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Proper Function Of The Urinary System Is Frequently Evaluated By
A nephrologist is a kidney specialist. They can perform diagnostic tests and treat conditions related to the kidneys.Nephrology is a subspecialty of internal medicine. To become a nephrologist, a person should:complete an undergraduate and medical degreecomplete a 3 year residency in basic internal medicine trainingcomplete a 2 or 3 year fellowship focusing on nephrologypass a board certification exam (optional)Nephrologists often work in individual or group practices caring for people referred from family doctors or specialists. Many nephrologists also consult on cases in hospitals and oversee dialysis units, usually in a clinic or a hospital.Some nephrologists also focus on clinical research, while others work as professors and supervisors.Nephrologists treat conditions that involve or impact the kidneys, both directly and indirectly.Some common conditions a nephrologist treats or helps treat include:advanced or chronic kidney diseaseglomerular conditions, such as glomerulonephritis and nephrotic syndrometubulointerstitial kidney diseasestubular defectskidney vascular conditions, such as renal artery stenosiskidney infectionskidney neoplasms, or abnormal growthsstructural or functional abnormalities of the kidney, bladder, or urine collection system, such as nephrolithiasishigh blood pressurevasculitisautoimmune conditions involving the kidneyselectrolyte, fluid, and acid-base imbalances or disturbancessome metabolic disorders, such as diabetesTheir training in internal medicine and nephrology allows nephrologists to perform a very long list of tests, procedures, and treatments.However, the most common tests they use to diagnose or monitor kidney conditions are blood and urine tests.The kidneys filter excess fluid and waste from the blood, creating urine. This means that blood and urine tests can often reveal whether or not the kidneys are working properly.Urine tests can also check for abnormal levels of proteins linked to kidney damage in the urine.The following sections discuss these types of test in more detail.Blood testsCommon blood tests include:Serum creatinineThe body produces creatinine as a byproduct of day-to-day muscle damage.However, having high levels of creatinine in the blood, or elevated serum creatinine, is usually a sign of progressive kidney disease.Serum creatinine levels depend on factors including age, body size, and race. A value of greater than 1.2 for women or greater than 1.4 for men may signal kidney problems.Glomerular filtration rateThe glomerular filtration rate (GFR) tests how well the kidneys are able to filter out excess fluid and waste from the blood. Nephrologists can determine this value by calculating the serum creatinine level and factoring in age, sex, and race.Value typically decreases with age, but important GFR values include:90 or above (normal)60 or below (kidney dysfunction)15 or below (high risk of needing dialysis or a transplant for kidney failure)Blood urea nitrogenUrea nitrogen is a waste product from the body breaking down protein in foods and drinks. Typically, blood urea nitrogen (BUN) levels increase with decreasing kidney function.Normally, BUN levels range from 7 to 20.Urine testsCommon urine tests include:UrinalysisTo perform a urine analysis, or urinalysis, a nephrologist will usually look at a urine sample under a microscope to check for abnormalities.Urinalysis can also involve a dipstick test, during which a nephrologist will dip a small, chemically treated strip into a urine sample. The strip will change color if it reacts with abnormal protein levels, blood, bacteria, sugar, or pus.This helps detect many kidney and urinary tract conditions.24 hour urine testIn a 24 hour urine test, a person will collect their urine for 24 hours to show how much urine the kidneys can produce and how much protein and electrolytes the kidneys leak into urine each day.Creatinine clearanceA creatine clearance test compares the amount of creatinine in a 24 hour urine sample with that in blood samples to determine how much waste the kidneys are filtering each minute.MicroalbuminuriaA microalbuminuria test is a sensitive type of dipstick test that can pick up small amounts of the protein albumin in urine.People at risk of kidney conditions, including those with high blood pressure or metabolic conditions such as diabetes, may undergo this test if their standard dipstick test is negative for excess protein levels in the blood (proteinuria).Medical proceduresNephrologists use several types of procedure to help diagnose, monitor, and treat kidney conditions. These procedures include:UltrasoundUltrasound uses sound waves to create a picture of the kidneys. This test can detect changes in the size or position of the kidneys, as well as any obstructions.Obstructions can take the form of tumors, other abnormal growths such as cysts, or kidney stones.CT scanA CT scan uses X-rays to create a picture of the kidneys, sometimes with the help of an intravenous contrast dye. This test can detect obstructions or abnormalities in structure.However, contrast dyes may be problematic for people with kidney conditions.BiopsyA biopsy involves inserting a thin needle that has a cutting edge to take tiny slices of kidney tissues so that a healthcare professional can examine them.A nephrologist may perform a biopsy for a few specific reasons, typically to:assess kidney damageidentify a disease process and learn how it may respond to treatmenthelp understand transplant complicationsHemodialysisHemodialysis involves running blood through an artificial kidney machine called a hemodialyzer to remove waste, extra fluid, and extra chemicals before returning it to the body. The blood will return to the body through a port, or catheter, in the arm, leg, or sometimes neck.Hemodialysis typically treats end stage kidney failure, which occurs when the kidneys have lost around 85–90% of normal function and have a GFR rate of under 15.People often require 4 hour sessions three times weekly. A nephrologist will usually oversee these sessions.Kidney transplantA transplant involves removing a portion or all of a damaged kidney and replacing it with a matching donor organ.Surgeons perform transplant procedures, but nephrologists commonly work with a larger care team to help guide people through the process.
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Urinary System, Part 1: Crash Course Anatomy & Physiology #38
Even though you probably don’t choose to spend a lot of time thinking about it, your pee is kind of a big deal. Today we’re talking about the anatomy of your urinary system, and how your kidneys filter metabolic waste and balance salt and water concentrations in the blood. We’ll cover how nephrons use glomerular filtration, tubular reabsorption, and tubular secretion to reabsorb water and nutrients back into the blood, and make urine with the leftovers.
Pssst… we made flashcards to help you review the content in this episode! Find them on the free Crash Course App!
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Chapters:
Introduction: Urinary System 00:00
What Do Kidneys Do? 1:25
Urinary System Structure 3:02
Nephrons 4:13
Glomerular Filtration 4:37
Tubular Reabsorption 5:14
Tubular Secretion 8:17
Urine 8:40
Review 9:10
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