You have been referred to a doctor called a nephrologist. Here is what that means, and how to prepare for a successful and useful first encounter. The first thing to know is that a nephrologist is a physician trained in internal medicine or pediatrics and then additionally trained to understand and care for patients with kidney related disorders that affect the kidney function as well as the other organs that rely on good kidney function to work properly. Before your appointment with the nephrologist, prepare by thinking about what you should understand.
Don’t be shy about asking questions or expressing concerns you have about the condition that your nephrologist has been asked to see you for. The top eight questions below can start you on a path to better understanding of your condition, but are by no means the only questions that might come up or be appropriate for your first visit:
Why was I referred to see you?
Many people don’t know the reason for their referral and have questions about why the nephrologist was asked to assist in their care. The referring physician may have a general need for the opinion and participation of the nephrologist, or may have very specific questions about the type of kidney disease a patient exhibits or the treatment plan to offer a patient.
What is the reason my kidneys are not working properly?
Kidney function is a measure of the ‘cleaning’ capacity of the kidneys, and the term kidney dysfunction primarily refers to: 1) kidneys’ reduced cleaning capacity in removing toxins from the body that build up from everyday living; and 2) kidneys’ reduced ability to balance fluid in the body. These two functions of the kidneys, among others, are frequently the focus of a visit when a patient’s kidney function is impaired or at risk of deteriorating. Other structural or functional aspects of the kidneys may have been the reason for a referral. Your nephrologist should know why you were referred, and their job with you is to further understand your condition so that they can assist in your care.
What degree of kidney function loss exists now?
If your kidneys are not working properly, it is important for you to know how poorly they are functioning compared to normal. This is a reasonable question to ask and to track on your initial and subsequent visits to the nephrologist.
How rapidly is my kidney function declining?
Some causes of dysfunction of the kidneys are temporary, and some are permanent. Some conditions are associated with a continued loss of function over time; and the rate at which this happens will be an indicator of the frequency and extent of attention needed to try to delay or slow kidney function decline.
What can I do to slow, delay or reverse the decline in my kidney function?
Preserving kidney function is the desire of every physician that is treating you for your kidney disease. This may or may not be possible depending on your individual health situation and medical condition. Your nephrologist can help you understand if your kidney function is likely to continue to decline over time or if certain therapies might preserve or even improve that function.
What are my options for treatment and how do I learn about these options
Depending on the degree of kidney function loss you have, and the speed to which that loss of function has occurred, there will be options offered to either stall, reverse or delay the progression of the kidney disease. The nephrologist can explain and prepare you for decisions about additional therapy needed if your kidney function deteriorates to the point that renal replacement therapy options should be considered.
Who should I call with new problems or questions?
By the end of the visit with your nephrologist, you should understand the role that she or he will play in your ongoing care. The nephrologist should be able to determine if and when they should be called for questions about the kidney disease or other problems. Many other medical conditions are affected by the fact that the kidneys are not working well, and these will influence the approach by your clinical care team.
How can I simplify the medicines, tests and follow-up needed to get the best balance between my life and my kidney disease care?
The management of kidney disease frequently requires multiple medicines, diet and activity changes and frequent interactions with the health care system. It is reasonable to have a discussion with your nephrologist about challenges you may have with taking multiple medications, and the about impact of your medical regimen on your daily life. Your nephrologist will work to help you adhere to a medical plan of care and avoid the known potential consequences resulting from the kidney disease.
Franklin W. Maddux MD, FACP is the Fresenius Medicare Chief Medical Officer & Executive Vice President for Clinical & Scientific Affairs.
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