Description of specialty
Renal medicine, or nephrology, involves the care of people with all forms of kidney disease. Major components of the service are:
- the management of people with acute kidney injury (AKI)
- chronic kidney disease (CKD) – managing people with predominantly advanced levels of CKD is a growing aspect of the work of renal physicians, in partnership with primary care and other secondary care specialties. It involves the early detection of kidney problems and the prevention and management of progressive kidney disease.
- care for patients with kidney diseases without impairment of excretory kidney function, including proteinuria and nephrotic syndrome, kidney involvement in multisystem immune diseases such as systemic lupus erythematosus and vasculitis, and inherited and acquired tubular and other metabolic disorders that affect the kidney.
- care, support and treatment of patients with end-stage kidney failure. Renal physicians supervise and plan renal replacement programmes (including haemodialysis, peritoneal dialysis and renal transplantation).
Renal physicians, or nephrologists, work closely with a number of specialties including:
- urology to provide care for patients with haematuria, recurrent infections of the urinary tract, kidney stone disease, urinary tract obstruction and neurogenic bladder
- obstetrics to care for women with kidney disorders in pregnancy
- rheumatology to manage patients with systemic vasculitis
- cardiology to manage patients with ‘cardiorenal syndrome’
- vascular surgery to manage vascular access for dialysis.
Many diseases have the potential to affect the kidneys, and renal impairment impacts and influences the treatment of non-renal disease.
A coordinated approach involving a wide range of healthcare professionals is required to ensure that the nutritional, lifestyle, social and psychological needs of patients are met, alongside clinical management. The complexity of this care requires integrated multiprofessional working to provide a high-quality service.
The care of children with kidney disease is coordinated by paediatric renal physicians, and particular support is required for the transition from paediatric to adult renal services. The British Association for Paediatric Nephrology (BAPN) is the specialist society. It is a division of the Renal Association the professional body for nephrologists and renal scientists in the UK.