Nephrology

Nephrology ([nefroloˈgiː], from ancient Greek νεφρός "kidney" and λόγος "word, doctrine": "kidney doctrine") is a branch of internal medicine that covers a wide range of topics. Basically, nephrology deals with the prevention, diagnosis, conservative (non-surgical) therapy and follow-up of renal and hypertensive diseases. The performance of all extracorporeal blood purification procedures (dialysis, apheresis, immunoadsorption) and the care of patients with a transplanted kidney also fall within the specialist field of nephrology.

Nephrology is still a relatively young discipline; Franz Volhard (1872-1950) and Georg Haas (1886-1971) are considered the founders of modern nephrology. Dialysis treatments were carried out experimentally in some clinics as early as the 1950s. A pioneer of hemodialysis treatment in Germany was Curt Moeller in Hamburg. The establishment of nationwide dialysis care proceeded slowly. The largest non-profit dialysis provider, the Kuratorium für Dialyse und Nierentransplantation e. V. (KfH), was founded in 1969. (KfH), the largest non-profit dialysis provider, was founded in 1969 because there was still a medical shortage of dialysis patients in Germany at that time. Today, high-quality dialysis care is available throughout Germany. Even though nephrology is still a relatively young academic subject, it has been one of the core areas of medicine since the beginning.

The urine examination has been an integral part of medicine since Galenos of Pergamon (ca. 1st-2nd century AD). The urine jar (matula) was a symbol of the doctors' guild in the Middle Ages. The central importance of the kidneys for general health has even become proverbially anchored in German usage, we examine "on heart and kidneys" (Psalm 7,10 Lu).

Nephrologist is a professionally protected designation that may only be used by specialists in internal medicine with the corresponding, successfully completed specialist training. Paediatric nephrology is an independent sub-speciality of paediatrics.

Nephrology diagnoses

  • Systemic diseases with renal involvement and/or hypertension: Collagenoses (lupus erythematosus, scleroderma, CREST syndrome, dermatomyositis-polymyositis, Sjögren's syndrome, mixed collagenosis (Sharp syndrome)/undifferentiated collagenoses), Vasculitides (Takayasu syndrome, giant cell arteritis, panarteritis, Kawasaki syndrome, granulomatosis with polyangiitis (Wegener's disease), eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome), microscopic polyangiitis, Schoenlein-Henoch purpura, essential cryoglobulinemic vasculitis, Goodpasture syndrome), other systemic diseases (amyloidosis, Behçet's disease, familial Mediterranean fever, Raynaud's syndrome, hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, HELLP syndrome).
  • Glomerular diseases that are not part of a systemic disease: Glomerulonephritis, Glomerular diseases without known histological diagnosis: acute nephritic syndrome, rapid-progressive glomerulonephritis, recurrent and persistent hematuria, chronic nephritic syndrome, nephrotic syndrome, isolated proteinuria secondary to tumor disease, infectious disease (incl. hepatitis) or gestational gestosis.
  • Tubulointerstitial diseases: Tubulointerstitial nephritis, obstructive uropathy and refluxuropathy, drug- and heavy metal-induced tubulointerstitial and tubular disease states, tubulointerstitial kidney disease in other diseases, other tubulointerstitial kidney diseases (for example, Balkan nephropathy, renal abscess, perinephritic abscess, analgesic nephropathy).
  • Nephrolithiasis (kidney stone disease)
  • Endogenous poisoning by uremic toxins and nephrotoxins
  • exogenous poisoning by various renal toxins (e.g. analgesic anphropathy)
  • Hereditary disorders: Alport syndrome, autosomal dominant or recessive cystic kidneys, Von Hippel-Lindau syndrome (Hippel-Lindau disease), nephronophthisis, tuberous sclerosis.
  • Tumor diseases: Renal cell carcinoma (kidney cancer), renal sarcoma and Wilms tumor (nephroblastoma), plasmocytoma (multiple myeloma) and malignant neoplasm of plasma cells, tumor lysis syndrome.
  • Acute kidney failure: Acute kidney injury (AKI) is a rapid decline in glomerular filtration rate. Acute kidney injury is defined as a rise in serum creatinine of at least 50% from a measured or presumed baseline level within seven days or a rise above a measured baseline level of at least 0.3 mg/dl within 48 hours. In addition, acute renal failure is present with a measured urine output of less than 0,5 ml/kg/h in six hours.
  • Chronic renal failure: According to the KDIGO recommendations, chronic renal disease exists if renal damage is present and/or the glomerular filtration rate (GFR) is less than 60 ml/min/1.73 m² for probably more than three months.
  • Acute kidney disease: Since for some patients with kidney disease neither the definition of ANV nor the definition of chronic kidney disease applies, the KDIGO working group proposes the definition of a further entity, the so-called "acute kidney disease" (AKD).
  • Concomitant diseases of chronic kidney disease: renal anemia, secondary hyperparathyroidism (sHPT), CKD-MBD ("Chronic Kidney Disease - Mineral Bone Disease"), uremic bleeding tendency, uremic encephalopathy, uremic pericarditis and neuropathy, nephrogenic systemic fibrosis (NSF)
  • Clinical conditions in renal disease: overhydration and exsiccosis, electrolyte disturbances, disturbances of the acid-base balance (acidosis, alkalosis), pruritus, thirst, malnutrition, uremia.
  • Metabolic disorders: Gout, hyperlipoproteinemia (HLP) or hyperlipidemia, obesity, protein metabolism disorders (hypoproteinemia, hypalbuminemia), diabetes mellitus.
  • Hypertension and vascular disease: Essential hypertension, secondary hypertension, gestational hypertension.
  • Diseases of the cardiovascular system concomitant with or as a consequence of kidney disease (cardiorenal syndrome, hepatorenal syndrome): coronary heart disease, angina pectoris, acute myocardial infarction, diseases of the heart valves, heart failure, peripheral arterial occlusive disease, thrombosis and embolism of the renal artery, thrombosis and embolism of the renal vein
  • Pulmonary complications: Pleural effusion and noncardiac pulmonary edema, congestive pneumonia...
  • Infections: Urethritis, tubulointerstitial nephritis, urinary tract infection, systemic inflammatory response syndrome (SIRS) / sepsis, hepatitis, tuberculosis, CMV infection, MRSA / multidrug-resistant pathogens (multidrug resistance), influenza, enterohemorrhagic Escherichia coli (EHEC), hantavirus.
  • Treatment of other complications: Neurologic complications/uremic neuropathy, osteoporosis, sexual dysfunction, poisoning symptoms, dialysis access complications (steal syndrome, catheter thrombosis).
  • The extrarenal renal syndromes according to Wilhelm Nonnenbruch, i.e. renal insufficiency even without renal disease
  • Kidney worms and other parasites can also damage kidney tissue.
  • Diseases for which extracorporeal therapy procedures may be used: Familial essential hypercholesterolemia, calcium metabolism disorders, hyperviscosity syndrome, multiple myeloma (plasmacytoma), acute myeloblastic leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML),BCR/ABL positive, B-cell chronic lymphocytic leukemia (CLL), Guillain-Barré syndrome/polyradiculoneuritis, myasthenia gravis, acute liver failure, alcohol toxic liver failure, toxic liver disease with hepatic necrosis, adult respiratory distress syndrome (ARDS), dilated cardiomyopathy, hearing loss, senile macular degeneration, inhibitory haemophilia, rheumatoid arthritis

Renal Replacement Therapies

  • Dialysis: Hemodialysis, Hemofiltration, Hemodiafiltration, Peritoneal Dialysis
  • Kidney transplantation: kidney transplantation follow-up, therapy of functional disorders, failure, rejection of a kidney transplant, evaluation of the recipient as well as in case of living donation of the donor

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