control with ACE inhibitors or ARBs, glycemic control in diabetes, and dietary measures. Renal replacement therapy—hemodialysis or peritoneal dialysis—provides life-sustaining treatment for end-stage kidney disease, while kidney transplantation can offer improved long-term outcomes. Palliative and conservative care are considerations in advanced disease.

Historically, nephrology developed as a distinct field in the mid-20th century with advances in dialysis, transplantation, and integrated multidisciplinary care.