Nephrology

What is Nephrology? Diagnosis and Treatment of Kidney Diseases

Kidney diseases often progress without any symptoms in the early stages, making early diagnosis and proper treatment planning vital. In this article, we have gathered all the important topics of interest, from the fundamental differences between nephrology and urology to the symptoms of kidney failure.

At the Daviva Health Group Nephrology Department; our team of expert nephrologists, modern technological infrastructure, and multidisciplinary treatment approach aim to secure your kidney health and maintain your quality of life at the highest level.

What is Nephrology?

Nephrology is a subspecialty of internal medicine that studies the structure, normal functions, and all diseases affecting the kidneys, which are vital filters of the human body. The word is derived from the Greek words "nephros" (kidney) and "logia" (study).

Doctors who specialize in this field are called Nephrologists.

Nephrologists manage a wide clinical spectrum, from acute (sudden onset) kidney injuries to chronic (progressive) conditions.

They have deep expertise in the complex relationship between kidney health and the vascular (circulatory), cardiovascular (heart and blood vessels), and endocrine (hormonal) systems.

What Diseases Does Nephrology Address?

Nephrology specialists take on the diagnosis, treatment, and management of localized problems arising directly from kidney tissue, as well as systemic (affecting the whole body) disorders that damage the kidneys.

• Chronic Kidney Failure

It is the progressive and irreversible loss of kidney functions due to structural damage. It is often triggered by systemic diseases such as uncontrolled diabetes and hypertension that damage the kidney vessels. It typically progresses in a vicious cycle without symptoms. Chronic kidney failure, which is divided into 5 stages based on the level of Glomerular Filtration Rate, shows no symptoms in the early stages, but as it progresses towards the final stage, it can lead to serious systemic complications such as mineral-bone disorders, anemia (due to erythropoietin hormone deficiency), and life-threatening electrolyte imbalances.

The primary goal of treatment is to slow the progression of the disease with medication, manage accompanying risks, and minimize the cardiovascular (heart and blood vessel) burden, which is a leading risk factor in patients. In the event of reaching the final stage of the disease, treatment methods such as hemodialysis, peritoneal dialysis, and kidney transplantation are applied to improve the quality of life of patients.

• Acute Kidney Failure

It is the sudden and rapid decline of kidney functions within a very short period, such as hours or days. Acute kidney failure can lead to dangerous levels of waste accumulation in the blood and fluid-electrolyte imbalances. With early diagnosis and appropriate intervention, it is usually a reversible condition.

The factors triggering the disease are clinically examined in three main groups.

• Sudden decrease in blood flow to the kidneys due to severe fluid loss, blood loss, or heart failure
• Toxins, autoimmune diseases, or severe infections directly damaging kidney tissue
• Physical obstruction of urine flow due to enlarged prostate, kidney stones, or tumors

The symptoms of acute kidney failure may vary depending on the speed of progression of the condition. Generally, the symptoms of acute kidney failure are as follows.

• Sudden fluid retention in the legs and ankles (edema)
• Significant decrease in urine output (sometimes may remain normal)
• Nausea and vomiting
• Excessive fatigue
• In advanced cases, it may present with neurological symptoms such as confusion.

Diagnosis of acute kidney failure can be made through serum creatinine and urea measurements, urine analyses, and imaging methods such as ultrasound. The underlying cause should primarily be eliminated. Blood pressure and fluid-electrolyte levels should be managed carefully. In life-threatening severe cases, temporary dialysis applications may be used in treatment to allow kidney tissue to recover and heal.

• Glomerulonephritis

It is a disorder that arises from the inflammation of microscopic capillary clusters called "glomeruli" responsible for filtering blood in the kidneys. The body's defense system may react incorrectly to its own tissues, or infections and systemic diseases like lupus may trigger it. This inflammatory process damages the kidney's filtering barrier, causing proteins and blood cells that should normally remain in the body to mix with urine. In the early stages, it may sometimes show no symptoms.

Glomerulonephritis can generally present the following symptoms.

• Darkening of urine resembling tea or cola
• Foamy urine (protein leakage)
• Persistent edema around the eyes or in the legs, especially in the mornings
• Uncontrolled high blood pressure

Diagnosis of glomerulonephritis is made through precise blood and urine analyses conducted in a laboratory setting. A "kidney biopsy" may be performed to determine the subtype of the disease and the extent of damage.

The treatment process is planned specifically for each patient according to the cause and severity of the inflammation. Along with immunosuppressive treatments that control excessive activity in the immune system, medications that reduce intra-renal pressure may be used.

With low-salt diets and edema management, the progression of the disease can be halted, and the kidneys can maintain their vital functions healthily for many years.

• Kidney Stones

They are hard, solid mineral and salt deposits formed in the kidneys as a result of the crystallization and aggregation of minerals such as calcium, oxalate, and uric acid, leading to urine becoming denser than normal.

Kidney stones, which can vary in size from a grain of sand to the size of a ping pong ball, move through the urinary system and pass through the urinary tract. Small stones can usually be expelled naturally and unnoticed through urine. Large stones can obstruct urine flow. In this blockage situation, severe and sharp pains suddenly begin in the back, sides, lower abdomen, or groin.

Kidney stones, which fall under the common expertise of nephrology and urology units, are a condition that directly affects the patient's quality of life and requires rapid intervention.

The treatment of kidney stones is planned individually based on the size, chemical composition, location of the stone, and severity of the patient's symptoms.

• In the case of small stones, methods that can be applied at home, such as having the patient drink 2-3 liters of water daily to dilute urine, using pain relievers under medical supervision, or medications that relax the ureter muscles to facilitate the passage of the stone, are preferred.
• However, for stones that are too large to pass spontaneously, completely block urine flow, or cause severe bleeding, medical intervention is mandatory.
• In this regard, non-invasive shock wave lithotripsy (ESWL), which breaks stones using sound waves from outside, can be applied.
• The ureteroscopy method, which involves entering the urinary tract with a thin tube and using laser assistance to break the stone, has been successful.
• For very large stones, minimally invasive surgical procedures such as percutaneous nephrolithotomy, which reaches the kidney through a small incision in the back, are successfully applied.
• Additionally, for certain special types of stones caused by uric acid, drug treatments aimed at changing the pH balance of urine to dissolve the stone may also be utilized.

• Kidney Infections

It is a serious type of urinary tract infection that usually starts from the urinary tract or bladder and ascends through the urinary channels, affecting one or both kidneys.

Unlike standard bladder infections, kidney infections present with more severe, systemic symptoms that develop rapidly within hours or days and affect the entire body. Patients often feel sharp pain in the lower back or in the sides between the ribs and hips.

In addition to the pain;

• High fever accompanied by chills
• Nausea and vomiting
• Burning sensation while urinating
• Blood or cloudiness in urine
• Sudden and frequent urge to urinate may also occur.

Kidney infections usually arise from the uncontrolled multiplication of bacteria entering through the urinary tract.

Untreated standard urinary tract infections, anatomical obstructions that block urine flow such as kidney stones or prostate enlargement, diabetes, and a weakened immune system significantly increase the risk of this infection.

Kidney infections require urgent medical intervention. If left untreated, they can lead to permanent damage to kidney tissue or a life-threatening systemic infection known as "sepsis" due to bacteria entering the bloodstream.

• Polycystic Kidney Disease

It is a hereditary disease that causes the growth of numerous fluid-filled cysts in the kidneys. Over time, these expanding cysts exert pressure on the surrounding healthy kidney tissue, causing damage. It is one of the most common hereditary causes of chronic kidney failure. Symptoms of polycystic kidney disease typically begin to appear between the ages of 30 and 40.

As the cysts grow, patients may experience;

• High blood pressure
• Pain in the back and sides
• Blood in urine
• Symptoms such as recurrent urinary tract or kidney infections develop.

There is currently no definitive treatment that completely eliminates polycystic kidney disease. Treatment focuses on slowing the growth rate of the cysts, controlling symptoms, and preventing complications.

The most critical step in preserving kidney functions during this process is the strict control of blood pressure (hypertension). Pain relievers and appropriate antibiotic treatments for developing infections are applied to improve the quality of life of patients.

• Electrolyte and Fluid Balance Disorders

These are clinical conditions characterized by the levels of vital minerals and water in the body exceeding normal limits. Essential electrolytes such as sodium, potassium, calcium, magnesium, and bicarbonate directly manage cellular functions, nerve-muscle transmission, and heart rhythm. When this balance is disrupted, deficiencies are referred to as "hypo-" and excesses as "hyper-" leading to serious clinical conditions. For example, volume disorders such as dehydration, which is accompanied by net water loss, or fluid overload due to kidney failure, as well as specific mineral imbalances can be observed.

While sodium imbalance can lead to cellular swelling or brain edema; potassium irregularities can cause very serious conditions such as muscle weakness, life-threatening rhythm disturbances, and cardiac arrest.

Fluid and electrolyte disorders usually arise not as a primary disease but as a result of another health issue. Chronic kidney failure, which disrupts the filtration and secretion capacity of the kidneys, imbalances in hormones that directly regulate ion absorption in the body, and the use of certain medications, especially diuretics, are the most common triggers of these disorders.

Treatment processes aim to eliminate the underlying causes. Additionally, dietary models tailored to the patient's needs can be implemented, including potassium and salt restrictions, personalized fluid management, and mineral supplements.

These methods, applied to restore intracellular balance and preserve vital organ functions, are planned and executed with a multidisciplinary approach.

• Diabetic Nephropathy

Uncontrolled chronic high blood sugar and hypertension lead to a serious complication of diabetes that damages the small blood vessels in the kidneys' filtering units.

This condition can directly affect patients with Type 1 and Type 2 diabetes, impairing the kidneys' ability to remove waste products and excess fluid from the body.

The early stages of the disease usually progress insidiously without any symptoms.

However, as the damage deepens;

• Protein leakage in urine known as albuminuria
• Swelling in the ankles
• Chronic fatigue
• Difficulty falling asleep may begin to manifest as symptoms.

Cases that are not intervened in a timely manner prepare the ground for progressive organ damage and ultimately end-stage kidney failure.

Early diagnosis in the management of diabetic nephropathy is critical to slow or halt the progression to end-stage kidney failure. The most vital step in treatment approaches is to maintain strict control of blood sugar and blood pressure. In this regard, medications that lower blood pressure and relieve the excessive filtration burden on the kidneys are used.

Treatment is supported by kidney-friendly dietary models that limit sodium, phosphorus, and protein consumption as needed, lifestyle changes such as quitting smoking, and multidisciplinary follow-up coordinated with the endocrinology unit.

What Are the Symptoms of Kidney Diseases?

Kidney diseases are often referred to as "silent diseases" because they typically progress insidiously without any symptoms in the early stages. However, as kidney functions decline and waste products and fluids begin to accumulate in the body, the following symptoms may develop:

• Foamy urine due to protein leakage
• Significant increase or decrease in urination frequency
• Blood in urine or darkening of urine resembling tea/cola.
• Swelling in the body, especially in the feet, ankles, legs, hands, or around the eyes in the mornings, due to the kidneys' inability to excrete excess fluid.
• Feeling excessively tired and weak, and having difficulty falling asleep due to the accumulation of toxins in the body or anemia (due to deficiency of erythropoietin hormone produced by the kidneys).
• Dry skin and severe itching triggered by the disruption of mineral and fluid balance in the body
• Painful muscle cramps that occur especially at night
• Nausea, vomiting, loss of appetite, or a metallic taste in the mouth due to the entry of toxic substances into the bloodstream

When Should One Consult a Nephrology Specialist (Nephrologist)?

• Consistently low eGFR (Glomerular Filtration Rate) values in blood tests
• High serum creatinine and urea (BUN) levels.
• Detection of albumin or protein levels above normal limits in urine analyses.
• Presence of chronic hypertension that cannot be reduced to normal levels despite the use of multiple antihypertensive medications or complex medical interventions.
• Consistent fluctuations in vital mineral levels such as sodium, potassium, calcium, or magnesium in blood tests, with values falling under "hypo-" or "hyper-" categories.
• Those with chronic heart diseases or a family history of hereditary kidney disorders such as polycystic kidney disease, including Type 1 and Type 2 diabetes, should regularly follow up with nephrology to protect their kidney health, even if there are no symptoms.

What Are the Diagnostic and Diagnostic Methods in Nephrology?

Blood Tests

Serum creatinine and blood urea nitrogen (BUN) levels are meticulously examined to measure the kidneys' capacity to clear waste products from the blood.

Based on these results, the Glomerular Filtration Rate is calculated to evaluate kidney functions.

Urine Tests

To determine whether the filtering barrier in the kidneys is damaged, protein leakage (proteinuria) and the presence of blood cells (hematuria) in urine are investigated.

Especially for the early detection and monitoring of kidney damage, the Urine Albumin/Creatinine Ratio and 24-hour urine clearance tests are utilized.

Imaging Methods

Ultrasound (including biopsy guidance or Doppler), computed tomography (CT), and magnetic resonance imaging (MRI) technologies are used to examine the size, structural integrity, and anatomical condition of the kidneys.

These methods allow for clear diagnosis of cysts, tumors, stones, or physical obstructions that block urine flow in the kidneys.

Kidney Biopsy

Especially in complex kidney diseases of immune origin, such as glomerulonephritis, a very small kidney tissue sample is taken using a needle under ultrasound guidance to determine the exact cause and stage of the damage.

Histopathological examination of this tissue in the laboratory ensures the selection of the most accurate treatment strategy.

What Are the Treatment Methods in Nephrology?

• Medications used to protect the filtering units in the kidneys and reduce protein leakage (proteinuria) in urine are preferred as first-line treatment.
• To reduce the risk or progression of kidney damage (diabetic nephropathy) due to diabetes, current agents that lower blood sugar while slowing the progression of chronic kidney disease and reducing cardiovascular risk are utilized.
• Synthetic erythropoietin and iron supplements may be used for anemia (due to decreased kidney function). To prevent bone-mineral disorders, phosphate binders and Vitamin D analogs are used.
• New generation therapeutic drugs that provide anti-inflammatory and antifibrotic protection in kidney tissue can be included in treatment protocols.
• When the kidneys lose 85-90% of their filtering functions, dialysis methods are employed to clear waste products and excess fluid from the blood.
• Hemodialysis: It is the process of filtering the blood with the help of a special machine outside the body and returning it to the bloodstream after removing toxins. It is usually applied in a clinical setting three times a week.
• Peritoneal Dialysis: It is the process of administering a cleansing fluid into the abdominal cavity through a special catheter. The peritoneum acts as a natural filter. This method can be applied daily at home or during travel, depending on the patient's condition.
• Kidney Transplant: In the case of end-stage kidney failure, it is the surgical procedure of placing a healthy kidney obtained from a living or deceased donor into the patient. Kidney transplantation, considered the most effective treatment method, requires lifelong careful use of immunosuppressive medications to prevent the body from rejecting the new organ.

How Should the Nutrition Plan Be for Kidney Health?

• To control blood pressure, daily salt (sodium) intake is limited to approximately 2,000 mg.
• To alleviate the metabolic workload on the kidneys, protein consumption is also restricted in a controlled manner.
• In advanced kidney disease, to prevent life-threatening rhythm disturbances, the consumption of potassium-rich foods (such as bananas, potatoes, etc.) and foods high in phosphorus (such as dairy products, dark-colored colas, etc.) is limited.
• While the patient adheres to strict dietary limits, they should work in coordination with a specialized kidney dietitian to ensure they receive adequate calories in a healthy manner.