Nephrology is the subspeciality under Internal Medicine that deals with<unk>  function and disease states related to renal malfunction and their management including dialysis and<unk>  transplantation. Urology is the specialty under Surgery that deals with<unk>  structure abnormalities such as<unk>  cancer and cysts and problems with urinary tract. Nephrologists are internists, and urologists are surgeons, whereas both are often called<unk>  doctors". There are overlapping areas that both nephrologists and urologists can provide care such as<unk>  stones and<unk>  related infections. There are many causes of<unk>  disease. Some causes are acquired over the course of life, such as diabetic nephropathy whereas others are congenital, such as polycystic<unk>  disease. Medical terms related to the<unk> s commonly use terms such as renal and the prefix nephro-. The adjective renal, meaning related to the<unk> , is from the Latin rēnēs, meaning<unk> s; the prefix nephro- is from the Ancient Greek word for<unk> , nephros (νεφρός). For example, surgical removal of the<unk>  is a nephrectomy, while a reduction in<unk>  function is called renal dysfunction. Acquired *Diabetic nephropathy *Glomerulonephritis *Hydronephrosis is the enlargement of one or both of the<unk> s caused by obstruction of the flow of urine. *Interstitial nephritis<unk>  stones (nephrolithiasis) are a relatively common and particularly painful disorder. A chronic condition can result in scars to the<unk> s. The removal of<unk>  stones involves ultrasound treatment to break up the stones into smaller pieces, which are then passed through the urinary tract. One common symptom of<unk>  stones is a sharp to disabling pain in the middle and sides of the lower back or groin.<unk>  tumour *Wilms tumor *Renal cell carcinoma *Lupus nephritis *Minimal change disease *In nephrotic syndrome, the glomerulus has been damaged so that a large amount of protein in the blood enters the urine. Other frequent features of the nephrotic syndrome include swelling, low serum albumin, and high cholesterol. *Pyelonephritis is infection of the<unk> s and is frequently caused by complication of a urinary tract infection.<unk>  failure * Acute<unk>  failure * Stage 5 Chronic<unk>  Disease * Renal artery stenosis * Renovascular hypertension<unk>  injury and failure Generally, humans can live normally with just one<unk> , as one has more functioning renal tissue than is needed to survive. Only when the amount of functioning<unk>  tissue is greatly diminished does one develop chronic<unk>  disease. Renal replacement therapy, in the form of dialysis or<unk>  transplantation, is indicated when the glomerular filtration rate has fallen very low or if the renal dysfunction leads to severe symptoms. Dialysis A depiction of peritoneal dialysis. Dialysis is a treatment that substitutes for the function of normal<unk> s. Dialysis may be instituted when approximately 85%-90% of<unk>  function is lost, as indicated by a glomerular filtration rate (GFR) of less than 15. Dialysis removes metabolic waste products as well as excess water and sodium (thereby contributing to regulating blood pressure); and maintains many chemical levels within the body. Life expectancy is 5–10 years for those on dialysis; some live up to 30 years. Dialysis can occur via the blood (through a catheter or arteriovenous fistula), or through the peritoneum (peritoneal dialysis) Dialysis is typically administered three times a week for several hours at free-standing dialysis centers, allowing recipients to lead an otherwise essentially normal life. Congenital disease *Congenital hydronephrosis *Congenital obstruction of urinary tract *Duplex<unk> s, or double<unk> s, occur in approximately 1% of the population. This occurrence normally causes no complications, but can occasionally cause urinary tract infections. *Duplicated ureter occurs in approximately one in 100 live births *Horseshoe<unk>  occurs in approximately one in 400 live births *Nephroblastoma (Syndromic Wilm's tumour) * Nutcracker syndrome *Polycystic<unk>  disease *Autosomal dominant polycystic<unk>  disease afflicts patients later in life. Approximately one in 1000 people will develop this condition *Autosomal recessive polycystic<unk>  disease is far less common, but more severe, than the dominant condition. It is apparent in utero or at birth. *Renal agenesis. Failure of one<unk>  to form occurs in approximately one in 750 live births. Failure of both<unk> s to form used to be fatal; however, medical advances such as amnioinfusion therapy during pregnancy and peritoneal dialysis have made it possible to stay alive until a transplant can occur. *Renal dysplasia *Unilateral small<unk>  *Multicystic dysplastic<unk>  occurs in approximately one in every 2400 live births *Ureteropelvic Junction Obstruction or UPJO; although most cases are congenital, some are acquired. Diagnosis Many renal diseases are diagnosed on the basis of a detailed medical history, and physical examination. The medical history takes into account present and past symptoms, especially those of<unk>  disease; recent infections; exposure to substances toxic to the<unk> ; and family history of<unk>  disease.<unk>  function is tested by using blood tests and urine tests. The most common blood test are creatinine, urea and electrolytes. Urine tests such as urinalysis can evaluate for pH, protein, glucose, and the presence of blood. Microscopic analysis can also identify the presence of urinary casts and crystals. The glomerular filtration rate (GFR) can be directly measured ("measured GFR", or mGFR) but this rarely done in everyday practice. Instead, special equations are used to calculate GFR ("estimated GFR", or eGFR). Imaging Renal ultrasonography is essential in the diagnosis and management of<unk> -related diseases. Other modalities, such as CT and MRI, should always be considered as supplementary imaging modalities in the assessment of renal disease. Biopsy The role of the renal biopsy is to diagnose renal disease in which the etiology is not clear based upon noninvasive means (clinical history, past medical history, medication history, physical exam, laboratory studies, imaging studies). In general, a renal pathologist will perform a detailed morphological evaluation and integrate the morphologic findings with the clinical history and laboratory data, ultimately arriving at a pathological diagnosis. A renal pathologist is a physician who has undergone general training in anatomic pathology and additional specially training in the interpretation of renal biopsy specimens. Ideally, multiple core sections are obtained and evaluated for adequacy (presence of glomeruli) intraoperatively. A pathologist/pathology assistant divides the specimen(s) for submission for light microscopy, immunofluorescence microscopy and electron microscopy. The pathologist will examine the specimen using light microscopy with multiple staining techniques (hematoxylin and eosin/H&E, PAS, trichrome, silver stain) on multiple level sections. Multiple immunofluorescence stains are performed to evaluate for antibody, protein and complement deposition. Finally, ultra-structural examination is performed with electron microscopy and may reveal the presence of electron-dense deposits or other characteristic abnormalities that may suggest an etiology for the patient's renal disease.
Kidney
Liver
Lung
Heart
Peripheral nervous system
Central nervous system
Brain
Adrenal gland