Q. What is the difference between a urologist and a nephrologist?


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Both , Urologists and nephrologists treat and address diseases and issues related to the kidney. Urologists are  basically surgeons that have specialized in treating structural abnormalities and diseases of the urinary tract. These include urinary tract stones, strictures and blockages including kidney cancer. Urologists have a number of gadgets at their disposal for performing various types of procedures such as Cystoscopy, Extracorporeal shock wave lithotripsy (ESWL) which is a non-invasive treatment of kidney stones and percutaneous nephrolithotomy (PCN).Nephrologists or Renal physicians are basically medical specialists that diagnose and treat kidney diseases and the various comorbidities that affect its functioning such as diabetes and chronic kidney disease. Nephrologists aren’t surgeons. Their field includes treating acute and chronic kidney injury , hypertension and electrolyte imbalance, diabetes, autoimmune diseases that specifically affect the kidney and renal replacement therapy. A nephrologist may work with the acute medical team or further specialize into one of the branches described above.

Acute renal failure and chronic kidney disease are mainly treated by nephrologists as they are mainly concerned about the proper functioning of kidneys while urinary tract infections (UTI), kidney stones and structural abnormalities are dealt with by urologists.
Urinary tract infections mostly involve urethra and bladder and are much more common in females than males because of the short urethra and its close proximity to vagina and anus. However it can extend upwards into ureters and renal pelvis, sometimes even involving the renal parenchyma and may result in abscess formation which then needs to be drained by a urologist under Ultrasound or CT guidance.  Chronic infection can also lead to repeated mucosal injury that can give rise to stricture formation and urinary blockage which is relieved by surgically removing the stricture. This job is also assigned to the urologists. Acute UTIs are mostly treated with antibiotics, plenty of water and pain medications, that too mostly suggested /prescribed by urologist. That being said, if however ,a urinary tract infection leads to poor renal function as a result of hydronephrosis /pyonephrosis or renal abscess,  the case is then best handled in coordination with the nephrologist.
 Kidney stones are very common in the general population. Mostly they are asymptomatic and are passed out in urine if smaller in size . 5 to 10 mm size stones can be passed spontaneously or with medicine. However bigger kidney stones are mostly problematic and do not pass spontaneously. They can predispose to urinary tract infections and distal obstruction leading to hydronephrosis and acute kidney injury.   Such problematic stones are removed with different surgical methods depending upon the size of the stone and the general wellbeing of the patient. These include ESWL, Lithotripsy PCN and open surgery.
 All of these procedures are performed by a urologist. Autoimmune diseases affecting Kidneys include lupus nephritis IgA nephropathy , Goodpasture’s syndrome, Wegener’s granulomatosis amyloidosis etc. All these autoimmune conditions cause renal damage and impaired renal function. The diagnosis and treatment of autoimmune nephritis comes under the domain of a nephrologist. Sometimes the nephrologist needs the help of a team of surgeons if the kidney is irreversibly damaged both structurally and functionally, thus requiring a transplant procedure.

Wishing you best of health


Dr. Sareer Khalil


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