Nephrology

Nephrology is the branch of medicine that specializes in the study, diagnosis, and management of diseases pertaining to the kidneys. Common disease include acute and chronic failure of the kidneys to filter blood (kidney injury), nephrolithiasis (kidney stones), acid-base and electrolyte imbalances, conditions that affect the glomerulus, and urinary tract infections.

A competent physician must have a keen eye for the clinical manifestations, both acute and chronic, of the most common conditions affecting the kidneys in order to start the proper initial management and know which conditions need to be examined by an internist or a nephrologist.

For this course, the student needs to be acquainted with the anatomy and physiology of the kidneys, the physiology of acid-base and electrolyte balance, and cell-mediated immunity.

Although it might seem challenging, a good grasp of basic concepts of nephrology aids in attaining a fuller picture of the most important systemic ailments. For example, medication-resistant hypertension may be due to a secondary cause affecting the kidneys, such as renal artery stenosis.

For optimal understanding, the student should be familiarized with the anatomy of the heart, with special emphasis on coronary circulation and the conduction system; cardiac physiology, with special attention to the cardiac cycle and membrane potential; and embryology of the heart and major vessels. Dysfunction of the cardiac pump can manifest in several ways depending on the underlying cause. Respiratory signs and symptoms are common in the case of poor cardiac performance or inadequate oxygenation of blood. Cardiovascular disease is one of the major public health concerns in the western world, and its associated morbidity can severely impair functionality and the quality of life of the affected individual. A good clinician should be able to identify the most common signs and symptoms associated with cardiac anomalies and also be proficient in analyzing ECG tracings. Coronary artery disease and conduction abnormalities are of special interest for general practitioners and ER physicians. For students, their importance cannot be understated.