Nephrology involves disease of the kidneys, its contiguous collecting system, and its vasculature.

The kidneys play a key role in fluid, electrolyte, and acid-base regulation and are affected by a

wide range of systemic disorders, drugs, and toxins.

The general internist should be competent to evaluate and appropriately refer patients with

glomerular disorders, asymptomatic urine abnormalities, tubulointerstitial diseases, renal

vascular disease, renal failure, nephrolithiasis, tubular defects, and infections and neoplasms of

the kidneys, bladder, and urethra, and should also be able to provide principle treatment for some

of these conditions. He or she should be able to manage fluid, electrolyte, and acid-base

disorders; understand the ways in which systemic diseases may affect the kidneys; and recognize

the potential nephrotoxicity of various therapeutic and diagnostic agents. The general internist

must also be familiar with guidelines for pre-dialysis management of patients with renal failure

and be able to recognize indications for dialysis and for referral to a nephrologist.

The range of competencies in managing renal disease will depend on the availability of a

nephrologist to the primary care internist. Although all general internists should know the

indications for dialysis, in some cases (for example, if a nephrologist is unavailable), the general

internists may be responsible for initiating and maintaining patients on peritoneal dialysis. In

most situations, hemodialysis will be the responsibility of a nephrologist, as will renal biopsies

and nephrostomy tube placement.

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None specific to the discipline

the kidneys