Nephrology

Nephrology is a subspecialty of internal medicine that deals with the structure, functions, and diseases of the kidneys. The kidneys are among the most vital organs in our body, undertaking critical tasks such as filtering blood, removing waste products, maintaining fluid-electrolyte balance, and regulating blood pressure. The Koru Hospital Nephrology department offers expert healthcare services in a wide spectrum, ranging from the early diagnosis of kidney diseases to advanced treatment methods.

The Role and Importance of Kidneys in the Body

By filtering approximately 180 liters of blood per day, the kidneys ensure that waste products in the body are removed through urine. In addition to this filtration function, the kidneys regulate the balance of electrolytes such as sodium, potassium, calcium, and phosphate; secrete hormones that control blood pressure; produce the hormone erythropoietin, which stimulates erythrocyte production; and play a role in vitamin D activation. Impairment in kidney functions can affect all body systems and lead to serious health problems.

Chronic Kidney Disease

Chronic Kidney Disease (CKD) is a condition characterized by the progressive deterioration of kidney functions over a period of more than three months. Affecting approximately ten percent of the population worldwide, this disease is considered a silent danger as it often does not show symptoms in the early stages.

• Stage 1-2 (Mild): Kidney functions are slightly reduced, but no significant symptoms are observed. Detection of the disease at this stage usually occurs during routine blood and urine tests.
• Stage 3 (Moderate): Kidney functions are significantly reduced. Symptoms such as fatigue, loss of appetite, sleep disorders, and swelling in the legs may appear.
• Stage 4 (Advanced): There is a serious loss of kidney function. Uremic symptoms such as nausea, vomiting, itching, muscle cramps, and difficulty concentrating become prominent.
• Stage 5 (End-Stage): The kidneys have almost completely lost their function. Dialysis treatment or kidney transplantation becomes necessary.

Causes of Chronic Kidney Disease

Diabetes and hypertension are among the most common causes of chronic kidney disease. These two diseases are responsible for approximately two-thirds of end-stage renal disease cases worldwide. Apart from these, other important causes that can lead to chronic kidney disease are as follows:

• Diabetic Nephropathy: This complication, which develops as a result of diabetes damaging the kidney vessels, is the most common cause of kidney failure. Good blood sugar control slows the progression of the disease.
• Hypertensive Nephrosclerosis: Long-term high blood pressure damages the kidney vessels, negatively affecting kidney functions.
• Glomerulonephritis: Inflammation of the glomeruli, which are the filtering units of the kidneys, can develop as a result of various autoimmune diseases or infections.
• Polycystic Kidney Disease: In this genetically transmitted disease, numerous cysts form in the kidneys, causing kidney functions to deteriorate over time.
• Interstitial Nephritis: Inflammation of the kidney tissue can develop due to medications, infections, or autoimmune processes.
• Obstructive Uropathy: Blockages in the urinary tract can cause back pressure on the kidneys, leading to kidney damage.

Acute Kidney Injury

Acute kidney injury is the sudden deterioration of kidney functions within hours to days. Unlike chronic kidney disease, acute kidney injury can be reversible with appropriate and timely treatment. However, temporary dialysis treatment may be required in severe cases.

Major causes of acute kidney injury include severe infections, excessive fluid loss, toxic effects of certain medications, obstruction of kidney vessels, and urinary tract obstructions. Early intervention and treatment of the underlying cause are of vital importance for preserving kidney functions.

Diagnostic Methods in Nephrology

Various laboratory tests and imaging methods are used in the diagnosis of kidney diseases. Accurate diagnosis plays a critical role in determining the treatment plan.

• Blood Tests: Measurement of serum creatinine, urea, electrolyte levels, and glomerular filtration rate (GFR) are the fundamental laboratory parameters for evaluating kidney functions.
• Urinalysis: Complete urinalysis, microalbumin measurement, 24-hour urine collection, and urine electrophoresis provide important information in the diagnosis of kidney diseases.
• Imaging Methods: Kidney ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) are used in the structural evaluation of the kidneys.
• Kidney Biopsy: Pathological examination of a small sample taken from the kidney tissue is the gold standard method for the definitive diagnosis of glomerulonephritis and other kidney diseases.
• Renal Scintigraphy: A nuclear medicine method used to evaluate the individual functions and blood flow of the kidneys.

Dialysis Treatments

In end-stage renal failure, dialysis treatment, which artificially performs the functions of the kidneys, is a life-saving treatment method. There are two main types of dialysis treatment.

• Hemodialysis: The patient's blood is filtered outside the body via a dialysis machine to remove waste products and excess fluid. It is generally applied in three sessions per week, with each session lasting approximately four hours.
• Peritoneal Dialysis: The abdominal membrane (peritoneum) is used as a natural filter. Dialysis fluid is introduced into the abdominal cavity via a catheter placed in the abdomen and is drained after a certain period. This method provides patients with more freedom of movement as it can be performed at home.

Kidney Transplantation

Kidney transplantation is the most effective treatment method for end-stage renal failure. Kidney functions are restored by transplanting a kidney taken from a living or deceased donor to the patient. After a successful kidney transplant, patients' quality of life increases significantly, and the need for dialysis is eliminated. Regular use of immunosuppressive drugs after transplantation is critical for the success of the transplant.

The Relationship Between Hypertension and Kidneys

There is a reciprocal relationship between hypertension and kidney diseases. While high blood pressure damages the kidneys, kidney diseases also cause blood pressure to rise. Breaking this vicious cycle is possible both through effective control of blood pressure and the preservation of kidney functions. Nephrologists investigate secondary causes, such as renal artery stenosis, in cases of resistant hypertension that cannot be controlled with medication.

Kidney Stone Disease and Nephrological Approach

Kidney stones occur when minerals in the urine crystallize to form stones. Nephrologists specifically investigate the metabolic causes of recurrent kidney stone formation and develop preventive treatment strategies. Based on the metabolic evaluation, dietary recommendations and, if necessary, medication treatment are planned.

Prevention of Kidney Diseases

Precautions taken to protect kidney health are of vital importance. Adequate water consumption, a balanced diet, regular exercise, limiting salt intake, and avoiding smoking and alcohol are fundamental lifestyle changes that help protect kidney health. Regular check-ups for diabetic and hypertensive patients and the consistent use of their medications are among the most important steps in preventing kidney diseases.

At the Koru Hospital Nephrology department, our specialist physicians provide evidence-based, up-to-date, and individualized treatment services to our patients at every stage, from the early diagnosis of kidney diseases to advanced treatment methods. Our experienced nephrology team aims to maximize the quality of life of our patients.