Renal Medicine
Nature of the work
Renal medicine (nephrology) is the medical
specialty with primary responsibility for the management of
patients with kidney disease. Specialists treat:
- disorders that primarily or solely affect the kidneys (such as
some forms of glomerulonephritis)
- disorders that affect the kidney as part of a multi-system
disease (such as diabetic nephropathy)
- disorders that are linked to changes or abnormalities in renal
physiology (such as acid base disturbances).
Nephrologists are involved in the management
of patients with reversible kidney disease, such as acute renal
failure and patients with chronic kidney disease (CKD). Some CKD
patients will eventually require renal replacement therapy, and the
nephrologist must therefore be capable of managing dialysis and
kidney transplant patients. A patient may progress to renal failure
and require dialysis and subsequently a renal transplant over a
period of 10 to 20 years.
Working in renal medicine
Nephrologists generally work in renal units
based in district general hospitals or university teaching
hospitals. The renal services in these two types of hospital are
broadly similar, with the exception that renal transplantation
mostly takes place in university teaching hospitals. Many renal
units also manage satellite haemodialysis units, either in other
hospitals or in community-based facilities.
Larger renal units are often organised so that
patients can be managed in these four distinct areas, although an
individual patient can move through each of these areas during the
course of their disease. So a patient with vasculitis may initially
be managed in a general nephrology. But the condition may
eventually develop into end-stage kidney disease and result in
dialysis treatment before a kidney transplant is received. This
illustrates one of the main attractions of nephrology – patients
are often followed for many years, allowing a partnership to
develop between the renal team and the patient with respect to
disease management.
The number of people with chronic kidney
disease in the UK is unfortunately increasing and thus renal
medicine is an expanding specialty. Nephrologists are increasingly
sub specialising, for example, in transplantation. Academic
nephrology provides many exciting opportunities to drive new
research in renal medicine, dialysis and transplantation.
Common procedures/interventions
The renal curriculum requires competency to be
attained in two procedures – renal biopsy and the insertion of
temporary vascular access for haemodialysis. Some nephrologists
also become competent in the insertion of tunnelled catheters for
haemodialysis vascular access and in the insertion of peritoneal
dialysis catheters.
Associated sub-specialties
Some nephrologists eventually sub-specialise,
although most continue to manage at least some patients across the
broad range of renal disease. Common areas in which sub
specialisation occurs include haemodialysis, renal transplantation,
peritoneal dialysis and academic nephrology. Sub specialisation
tends to occur more often in larger renal units, although some
smaller renal units employ staff grade or associate specialist
nephrologists who specialise in haemodialysis.
Further information
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