On Nephrology (Kidney disease)
What is Nephrology?
Nephrology is the study and treatment of kidney disease. Nephrologists treat patients with kidney disorders and manage patients on dialysis and those who have had a kidney transplant. Like other specialists, nephrologists serve an additional residency in their field, beyond the standard training for a general internist. Because kidney disease affects the entire body, a nephrologist must also have a good grasp of other aspects of internal medicine, and how kidney failure can affect other body systems.
A Nephrologist is not a Urologist. A Urologist is a surgeon, and specializes in surgical diseases of the urinary tract including kidneys, ureters, bladder, prostate and urethra.
What do my kidneys do?
You have two kidneys. Your kidneys clean your blood and make urine. This drawing shows a cross section of a kidney.
When kidneys are healthy, the renal arteries bring blood and wastes from the bloodstream into the kidneys. The glomeruli clean (filter) the blood of wastes. Then wastes and extra fluid go out into the urine and through the ureters to the bladder. Clean blood leaves the kidneys and goes back into the bloodstream through the renal vein.
How is Kidney Function Measured?
Kidney function is measured by a blood test called “creatinine.” Creatinine is actually one of these waste products. The creatinine value increases if kidney function is decreased. There are other causes of elevated creatinine, which Dr. DeFabritus will discuss with the patient. A more recently developed measure of kidney function is the Glomerular Filtration Rate (GFR.) The GFR is thought of as a percentage scale of 1-100%, where 100% is normal. The stages of kidney disease are divided according to GFR, with Stage 1 being the best and Stage 5 the worst.
What are Common Kidney Problems and Associated Treatments?
The most important type of kidney disease treated by Dr. DeFabritus is Chronic Kidney Disease (CKD.) This is often a silent disease, coming to the attention of the physician through blood tests and/or through urinalysis. Dr. DeFabritus receives referrals from other internists who have found evidence of CKD this way. Chronic Kidney Disease often occurs in patients who are most prone to it, namely, those with diabetes or hypertension. There are, however, numerous other causes of CKD.
Can CKD lead to complete kidney failure?
Yes, CKD can lead to complete kidney failure. Complete kidney failure is known as End Stage Renal Disease (ESRD.) However, Dr. DeFabritus specializes in preventing this from happening, through careful blood pressure control and with the use of medications known to reduce the risk of complete kidney failure.
How can my doctor protect my kidneys during special x-ray tests?
Patients with CKD are prone to develop acute kidney injury (AKI), formerly known as acute renal failure, especially from certain dyes used for x-ray studies and from over-the-counter NSAIDs. These agents should be avoided in patients with CKD.
What are Causes of Hematuria (Blood in the Urine)?
Hematuria has many causes, and usually arises from some abnormality within the urinary tract (kidneys, ureters, bladder, urethra, and prostate.) Hematuria always needs to be investigated so that the cause can be determined and treated.
What Causes Kidney Stones?
Dr. DeFabritus treats patients who have recurrent kidney stones. There are many causes of kidney stones, and Dr. DeFabritus uses medication and diet to treat these causes, after the cause has been diagnosed with appropriate blood and urine tests.
How can diabetes hurt my kidneys?
Diabetes mellitus, especially type 2, formerly known as the adult type, is becoming more and more frequent in the general population. Either type 1 or type 2 can cause complete kidney failure, usually through a scarring process in the kidneys called glomerular sclerosis. Dr. DeFabritus will treat patients with diabetes mellitus with early or established kidney disease, in order to prevent progression to complete kidney failure.
What can I do if I have kidney problems caused by diabetes?
Diabetes related chronic kidney disease is the most common cause of ESRD in the United States. Good control of blood sugar, good control of blood pressure, and use of certain medications can help to prevent diabetes related chronic kidney disease from progressing to ESRD.