Many kidney diseases are treated with medication, such as steroids, DMARDs (disease-modifying antirheumatic drugs), antihypertensives (many kidney diseases feature hypertension). Often erythropoietin and vitamin D treatment is required to replace these two hormones, the production of which stagnates in chronic kidney disease. When chronic kidney disease progresses to stage five, dialysis or transplant is required. Please refer to the main articles dialysis and renal transplant for a comprehensive account of these treatments. Sub-specialties within nephrology include interventional nephrologists who focus on access placement and maintenance, a dialytician who focus upon ordering dialysis for patients, and transplant nephrologists who focus on the acute or sub-acute monitoring of immunosuppression in the transplant patient. If patients proceed to transplant, nephrologists will continue to follow patients to monitor the immunosuppressive regimen and watch for the infection that can occur post transplant.
As with the rest of medicine, important clues as to the cause of any symptom are gained in the history and physical examination.Laboratory tests are almost always aimed at: urea, creatinine, electrolytes, and urinalysis, which is frequently the key test in suggesting a diagnosis. More specialized tests can be ordered to discover or link certain systemic diseases to kidney failure such as hepatitis b or hepatitis c, lupus serologies, paraproteinemias such as amyloidosis or multiple myeloma or various other systemic diseases that lead to kidney failure. Collection of a 24-hour sample of urine can give valuable information on the filtering capacity of the kidney and the amount of protein loss in some forms of kidney disease. However, 24-hour urine samples have recently, in the setting of chronic renal disease, been replaced by spot urine ratio of protein and creatinine.
Other tests often performed by nephrologists are:
- Renal biopsy, to obtain a tissue diagnosis of a disorder when the exact nature or stage remains uncertain.;
- Ultrasound scanning of the urinary tract and occasionally examining the renal blood vessels;
- CT scanning when mass lesions are suspected or to help diagnosis nephrolithiasis;
- Scintigraphy (nuclear medicine) for accurate measurement of renal function (rarely done), and MAG3 scans for diagnosis of renal artery disease or 'split function' of each kidney;
- Angiography or Magnetic resonance imaging angiography when the blood vessels might be affected
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