DR. RADU DRĂGULETE, PRIMARY NEPHROLOGIST

Nephrology is the branch of internal medicine that detects and treats kidney, urinary tract and prostate diseases - except for the surgical treatment provided by urology.

Nephrology is closely related to the rest of internal medicine (cardiology, gastroenterology, etc.), from at least the following:

1.    Kidney pain can have consequences for the whole body:

        High blood pressure, sodium retention (edema), heart failure

Hematological         disorders: anemia, thrombosis

Electrolyte         and acid-base disorders: hyperkalemia (increased potassium in the blood), acidosis, hypocalcemia (decreased calcium)

Cocaine         disorders: osteoporosis, hyperparathyroidism

Neurological         disorders: neuropathy, encephalopathy

2. The    kidneys are frequently affected by systemic diseases:

        High blood pressure, diabetes, atherosclerosis

        Heart failure

Hematological         diseases: multiple myeloma

        Policastro-meteorological: viral hepatitis, liver cirrhosis

Infectious         diseases: bacterial endocarditis, sepsis, leptospirosis

3. The    kidneys can be the victim of a variety of medications with very different uses:

        Anti-inflammatory steroids (e.g. aspirin, diclofenac)

        Conversion enzyme inhibitors (e.g. enalapril, perindopril), use extensively as antihypertensives and in cardiology (e.g. in the treatment of heart failure)

Antibiotic         tools (e.g. gentamicin)

Certain         anti-cancer drugs (e.g. cisplatin

        Iodinated contrast agents used in radiology (e.g. for coronary angiography)

4.     Most patients with nephrological conditions encountered

In practice are elderly and have numerous comorbidities (associated diseases). Doctor Muhammad Khan provides the best nephrology physicians in the USA.  Often interconnected, which must be carefully evaluated in the medical thought process, in order to diagnose as accurately and completely as possible, to facilitate the choice of therapeutic options. Good for each patient.

 

Therefore, I believe that for a correct and good quality nephrological practice, a good knowledge of internal medicine as a whole is absolutely necessary.

Indications for nephrological consultation

In which situations is nephrological consultation indicated? Here are the highlights: Stinging urination, frequent urination, pain in the suprapubic region, cloudy urine ( acute cystitis ) fever, chills, low back or hip pain, nausea or vomiting (with or without symptoms of cystitis) - acute pyelonephritis (kidney infection men: fever, chills, perineal pain, urinary incontinence, difficulty urinating, cloudy urine - a picture of acute prostatitis.

In all cases, urine tests should be performed to confirm the diagnosis: urine summary and urine culture. At 48-72 hours) will allow the adjustment of the antibiotic treatment according to the sensitivity of the isolated germ. If possible, the urine culture should be harvested before the first dose of antibiotic, otherwise, the result may be false-negative. It is important to remember that a positive urine culture in the absence of symptoms of urinary tract infection means usually the colonization of the urinary tract with germs and not the infection itself and most of the time does NOT justify an antibiotic treatment!

2.     In people with known kidney stones (who have spontaneously removed urinary stones, who have undergone urological procedures to remove or crush stones, or whose imaging investigations have shown kidney stones: abdominal ultrasound, simple kidney x-ray, computed tomography). In this situation, as a minimal investigation, abdominal ultrasound and a brief urine test are needed, along with older results if available (imaging, urine tests, hospital tickets, results of chemical analysis of the stones removed or extracted).

In the case of macroscopic hematuria

3.     In the case of macroscopic hematuria (red or brown bloody urine) or microscopic (the presence of red blood cells in the urine in the urine, but without changing the macroscopic appearance of the urine). Hematuria can occur in a range very different from diseases: urinary tract infections, kidney stones, glomerulonephritis (inflammatory kidney disease), kidney or bladder tumors, an overdose of anticoagulant drugs (e.g. Sintrom), etc.

4.     In the case of proteinuria highlighted in the urine summary (prein urf in urine proteins). If confirmed by quantitative dosing in 24-hour urine, proteinuria may indicate a primary renal disease - for example, glomerulonephritis, or secondary to another disease - for example, nephropathy diabetic, a complication of long-term diabetes. In many kidneys, the level of proteinuria correlates positively with their severity

In patients with high levels

5.     in patients with high levels of retention products in the blood: creatinine, urea, uric acid. These may indicate acute (new) or chronic (old) renal failure (reduced renal filtration function). Acute renal failure (ARF) is usually reversible if the cause is identified and corrected. I nsuficienţa chronic kidney disease (CKD) is the result of progressive and irreversible destruction of kidney tissue by various diseases, therefore does not heal and usually worsens over time, but can often be stabilized with certain therapeutic interventions. In time with IRC. The most advanced stage of CKD is called the uremic stage and leads to death if you do not resort to renal function replacement treatments: dialysis or kidney transplantation. Serum creatinine is the most common indicator of kidney function and therefore any patient with an elevated creatinine should have a nephrological consultation!

6.     in men over 50 years of age, symptoms suggestive of a hypertrophic benign prostate: wea, interrupted urine flow, frequent urination, feelings of incomplete emptying of the bladder. In this context, a minimum set of investigations is recommended:

Abdominal ultrasound with measurement

        Abdominal ultrasound with measurement of prostate volume and post-micturition bladder residue (volume of urine remaining in the bladder after complete urination)

        Determination of total serum PSA (specific prostate antigen) - to differentiate benign hypertrophy from prostate cancer, high values ​​suggesting the possibility of a malignant lesion. Doctor Muhammad Khan provides the best Clinical Consultation in the USA. The definite diagnosis in this situation can be established only with the help of prostate puncture-biopsy, a procedure performed by a urologist.

        Creatinine and serum urea for assessment of renal function

        Urine and urine culture summary toa rule out a urinary tract infection (a possible consequence of urinary obstruction due to prostate pathology or previous urological interventions, but also possible cause of false PSA increase)