Discussion in 'Other Subspecialties' started by DoujeDog, Mar 3, 2004.

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  1. DoujeDog

    DoujeDog Junior Member 7+ Year Member

    Aug 23, 2003
    Hey everyone, had a quick question concerning Nephrology.

    There's a substantial amount of talk about Cardiology/GI/Oncology/etc., but I haven't seen much concerning Nephrology. I have a slight interest in Nephrology, but don't really know as much about it as I do about other fields.

    Can any Nephrologists/residents out there explain the things that a Nephrologists manages/treats? I know their bread and butter work must be dialysis patients/kidney transplant patients, but there must be more to the field than that?

    I really appreciate your time, patience, thanks!!
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  3. They do a lot with transplant patients.

    Other than that, your guess is as good as mine.
  4. Kalel

    Kalel Banned Banned

    Feb 1, 2004
    Nephrology is an IM fellowship. Dialysis is the bread and butter of nephrology; ESRD patients are a socially interesting patient population of medicine because their dialysis care is covered by medicare irrespective of how old they are. This makes nephrologists particularly susceptible to the inklings of politicians in DC re-adjusting reimbursement rates. Besides doing dialysis and transplant (which is normally only done after doing a fellowship after a nephrology fellowship), neprhologists get consulted in hospitals for things like a bump in creatinine (which is usually due to ATN) and drug dosing reccomendations for patients with renal disease. The kidneys are particularly susceptible to damage during any kind of bodily injury because it's not a priority organ (blood is frequently re-directed to other organs when BP drops), so the kidney's actually get injured fairly frequently when patients get really sick. On an outpatinet basis, they do a lot of kidney biopsies to figure out why a patient has renal insufficiency (even when patients have diabetes, other causes of renal disease can be found in ~5-10% of patients who have biopsies performed). They can be consulted to manage recurrent nephrolithiasis, and they get consulted in an outpatient clinic whenever patients develop proteinuria, hematuria, or their creatinine increases. Some nephrologists are doing "interventional" fellowships (not an academically recognized fellowship) that allows them to take business away from vascular surgeons by doing things like making fistulas and placing grafts for dialysis access (minor to major surgical procedures). I don't think that you can be a nephrologists and not do dialysis though, since so many patients with renal disease will either need dialysis permantently or temporarily. Anyways, here's a basic website fromt he AASN:
  5. treasure

    treasure Senior Member 7+ Year Member

    Mar 3, 2004
    I have done my Neph fellowship and it involves:
    Acute renal failure
    Chronic renal failure
    Acid base and electrolyte problems
  6. doc05

    doc05 2K Member 10+ Year Member

    May 24, 2003
    What? Nephrologists doing AV fistulas? That's absurd. Who would allow that?
  7. Kalel

    Kalel Banned Banned

    Feb 1, 2004
    I may have misspoken, I'm not certain about the creation of new fistulas. I know that Interventional nephrologists do things like angioplasties, thrombolysis, and angiography with fistulas; making their turf more similar to the IR folks rather then the vascular folks; but their website also says that they do "placements" under AV grafts and fistulas. I spoke with one of my attending nephrologists about this issue and he informed me that it's mainly a financial and patient access to care issue; the nephrologists who do this extra fellowship are private practioners who are tired of referring their patients to IR and vascular surgeons who often have long waiting lists for procedures that reimburse well compared to things that the avg nephrologist does. I don't think that the practice of interventional nephrology is accepted by most academic centers since others are others who are more thoroughly trained to do these procedures.

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