By George R. Aronoff, MD, FACP

A nephrologist is a doctor who has been trained in kidney diseases, kidney transplantation and dialysis therapies. After graduation from medical school, a nephrologist must complete three years of training in general internal medicine and two more years of subspecialty training caring for patients with kidney disease, those patients on dialysis and those who have had kidney transplants. At the end of this training, most kidney doctors take a national examination to become certified as a nephrologist. The nephrologist may be a primary care physician for patients with kidney disease or act as a consultant to other doctors who have patients with kidney problems. Some nephrologists may have even more special training in kidney transplantation, management of the dialysis access and certain diagnostic procedures like ultrasound.

Nephrologists are often the doctors who make the specific diagnosis that kidney disease is present and what kind of kidney disease is causing the problem. Once a diagnosis is made, the nephrologist may recommend specific treatment. Even if there is no specific medication to prevent the progression of the kidney disease, the nephrologist will make recommendations for treatment to slow down the kidney disease as much as possible. For example, the nephrologist might prescribe blood pressure medications or treatments for diabetes. When kidney diseases get worse, the nephrologist may be the one to make a recommendation for care when the kidneys no longer function. The nephrologist will help patients decide about hemodialysis, peritoneal dialysis and kidney transplantation. The nephrologist will also make recommendations about having a dialysis access placed.

Until about 30 years ago, almost all medical care was provided for individual patients by individual doctors. Nurses were often an important part of that continuing care but were seen as the doctor's assistant.  Long before we thought about medical care as being provided by a group of professional caregivers, kidney doctors found themselves organizing nurses, technicians, social workers, dietitians and organ procurement specialists into teams. This revolutionary approach to provide the best possible solutions to the problems of patients with kidney disease was brought about by the development of successful treatments for kidney failure: dialysis and transplantation.

Each member of the team plays an important role in ensuring that kidney patients receive excellent care. The nephrologist will be the person responsible for establishing a care plan and seeing to it that this plan is followed as best as possible.  The nephrologist will examine his patients, evaluate old and new medical problems, check test results and prescribe medications and other treatments. Patients should not be shy in asking questions and alerting the physicians regarding changes in the way they feel, no matter how insignificant it may seem.  For dialysis patients, the nephrologist will determine the dialysis prescription and for transplant patients the nephrologist may adjust medications. Many nephrologists also care for their patients' other medical problems.

In the dialysis unit, the nephrologist may be responsible for other aspects of the dialysis treatment besides an individual patient's dialysis prescription. The nephrologist may also have a role in setting the general policies of the dialysis unit, like standards for care, policies and procedures for the dialysis treatments of all patients and the activities of other members of the dialysis team.

The nephrologist will coordinate the activities of many of the other members of the dialysis or transplant team. Today nephrologists are specialists who lead a team of caregivers in the treatment of patients with kidney diseases, the appropriate use of dialysis techniques and the care of transplant patients.

Dr. Aronoff is a Professor of Medicine & Pharmacology and Chief, Division of Nephrology at the University of Louisville. He is also an AAKP Life Member and a member of AAKP's Medical Advisory Board.

This article originally appeared in the March 2002 issue of aakpRENALIFE Vol. 17, No. 5.

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