What is a nephrologist? Definition, role, indications, salary

What is a nephrologist?

A nephrologist is a specialist doctor in charge of the diagnosis and treatment of all kidney diseases (or nephropathies), which affect blood filtration, the kidneys’ primary function. Nephrology is the medical specialty aimed at preventing, diagnosing kidney disease. Management ranges from the most basic and early symptoms ( such as blood or protein in the urine ) to more serious complications such as chronic kidney disease, which may require dialysis or kidney transplantation.

“Nephrologists follow up in consultation with kidney transplant patients as well as patients treated on dialysis, specifies Dr Aldjia Hocine, nephrologist at the Landy Clinic in Saint-Ouen (93), practitioner attached to the Bichat hospital in Paris and President of the Club of Young Nephrologists. When renal function is severely degraded, the nephrologist accompanies the patient and his entourage to so-called substitute treatments. These are treatments designed to replace the working kidneys that are no longer functioning well enough. The treatments are: renal transplantation, dialysis treatments which can be carried out at home (hemodialysis and peritoneal dialysis) and in a center (hemodialysis with schedules and degrees of medicalization adapted to the personal and clinical situation of the patient).All practitioners are in close contact with a university hospital center which coordinates registration on the renal transplant list as soon as this is necessary depending on the deterioration of renal function and the patient’s clinical condition”.

When to see a nephrologist?

After consulting your doctor, you should refer to a nephrologist for all pathologies affecting the kidneys. Other specialists (cardiologists, endocrinologists, diabetologists, etc.) can refer you to the nephrologist. “It also happens that it is the occupational physician who detects a blood or protein problem on the urine test strip therefore requiring a specialist opinion from the nephrologist,” continues Dr Flora Brunner, nephrologist at the Bouchard Clinic in Marseille (13) and secretary deputy general of the Club of Young Nephrologists.The prevention and early detection of chronic kidney disease is one of the cornerstones of  nephrology care in order to slow down the deterioration of kidney function.” The reasons for consulting a nephrologist are:

  • Elevation of creatinine seen on a blood test
  • Presence of blood (hematuria) or protein (proteinuria) in the urine, chronic renal failure (CRF)
  • Arterial hypertension
  • Ionic disorders: calcium, potassium, sodium
  • Renal colic,
  • Repeated urinary tract infections 

“The nephrology consultation is an opportunity to give the patient the recommendations of nephroprotection adapted to his clinical condition,” said Dr Hocine Aldjia. Advocating a diet and appropriate fluid intake, improved control of blood pressure and other factors cardiovascular risk”.

Read Also: What is a kidney infection and how it should be treated?

What types of diagnosis do nephrologists provide?

A nephrologist treats and diagnoses a number of Kidney infections and disorders in the urinary tract. These infections include abnormality in the kidney, kidney stones, high blood pressure, disorders in the urine, etc.. So a pediatric nephrologists can perform many types of treatments;

  • kidney dialysis
  • kidney transplant
  • lithotripsy
  • monitor kidney blood pressure
  • X-ray analysis of kidney
  • urinary bladder stones

How is the visit to a nephrologist?

After having questioned his patient with precision, the nephrologist carries out a clinical examination, before prescribing additional examinations. “The evaluation of renal function is done through the blood test by measuring creatinine, which then allows the calculation of the glomerular filtration rate, the urine analysis also makes it possible to provide other elements to complete the diagnosis of kidney disease,” explains Dr. Brunner. “If at the end of the paraclinical and biological assessment, it is necessary to deepen the investigations, the nephrologist can offer you other examinations,” adds Dr Hocine. Among others:

  • performing a kidney biopsy which will require a short hospital stay and will clarify the existence of nephropathy and guide the treatment best suited to your situation
  • renal functional explorations in a specialized unit: measurement of glomerular filtration rate, assessment of ionic disorders (calcium, potassium, sodium for example), assessment of stones “.

Find out more: Kidney stones – Causes and remedies

How to prepare for your visit?

“It is always interesting to bring your complete medical file (for example the consultation reports of other specialists such as your cardiologist or diabetologist ) as well as the list of your usual medications to allow the nephrologist to have an overall view of your state of health”, acknowledges Dr Flora Brunner.

What is the price and reimbursement of a nephrologist?

Whatever the place of consultation, the vast majority of nephrologists in France are contracted in sector I, the duration of a consultation is on average 30 minutes “, says Dr Hocine. The consultation fees are as follows:

  • 60 dollars: patient referred by his attending physician for a one-off opinion or follow-up consultation and in coordination with the attending physician with an appointment more than 4 months apart.
  • 24 dollars: follow-up of a patient in coordination with the attending physician with an appointment less than 4 months apart.
  • 70 dollars: first summary consultation of a patient with progressive renal failure with a view to referral to a renal transplant team.

The reimbursement basis is that of consultations with sector I contracted specialists: 70% when the consultation takes place within the framework of the coordinated care pathway. “Specific care courses dedicated to patients with chronic renal failure from stage 4 have been put in place since 2020 which make it possible to support patients in the management of their pathology by calling on a set of caregivers in addition to consultation with the nephrologist: nephrology nurses, dieticians, social assistants.”, adds Dr Hocine.

How to become a nephrologist?

To become a nephrologist, the student must obtain a diploma of specialized studies (DES) in nephrology. After his baccalaureate, he must first follow 6 years at the faculty of medicine. At the end of the 6th year, students take the national classifying tests to access the boarding school. Depending on their classification, they will be able to choose their specialty and their place of practice. The internship in nephrology now lasts 5 years (recent reform of the 3rd cycle) and ends with obtaining the DES in nephrology after validation of a thesis in nephrology. “Finally, to be able to practice as a nephrologist and carry the title of doctor, the student also supports a medical thesis.,” adds Dr Hocine. It is not uncommon for nephrologists to complete their training with a science course (Master 2), some go on to a science thesis which opens them up to hospital-university careers. Like all practitioners, continuing medical education is essential to stay up to date with new developments in our specialty.”

What is the salary of a nephrologist?

The average salary of a nephrologist is 131322 dollars gross per year (or 6927 dollars net per month ).

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