Nephrology (from
Greek'' nephros'' "
kidney
The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; blo ...
", combined with the suffix ''-logy'', "the study of") is a
specialty of adult
internal medicine and
pediatric medicine that concerns the study of the
kidney
The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; blo ...
s, specifically normal
kidney function (
renal physiology) and
kidney disease
Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease of a kidney. Nephritis is an inflammatory kidney disease and has several types according to the location of the inflammation. Inflammation can ...
(renal pathophysiology), the preservation of kidney health, and the treatment of kidney disease, from diet and medication to
renal replacement therapy
Renal replacement therapy (RRT) is therapy that replaces the normal blood-filtering function of the kidneys. It is used when the kidneys are not working well, which is called kidney failure and includes acute kidney injury and chronic kidney ...
(
dialysis and
kidney transplantation). The word “
renal” is an adjective meaning “relating to the kidneys”, and its roots are French or late Latin. Whereas according to some opinions, "renal" and "nephro" should be replaced with "kidney" in scientific writings such as "kidney medicine" (instead of nephrology) or "kidney replacement therapy", other experts have advocated preserving the use of
renal and nephro as appropriate including in "nephrology" and "renal replacement therapy", respectively.
Nephrology also studies
systemic
Systemic fundamental to a predominant social, economic, or political practice. This refers to:
In medicine
In medicine, ''systemic'' means affecting the whole body, or at least multiple organ systems. It is in contrast with ''topical'' or ''loc ...
conditions that affect the kidneys, such as
diabetes
Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...
and
autoimmune disease; and systemic diseases that occur as a result of kidney disease, such as
renal osteodystrophy and
hypertension. A physician who has undertaken additional training and become certified in nephrology is called a ''nephrologist''.
The term "nephrology" was first used in about 1960, according to the French "néphrologie" proposed by Pr. Jean Hamburger in 1953, from the Greek νεφρός / nephrós (kidney). Before then, the specialty was usually referred to as "kidney medicine".
Scope
Nephrology concerns the diagnosis and treatment of kidney diseases, including
electrolyte disturbances and
hypertension, and the care of those requiring
renal replacement therapy
Renal replacement therapy (RRT) is therapy that replaces the normal blood-filtering function of the kidneys. It is used when the kidneys are not working well, which is called kidney failure and includes acute kidney injury and chronic kidney ...
, including
dialysis and
renal transplant patients. The word 'dialysis' is from the mid 19th century: via Latin from the Greek word 'dialusis'; from 'dialuein' (split, separate), from 'dia' (apart) and 'luein' (set free). In other words, dialysis replaces the primary (excretory) function of the kidney, which separates (and removes) excess toxins and water from the blood, placing them in the urine.
Many diseases affecting the kidney are systemic disorders not limited to the organ itself, and may require special treatment. Examples include acquired conditions such as systemic vasculitides (e.g. ANCA vasculitis) and
autoimmune diseases (e.g.
lupus), as well as
congenital or genetic conditions such as
polycystic kidney disease.
Patients are referred to nephrology specialists after a urinalysis, for various reasons, such as
acute kidney injury,
chronic kidney disease,
hematuria,
proteinuria,
kidney stones,
hypertension, and disorders of acid/base or
electrolytes.
Nephrologist
A nephrologist is a
physician
A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
who specializes in the care and treatment of kidney disease. Nephrology requires additional training to become an
expert with advanced skills. Nephrologists may provide care to people without kidney problems and may work in
general/internal medicine,
transplant medicine,
immunosuppression management,
intensive care medicine,
clinical pharmacology
Clinical pharmacology has been defined as "that discipline that teaches, does research, frames policy, gives information and advice about the actions and proper uses of medicines in humans and implements that knowledge in clinical practice". Clinic ...
,
perioperative medicine
Perioperative medicine is the medical care of patients from the time of contemplation of surgery through the operative period to full recovery. Perioperative care may be provided by an anesthesiologist, Intensivist, an internal medicine general ...
, or pediatric nephrology.
Nephrologists may further sub-specialise in
dialysis,
kidney transplantation, home therapies (home dialysis), cancer-related kidney diseases (
onco-nephrology), structural kidney diseases (uro-nephrology), procedural nephrology or other non-nephrology areas as described above.
Procedures a nephrologist may perform include native kidney and transplant
kidney biopsy
Renal biopsy (also kidney biopsy) is a medical procedure in which a small piece of kidney is removed from the body for examination, usually under a microscope. Microscopic examination of the tissue can provide information needed to diagnose, m ...
,
dialysis access insertion (temporary vascular access lines, tunnelled vascular access lines, peritoneal dialysis access lines),
fistula management (
angiographic
Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins, and the heart chambers. Modern angiography is perform ...
or surgical fistulogram and plasty), an
bone biopsy Bone biopsies are now unusual.
Training
India
To become a nephrologist in India, one has to complete an
MBBS (5 and 1/2 years) degree, followed by an
MD/
DNB (3 years) either in medicine or paediatrics, followed by a
DM/DNB (3 years) course in either nephrology or paediatric nephrology.
Australia and New Zealand
Nephrology training in Australia and New Zealand typically includes completion of a medical degree (
Bachelor of Medicine, Bachelor of Surgery: 4–6 years),
internship (1 year), Basic Physician Training (3 years minimum), successful completion of the
Royal Australasian College of Physicians written and clinical examinations, and Advanced Physician Training in Nephrology (3 years). The training pathway is overseen and accredited by the Royal Australasian College of Physicians, though the application process varies across states. Completion of a post-graduate degree (usually a
PhD PHD or PhD may refer to:
* Doctor of Philosophy (PhD), an academic qualification
Entertainment
* '' PhD: Phantasy Degree'', a Korean comic series
* '' Piled Higher and Deeper'', a web comic
* Ph.D. (band), a 1980s British group
** Ph.D. (Ph.D. al ...
) in a nephrology research interest (3–4 years) is optional but increasingly common. Finally, many Australian and New Zealand nephrologists participate in career-long professional and personal development through bodies such as the Australian and New Zealand Society of Nephrology and the Transplant Society of Australia and New Zealand.
United Kingdom
In the United Kingdom, nephrology (often called renal medicine) is a subspecialty of general medicine. A nephrologist has completed medical school, foundation year posts (FY1 and FY2) and
core medical training (CMT), specialist training (ST) and passed the
Membership of the Royal College of Physicians
Member may refer to:
* Military jury, referred to as "Members" in military jargon
* Element (mathematics), an object that belongs to a mathematical set
* In object-oriented programming, a member of a class
** Field (computer science), entries ...
(MRCP) exam before competing for a National Training Number (NTN) in renal medicine. The typical Specialty Training (when they are called a registrar, or an ST) is five years and leads to a
Certificate of Completion of Training
The Certificate of Completion of Training (CCT) is the certificate that medical doctors in the United Kingdom receive to indicate that they have completed training in their chosen specialty and are therefore eligible for entry onto the specialis ...
(CCT) in both renal medicine and general (internal) medicine. In those five years, they usually rotate yearly between hospitals in a region (known as a deanery). They are then accepted on to the Specialist Register of the General Medical Council (GMC). Specialty trainees often interrupt their clinical training to obtain research degrees (MD/PhD). After achieving CCT, the registrar (ST) may apply for a permanent post as Consultant in Renal Medicine. Subsequently, some Consultants practice nephrology alone. Others work in this area, and in Intensive Care (ICU), or General (Internal) or Acute Medicine.
United States
Nephrology training can be accomplished through one of two routes. The first path way is through an internal medicine pathway leading to an Internal Medicine/Nephrology specialty, and sometimes known as "adult nephrology". The second pathway is through
Pediatrics
Pediatrics ( also spelled ''paediatrics'' or ''pædiatrics'') is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until the ...
leading to a speciality in Pediatric Nephrology. In the
United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country Continental United States, primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., ...
, after
medical school
A medical school is a tertiary educational institution, or part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, Bachelor of Surgery (MBBS, ...
adult nephrologists complete a three-year
residency
Residency may refer to:
* Domicile (law), the act of establishing or maintaining a residence in a given place
** Permanent residency, indefinite residence within a country despite not having citizenship
* Residency (medicine), a stage of postgrad ...
in internal medicine followed by a two-year (or longer)
fellowship
A fellow is a concept whose exact meaning depends on context.
In learned or professional societies, it refers to a privileged member who is specially elected in recognition of their work and achievements.
Within the context of higher educatio ...
in nephrology. Complementary to an adult nephrologist, a pediatric nephrologist will complete a three-year pediatric residency after medical school or a four-year Combined Internal Medicine and Pediatrics residency. This is followed by a three-year fellowship in Pediatric Nephrology. Once training is satisfactorily completed, the physician is eligible to take the
American Board of Internal Medicine (ABIM) or
American Osteopathic Board of Internal Medicine (AOBIM) nephrology examination. Nephrologists must be approved by one of these boards. To be approved, the physician must fulfill the requirements for education and training in nephrology in order to qualify to take the board's examination. If a physician passes the examination, then he or she can become a nephrology specialist. Typically, nephrologists also need two to three years of training in an
ACGME or
AOA accredited fellowship in nephrology. Nearly all programs train nephrologists in
continuous renal replacement therapy
Hemofiltration, also haemofiltration, is a renal replacement therapy which is used in the intensive care setting. It is usually used to treat acute kidney injury (AKI), but may be of benefit in multiple organ dysfunction syndrome or sepsis. During ...
; fewer than half in the United States train in the provision of
plasmapheresis. Only pediatric trained physicians are able to train in pediatric nephrology, and internal medicine (adult) trained physicians may enter general (adult) nephrology fellowships.
Diagnosis
History
History (derived ) is the systematic study and the documentation of the human activity. The time period of event before the invention of writing systems is considered prehistory. "History" is an umbrella term comprising past events as well ...
and
physical examination
In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the pati ...
are central to the diagnostic workup in nephrology. The history typically includes the present illness, family history, general medical history, diet, medication use, drug use and occupation. The physical examination typically includes an assessment of volume state, blood pressure, heart, lungs, peripheral arteries, joints, abdomen and
flank. A rash may be relevant too, especially as an indicator of autoimmune disease.
Examination of the urine (
urinalysis
Urinalysis, a portmanteau of the words ''urine'' and ''analysis'', is a panel of medical tests that includes physical (macroscopic) examination of the urine, chemical evaluation using urine test strips, and microscopic examination. Macroscopic e ...
) allows a direct assessment for possible kidney problems, which may be suggested by appearance of blood in the urine (
hematuria), protein in the urine (
proteinuria), pus cells in the urine (
pyuria) or cancer cells in the urine. A 24-hour urine collection used to be used to quantify daily protein loss (see
proteinuria), urine output,
creatinine clearance or electrolyte handling by the
renal tubules. It is now more common to measure protein loss from a small random sample of urine.
Basic blood tests can be used to check the concentration of
hemoglobin
Hemoglobin (haemoglobin BrE) (from the Greek word αἷμα, ''haîma'' 'blood' + Latin ''globus'' 'ball, sphere' + ''-in'') (), abbreviated Hb or Hgb, is the iron-containing oxygen-transport metalloprotein present in red blood cells (erythroc ...
, white count,
platelets, sodium, potassium, chloride, bicarbonate,
urea
Urea, also known as carbamide, is an organic compound with chemical formula . This amide has two amino groups (–) joined by a carbonyl functional group (–C(=O)–). It is thus the simplest amide of carbamic acid.
Urea serves an important ...
,
creatinine, albumin, calcium, magnesium, phosphate, alkaline phosphatase and parathyroid hormone (PTH) in the blood. All of these may be affected by kidney problems. The serum creatinine concentration is the most important blood test as it is used to estimate the function of the kidney, called the
creatinine clearance or estimated
glomerular filtration rate (GFR).
It is a good idea for patients with longterm kidney disease to know an up-to-date list of medications, and their latest blood tests, especially the blood creatinine level. In the United Kingdom, blood tests can monitored online by the patient, through a website called RenalPatientView.
More specialized tests can be ordered to discover or link certain systemic diseases to kidney failure such as infections (
hepatitis B,
hepatitis C
Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver; it is a type of viral hepatitis. During the initial infection people often have mild or no symptoms. Occasionally a fever, dark urine, ...
), autoimmune conditions (
systemic lupus erythematosus,
ANCA vasculitis),
paraproteinemias (
amyloidosis
Amyloidosis is a group of diseases in which abnormal proteins, known as amyloid fibrils, build up in tissue. There are several non-specific and vague signs and symptoms associated with amyloidosis. These include fatigue, peripheral edema, weig ...
,
multiple myeloma
Multiple myeloma (MM), also known as plasma cell myeloma and simply myeloma, is a cancer of plasma cells, a type of white blood cell that normally produces antibodies. Often, no symptoms are noticed initially. As it progresses, bone pain, ...
) and metabolic diseases (
diabetes
Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...
,
cystinosis
Cystinosis is a lysosomal storage disease characterized by the abnormal accumulation of cystine, the oxidized dimer of the amino acid cysteine. It is a genetic disorder that follows an autosomal recessive inheritance pattern. It is a rare autosom ...
).
Structural abnormalities of the kidneys are identified with imaging tests. These may include
Medical ultrasonography/ultrasound,
computed axial tomography (CT),
scintigraphy
Scintigraphy (from Latin ''scintilla'', "spark"), also known as a gamma scan, is a diagnostic test in nuclear medicine, where radioisotopes attached to drugs that travel to a specific organ or tissue ( radiopharmaceuticals) are taken internally an ...
(
nuclear medicine
Nuclear medicine or nucleology is a medical specialty involving the application of radioactive substances in the diagnosis and treatment of disease. Nuclear imaging, in a sense, is " radiology done inside out" because it records radiation emi ...
),
angiography or
magnetic resonance imaging (MRI).
In certain circumstances, less invasive testing may not provide a certain diagnosis. Where definitive diagnosis is required, a
biopsy
A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a dise ...
of the kidney (
renal biopsy) may be performed. This typically involves the insertion, under
local anaesthetic
A local anesthetic (LA) is a medication that causes absence of pain sensation. In the context of surgery, a local anesthetic creates an absence of pain in a specific location of the body without a loss of consciousness, as opposed to a general a ...
and ultrasound or CT guidance, of a
core biopsy
A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a disea ...
needle into the kidney to obtain a small sample of kidney tissue. The kidney tissue is then examined under a microscope, allowing direct visualization of the changes occurring within the kidney. Additionally, the pathology may also
stage a problem affecting the kidney, allowing some degree of
prognostication. In some circumstances, kidney biopsy will also be used to monitor response to treatment and identify early
relapse. A transplant kidney biopsy may also be performed to look for rejection of the kidney.
Treatment
Treatments in nephrology can include
medications,
blood products, surgical interventions (
urology,
vascular or
surgical procedures),
renal replacement therapy
Renal replacement therapy (RRT) is therapy that replaces the normal blood-filtering function of the kidneys. It is used when the kidneys are not working well, which is called kidney failure and includes acute kidney injury and chronic kidney ...
(
dialysis or
kidney transplantation) and
plasma exchange. Kidney problems can have significant impact on quality and length of life, and so psychological support, health education and advanced care planning play key roles in nephrology.
Chronic kidney disease is typically managed with treatment of causative conditions (such as
diabetes
Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...
), avoidance of substances toxic to the kidneys (
nephrotoxins like
radiologic contrast and
non-steroidal anti-inflammatory drugs
Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. Side effects depend on the specific drug, its dose and duration of ...
),
antihypertensives, diet and weight modification and planning for
end-stage kidney failure. Impaired kidney function has systemic effects on the body. An
erythropoetin stimulating agent (ESA) may be required to ensure adequate production of
red blood cells,
activated vitamin D supplements and
phosphate binders Phosphate binders are medications used to reduce the absorption of dietary phosphate; they are taken along with meals and snacks. They are frequently used in people with chronic kidney failure (CKF), who are less able to excrete phosphate, resultin ...
may be required to counteract the effects of kidney failure on
bone metabolism
Bone remodeling (or bone metabolism) is a lifelong process where mature bone tissue is removed from the skeleton (a process called ''bone resorption'') and new bone tissue is formed (a process called '' ossification'' or ''new bone formation''). ...
, and blood volume and
electrolyte disturbance may need correction. Diuretics (such as furosemide) may be used to correct fluid overload, and alkalis (such as sodium bicarbonate) can be used to treat metabolic acidosis.
Auto-immune
In immunology, autoimmunity is the system of immune responses of an organism against its own healthy cells, tissues and other normal body constituents. Any disease resulting from this type of immune response is termed an "autoimmune disease". P ...
and
inflammatory kidney disease, such as
vasculitis
Vasculitis is a group of disorders that destroy blood vessels by inflammation. Both arteries and veins are affected. Lymphangitis (inflammation of lymphatic vessels) is sometimes considered a type of vasculitis. Vasculitis is primarily caused ...
or
transplant rejection
Transplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient ...
, may be treated with
immunosuppression. Commonly used agents are
prednisone,
mycophenolate
Mycophenolic acid (MPA) is an immunosuppressant medication used to prevent rejection following organ transplantation and to treat autoimmune conditions such as Crohn's disease and lupus. Specifically it is used following kidney, heart, and li ...
,
cyclophosphamide,
ciclosporin,
tacrolimus,
everolimus,
thymoglobulin
Thymoglobulin (manufactured by Sanofi) is an anti-human thymocyte immunoglobulin preparation made of purified polyclonal antibodies derived from rabbits. While these antibodies have a variety of specificities, their main mechanism of immunosuppres ...
and
sirolimus. Newer, so-called "
biologic drugs" or
monoclonal antibodies, are also used in these conditions and include
rituximab,
basiliximab
Basiliximab (trade name Simulect) is a chimeric mouse-human monoclonal antibody to the α chain (CD25) of the IL-2 receptor of T cells. It is used to prevent rejection in organ transplantation, especially in kidney transplants.
Uses
Basilix ...
and
eculizumab. Blood products including
intravenous immunoglobulin and a process known as
plasma exchange can also be employed.
When the kidneys are no longer able to sustain the demands of the body, end-stage kidney failure is said to have occurred. Without
renal replacement therapy
Renal replacement therapy (RRT) is therapy that replaces the normal blood-filtering function of the kidneys. It is used when the kidneys are not working well, which is called kidney failure and includes acute kidney injury and chronic kidney ...
, death from
kidney failure
Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney failure is classified as eit ...
will eventually result.
Dialysis is an artificial method of replacing some kidney function to prolong life.
Renal transplantation
Kidney transplant or renal transplant is the organ transplant of a kidney into a patient with end-stage kidney disease (ESRD). Kidney transplant is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantat ...
replaces kidney function by inserting into the body a healthier kidney from an
organ donor and inducing
immunologic tolerance
Immune tolerance, or immunological tolerance, or immunotolerance, is a state of unresponsiveness of the immune system to substances or tissue that would otherwise have the capacity to elicit an immune response in a given organism. It is induced by ...
of that organ with
immunosuppression. At present,
renal transplantation
Kidney transplant or renal transplant is the organ transplant of a kidney into a patient with end-stage kidney disease (ESRD). Kidney transplant is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantat ...
is the most effective treatment for end-stage kidney failure although its worldwide availability is limited by lack of availability of donor organs. Generally speaking, kidneys from living donors are 'better' than those from deceased donors, as they last longer.
Most kidney conditions are
chronic conditions and so long term followup with a nephrologist is usually necessary. In the United Kingdom, care may be shared with the patient's primary care physician, called a General Practitioner (GP).
Organizations
The world's first society of nephrology was the French 'Societe de Pathologie Renale'. Its first president was Jean Hamburger, and its first meeting was in Paris in February 1949. In 1959, Hamburger also founded the 'Société de Néphrologie', as a continuation of the older society. The UK's Renal Association was founded in 1950; the second society of nephrologists. Its first president was Arthur Osman and met for the first time, in
London
London is the capital and List of urban areas in the United Kingdom, largest city of England and the United Kingdom, with a population of just under 9 million. It stands on the River Thames in south-east England at the head of a estuary dow ...
, on the 30th of March 1950. The Società di Nefrologia Italiana was founded in 1957 and was the first national society to incorporate the phrase nephrologia (or nephrology) into its name.
The word 'nephrology' appeared for the first time in a conference, on 1–4 September 1960 at the "Premier Congrès International de Néphrologie" in Evian and Geneva, the first meeting of the International Society of Nephrology (ISN,
International Society of Nephrology). The first day (1.9.60) was in Geneva and the next three (2–4.9.60) were in Evian, France. The early history of the ISN is described by Robinson and Richet in 2005 and the later history by Barsoum in 2011. The ISN is the largest global society representing medical professionals engaged in advancing kidney care worldwide.
In the US, founded in 1964, the
National Kidney Foundation is a national organization representing patients and professionals who treat kidney diseases. Founded in 1966, the
American Society of Nephrology
Founded in 1966, the American Society of Nephrology (ASN) is the world's largest professional society devoted to the study of kidney disease. Composed of over 20,000 physicians and scientists, ASN promotes expert patient care, advances medical r ...
(ASN) is the world's largest professional society devoted to the study of kidney disease. The
American Nephrology Nurses' Association (ANNA), founded in 1969, promotes excellence in and appreciation of nephrology nursing to make a positive difference for patients with kidney disease. The
American Association of Kidney Patients
American(s) may refer to:
* American, something of, from, or related to the United States of America, commonly known as the "United States" or "America"
** Americans, citizens and nationals of the United States of America
** American ancestry, pe ...
(AAKP) is a non-profit, patient-centric group focused on improving the health and well-being of CKD and
dialysis patients. The
National Renal Administrators Association (NRAA), founded in 1977, is a national organization that represents and supports the independent and community-based dialysis providers. The
American Kidney Fund directly provides financial support to patients in need, as well as participating in health education and prevention efforts. ASDIN (American Society of Diagnostic and Interventional Nephrology) is the main organization of interventional nephrologists. Other organizations include CIDA, VASA etc. which deal with dialysis vascular access. The
Renal Support Network
The Renal Support Network (RSN) is an American nonprofit, kidney patient-focused, kidney patient-run organization that works to benefit individuals affected by chronic kidney disease (CKD). RSN's mission is to help patients develop their personal ...
(RSN) is a nonprofit, patient-focused, patient-run organization that provides non-medical services to those affected by chronic kidney disease (CKD).
In the United Kingdom,
UK National Kidney Federation and Kidney Care UK (previously known as British Kidney Patient Association, BKPA) represent patients, and the
Renal Association represents renal physicians and works closely with the
National Service Framework for kidney disease.
There is an international office in Brussels, Belgium.
References
External links
Nephrology International Society of Nephrology (ISN)Nephromap
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