When to See a Kidney Doctor

Who is a "nephrologist" and why you might need to see one

Doctor writing on medical chart with patient in the background
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Nephrologists are physicians who specialize in the diagnosis and treatment of kidney disease, electrolytes, high blood pressure, dialysis, kidney stones, etc. In the absence of impressive symptoms, it could be hard for patients to understand why they might have been asked to see one. Often, they even refuse! Typical responses for refusal are, "I pee fine. Nothing is wrong with my kidneys", or "I don't have any kidney pain".

As we know, peeing or not peeing, or pain in the kidneys, are not necessarily the symptoms of kidney disease

I don't blame anyone for this confusion. Its partly the nephrologists' fault who have not been good at educating people of the nephrologist's role. It also has to do with the nature of the disease. Chronic Kidney Disease (CKD) is a "silent killer". It destroys your kidneys slowly, and as I had mentioned in another post; the most common symptom is no symptom at all!  Other times, the symptoms can be very vague like fatigue or insomnia or a metallic taste in the mouth. So if you go to your primary doctor and tell him that, "doc, I am tired"; well...it could be so many other things that could be making you tired! It would usually take a specialist to put two and two together and pin the blame on kidney disease. When things don't hurt, you really have to be motivated to pay attention!

 And pain, the great motivator, is usually amiss when it comes to kidney disease. 

I am not emphasizing the importance of a referral to a nephrologist because I am one. In fact, multiple medical studies have clearly proved that patients who are referred late to nephrologists are  more likely to die, or progress to dialysis!

Here are a few more links to important studies done is this regard here, and here

Hence, in order to minimize your risk/slow down the progression to dialysis requiring kidney failure, you should ideally be seen by a nephrologist once your creatinine is high enough to be called CKD Stage 4. That would mean a GFR of less than 30. 

When it comes to kidney disease, recovery usually does not happen once your GFR has chronically declined to the advanced stages. Hence, the emphasis really needs to be on prevention. The next time you see your physician, do discuss what your "GFR" is, and do you need to be seen by a specialist. This is especially applicable to any one who has the common risk factors for chronic kidney disease, including but not limited to diabetes, long standing hypertension, cardiovascular disease conditions (coronary disease, congestive heart failure, stroke, aortic aneurysms), family history of kidney disease, prolonged use of over the counter pain killer medications (NSAIDS) like ibuprofen, celebrex, etc.


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