Nephrology – diagnosis and testing

Nephrology is a speciality which is concerned with the study of normal and disease kidney function. There are many diseases which are found to affect the kidney’s, the majority of these are systemic disorders that are not just limited to the organ itself and therefore might require specific treatment. Some common examples include: genetic and congenital conditions (such as polycystic kidney disease), acquired systemic vasculitudes conditions (such as ANCA vasculitis) and many autoimmune diseases (such as lupus). There are many different patients which might be referred to a specialist in nephrology following a urinalysis procedure for example: chronic kidney disease, acute kidney failure, kidney stones, hematuria, disorders of electrolytes and proteinuria.

Diagnosis

A physical examination and a check on patient’s history are fundamental during the initial diagnostic workup.

• Physical examination: Includes the assessment of volume state, lungs, blood pressure, peripheral arteries, heart, abdomen and joints.

• Patient’s history: Typically include going through and obtaining as much back information about the patient, information such as family history records, general medical history, any current illness or medications/drugs being used, diet and occupation.

Testing

Various tests which can be carried out include.

1. Urine test: the examination of the urine sample makes it possible to undertake a direct assessment for any possible kidney problems, things to keep an eye out here include: protein in urine (proteinuria), cancer cells in urine, blood in urine (haematuria) and pus cells in urine (pyuria). Generally, a 24 hour urine sample is collected in order to quantify daily urine output, protein loss, electrolyte handling by renal tubules and creatinine clearance.

2. Blood test: can be useful in detecting the concentration of platelets, haemoglobin, potassium, sodium, creatinine, bicarbonate, calcium, phosphate, magnesium, chloride and urea that could be present in the blood. All of these tests are most likely going to be affected if the patient has kidney problems when compared to the normal levels found in normal patients.

3. Structural abnormalities test: this can be carried out by using imaging test, example include: magnetic resonance imaging (MRI), computed axial tomography (CT), medical ultrasound/ultrasonography and scintigraphy.

In majority of cases when a definitive diagnosis is needed then a biopsy of the kidney might be required. Here a small sample of the kidney is taken and examined under the microscope, this can allow a direct visualisation of any changes which may be taking place within the kidney. Also, in some cases, a biopsy may be used in order to monitor the response to any treatment being carried out and possibly identify any potential relapse.

Useful Further Reading

1. Evidence-based practice in nephrology: systematic reviews. Adv Chronic Kidney Dis. (2012) 19 (1): 34-9. Review. Samuel J. and Samuels J.

2. Nephrology research--the past, present and future. Nat Rev Nephrol. (2015) 11 (11): 677-87. Review. Floege J., et al.

3. Improving the Nephrology Match: the Path Forward. J Am Soc Nephrol. (2015) 26 (11): 2634-9. Review. Hsu C.Y., et al.

4. Onco-nephrology: a decalogue. Nephrol Dial Transplant. (2016) 31 (4): 515-9. Review. Cosmai L., et al.

5. Adding up the evidence: systematic reviews and meta-analyses. Nephron Clin Pract. (2011) 119 (4): c310-6. Noordzij M., et al.

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Created on Sep 14th 2018 05:45. Viewed 381 times.

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