Nephrology: Definition, Scope and Recent Advances (2022)
Overview
Chronic kidney disease (CKD) has been recognised as a leading public health problem worldwide, with a global estimated cumulative of Chronic Kidney Disease is 13.4% (11.7-15.1%), along with patients with end-stage kidney disease (ESKD) needing renal replacement therapy are estimated between 4.902 and 7.083 million. The recognition of kidney disease - acute and chronic, has led to the development of nephrology nursing as a speciality as a major health problem. Now, we will talk about nephrology.
What is Nephrology?
It is the subspecialty of internal medicine that largely focuses on the diagnosis and treatment of diseases of the kidney. Just because the kidney performs so many critical functions, nephrologists maintain expertise in primary kidney disorders but also the management of the systemic results of kidney dysfunction. Even though the prevention and identification, and management of early kidney disease is a large part of general internal medicine practice, nephrologists are commonly called upon to assist and manage complicated or advanced nephrological disorders.
Some examples of conditions cared for by nephrologists include primary kidney disorders such as glomerular diseases such as - glomerulonephritis or nephrotic syndrome, tubulointerstitial kidney diseases, tubular defects, and the impact of toxins on the kidney, which include various diagnostic and therapeutic agents.
- The knowledge of disorders of the kidney vasculature, such as - infections and neoplasms of the kidney, renal artery stenosis, abnormalities of the kidney, collecting system, and bladder, such as - nephrolithiasis - are important aspects of nephrology practice.
- An understanding of the involvement of the kidneys in other systemic diseases, such as - vasculitis or heart failure - is a primary role of nephrologists, and due to the vital function of the kidney in maintaining blood pressure, they also possess expertise in the management of hypertension, mainly when it is difficult to control.
- They also help in managing fluid, electrolyte, and acid-base disturbances, particularly those occurring in advanced kidney disease. One of the major roles of nephrology is the oversight of dialysis, which includes hemodialysis and peritoneal dialysis in such patients who require renal replacement therapy and participation in the kidney transplant process if it is indicated.
What are the causes of Chronic Kidney Disease (CKD)?
Medical conditions like diabetes and high BP, or hypertension, are responsible for 2/3rd of chronic kidney disease cases. While there are many other reasons behind the CKDs, let’s discuss these two in brief:
Diabetes - It occurs mainly when your blood sugar remains too high. Therefore, over time, unmanaged blood sugar can cause damage to many organs in your body, including the heart, kidneys, nerves, eyes and blood vessels.
High blood pressure - It occurs when your blood pressure against the walls of your blood vessels increases. High blood pressure, if uncontrolled or poorly controlled, can be a leading cause of strokes, heart attacks, and chronic kidney disease. Additionally, chronic kidney disease can cause high blood pressure.
Who is a Nephrologist?
A nephrologist is a physician who specialises in the care and treatment of kidney disease. It requires additional training to become an expert with advanced skills. They may provide care to people without kidney problems and may work in transplant medicine, immunosuppression management, general/internal medicine intensive care medicine, perioperative medicine, clinical pharmacology, or pediatric nephrology.
They may further sub-specialise in dialysis, kidney transplantation, home therapies (home dialysis), cancer-related kidney diseases (onco-nephrology), structural kidney diseases (uro-nephrology), procedural nephrology or other non-nephrology areas as described above. The procedures that typically a nephrologist may perform include native kidney and transplant kidney biopsy, dialysis access insertion (temporary vascular access lines, tunnelled vascular access lines, peritoneal dialysis access lines), fistula management (angiographic or surgical fistulogram and plasty), and bone biopsy. Bone biopsies are now unusual.
Significance of Nephrology
The practice of nephrology comprises the roles of direct caregiver, coordinator, consultant, administrator, educator, and researcher. This healthcare practice extends to all care delivery settings in which patients are at risk for developing or experiencing CKD stages 1 through 5 and receive health care, counselling and education for kidney disease prevention, progression, diagnosis, and treatment.
We all know that optimal individual physical and cognitive function and family support throughout all phases of disease management are the major objectives of nephrology. Nephrology achieves these major objectives by timely diagnosing and treating human responses, which are exhibited by persons and families with kidney disease or who are at high risk for developing Chronic Kidney Diseases. These human responses are but are not limited to physical symptoms, functional limitations, psychosocial disruptions, and knowledge needs.
Scope of Practice for Nephrology
When we talk about the scope of practice for nephrology, it demonstrates for the public and for the profession the nature of this speciality’s practice. Typically, nephrology nursing comprises the primary, secondary, and tertiary care of individuals with potential and progressive CKD, acute kidney injury (AKI), end-stage renal disease (ESRD), and any other healthcare conditions which require nephrology intervention. This practice spans the continuum of care for patients with kidney disease.
Nephrology nurses provide care to neonatal, pediatric, adult, and older adults in all racial/ethnic groups. Nursing care can be complex, as these patient populations may have various comorbid conditions, including cardiovascular disease, diabetes, hypertension, infectious disease, and/or mineral and bone disease. In addition, many face psychosocial issues, such as depression and anxiety.
Recent advances
- The identification of the genetic basis for some rare disorders has led to an overall increased understanding of general renal physiology and opened up the possibility of new treatments for hyperparathyroidism and hyponatremic states.
- Significant advances have taken place in the overall understanding of the pathogenesis of IgA nephropathy and adult polycystic kidney disease; however, as yet, these have not led to breakthroughs inthe treatment of these conditions.
- The reduction of proteinuria by anti-hypertensives slows the progression towards the end-stage renal failure of many types of renal disease—angiotensin-converting enzyme inhibitors may have particular value in reducing proteinuria until and unless systemic blood pressure is lowered far enough.
- Even though only a small proportion of affected patients benefit from renal revascularisation, the high frequency of renal artery stenosis in patients suffering from atherosclerosis mandates regular monitoring of renal function if angiotensin-converting enzyme inhibitors are used.
Conclusion
The common people continually recognise healthcare as one of the most trusted professions. This ultimately imposes a responsibility to provide the best health care, which requires a well-educated, clinically astute and professional association composed of those products and services, which establishes a code of ethics and standards of care and practice.
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