Nephrology
The Nephrology ( from ancient Greek νεφρός " kidney" and λόγος " word, doctrine ": "Kidney doctrine ") is a branch of internal medicine. It deals with the diseases of the kidney and their conservative ( non- surgical ) therapy. In addition, include high blood pressure, disorders of fluid and electrolyte balance and disorders of acid - base balance to a field. The main objective of nephrologists is the stabilization of renal function in order to delay the need for continuous renal replacement therapy ( hemodialysis, peritoneal dialysis ) as far as possible. Typical problems associated with chronic renal insufficiency are renal anemia, hypertension, renal osteomalacia and the need for dose adaptation of many renal -eliminated drugs. If renal disease has occurred, the nephrologist leads dialysis treatments and / or prepares the kidney. Their follow-up is also one of the tasks of the nephrologists, as well as the treatment of patients with hypertension and implementation of the various Lipidaphereseverfahren in patients with severely elevated blood lipid levels. In the context of intensive care medicine is the nephrologists acute renal failure, for example, after trauma, sepsis or intoxication treated by dialysis method. Finally, many poisonings are treated in this way.
- 2.1 glomerulopathies
- 2.2 Interstitial nephropathies
- 2.3 Post Renal nephropathy
- 2.4 Other nephropathies
- 2.5 Renal involvement in systemic diseases
- 2.6 hereditary diseases of the kidney
- 2.7 hypertensive disorders
- 2.8 kidneys and high-pressure conditions in pregnancy
- 2.9 metabolic disturbances of the acid-base and water and electrolyte balance
- 2:10 Further syndromes from other areas of medicine without extracorporeal methods
- 2:11 Further syndromes, therapy by extracorporeal methods
Diagnostic methods
The Nephrology uses essentially the following procedure:
Laboratory diagnostics
Blood
For the assessment of renal function and acid - base balance in general, the following parameters are analyzed in serum:
- Creatinine
- Urea
- Uric acid
- Sodium
- Potassium
- Calcium, usually together with phosphate
- Chloride
- Protein
In addition, the blood count and blood gas analysis be monitored regularly. Depending on the problem or underlying ( or suspected ) disease further analyzes are required if necessary.
Urine
Here, the random urine or midstream urine be distinguished from the urine. In the study of spontaneous urine following parameters are semi-quantitatively using test strips studied:
- Erythrocytes or hemoglobin
- Leukocytes
- Protein
- Nitrite
- Ketone bodies
- Glucose
Usually, a transmitted light microscopy is connected, conspicuous greater urine constituents such as cells or casts can be further differentiated. To answer the question whether blood in the urine comes from the kidneys or the urinary tract, a phase-contrast microscopy is performed in dark-field technique often additionally.
For further clarification of the cause of kidney disease, a urine test is often required in the entire volume of urine collected over a defined period (usually 24 hours) and the composition is then analyzed.
Renal disease patterns
The following medical conditions are at the heart field of nephrology ( the list is not exhaustive):
Glomerulopathies
- Acute and subacute glomerulonephritis
- Chronic glomerulonephritis
- Glomerular disorders in other underlying diseases
Interstitial nephropathies
- Acute interstitial nephritis
- Analgesic
Post Renal nephropathy
- Reflux nephropathy
- Obstructive nephropathy
Other nephropathies
- Balkan nephropathy
- Strahlennephritis
- Urate nephropathy
- Nephrocalcinosis
Renal involvement in systemic diseases
- Diabetic nephropathy
- Hypertensive nephropathy and nephrosclerosis
- Amyloidosis
- Plasmacytoma
- Sarcoidosis
- Rheumatic diseases
- Collagen
- Vasculitis
- Immune system disorders such as Goodpasture's syndrome, cryoglobulinemia
Hereditary diseases of the kidney
- Cystic kidney
- Medullary sponge kidney
- Nephronophthisis
- Alport syndrome
- A variety of hereditary tubular disorders, including renal glucosuria, Renal Tubular Acidosis, Bartter 's syndrome, renal diabetes insipidus, diabetes insipidus, DeToni - Debré - Fanconi syndrome
- Metabolic disease with renal impairment, including galactosemia, Wilson's disease, cystinosis, Lowe syndrome, Fabry disease, LCAT deficiency
Hypertensive disorders
- Primary hypertension
- Renovascular hypertension and renal artery stenosis
Kidney and hypertensive disorders during pregnancy
- Hypertension in pregnancy
- Renal dysfunction in pregnancy
Metabolic disorders of acid-base and water and electrolyte balance
- Metabolic alkalosis and acidosis
- Disorders of sodium, potassium, calcium, chloride and phosphate balance
Further syndromes from other areas of medicine without extracorporeal methods
- From transplantation medicine: preparation and further care in renal transplant, partly also care after combined kidney -pancreas transplantation, islet cell transplantation or liver transplantation
- From the Endocrinology: Treatment of secondary and tertiary hyperparathyroidism
- From the osteology: treatment of bone diseases as a result of kidney disease
- For Diabetes Care: Treatment of diabetes mellitus -related diseases
- For vascular surgery: management of operations for creating a dialysis Huntes or a dialysis catheter
Other medical conditions, treatment by extracorporeal methods
- From the Endocrinology: apheresis therapy for hypercholesterolemia
- From the Oncology: plasma separation in multiple myeloma with hyperviscosity syndrome
- From the Neurology: plasma separation or apheresis in Guillain -Barré syndrome, possibly also in other neuropathies
- From the Gastroenterology: apheresis in severe forms of Crohn's disease
- From the Otolaryngology: Apheresis for acute hearing loss and partly also in tinnitus
- From the Toxicology: hemoperfusion in certain acute poisoning
- From the Cardiology: hemofiltration in severe, medically uncontrollable heart failure