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IM Subspecialities:

    Allergy and Immunology

    Cardiology

    Endocrinology

    Gastroenterology

    Geriatrics

    Hematology

    Oncology

    Infectious Diseases

    Nephrology

    Respirology

    Rheumatology

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Nephrology

Introduction

Nephrology is a subspecialty of internal medicine which is focused on the study, diagnosis and management of kidney disease in the adult population. Most kidney disease in adults are chronic and require long-term management. This is due to the degenerative effects of the most common diseases such diabetic nephropathy, hypertensive nephrosclerosis and glomerulonephritis on the kidney. Since kidney disease affects some patients throughout much of their lives, nephrologists have the opportunity to care for their patients for many years. Nephrologists are also deeply involved in the management of end stage renal disease requiring renal replacement therapy such as renal transplant, hemodialysis and peritoneal dialysis.

The training required for adult nephrology involves training through the internal medicine specialty which involves 3 years of core internal medicine training and 2 years of further subspecialty training in nephrology. A similar training trajectory exists through the pediatric specialty for pediatric nephrology. Most practicing nephrologists work at academic health science centers with some involvement of teaching and research in their practice.

Nephrologists are needed as consultants for other services in the hospital requiring their knowledge, while also acting as attending physicians who provide care for in-patients and out-patients in nephrology. They maintain a deep understanding of the anatomy and physiology of the kidney which includes an expertise in acid-base, electrolyte and metabolic disturbances. Nephrologists must be experts at the history and physical examination of renal patients while also being proficient in the interpretation of biochemical and electrolyte analysis. They are trained in the collection and analysis of renal biopsies to confirm the microscopic diagnosis of renal diseases. They also hold a vital role in interprofessional teams when managing patients needing renal replacement therapy.

Common Disease and Disorders

Diabetic nephropathy
The most common cause of kidney disease in the adult population is diabetes mellitus. Both type 1 and type 2 diabetes mellitus can cause a gradual loss of kidney function eventually leading to end stage renal disease. Nephrologists may work in a consultative role along with the primary care physician to manage a patient’s diabetes and prevent the degeneration of the organ. Nephrologists may also work on a multidisciplinary team aimed at care for diabetic patients. A nephrologist will also provide most of the extensive care required for patients who have progressed towards end stage renal disease and are required to prepare for renal replacement therapy.

Hypertensive glomerulosclerosis
Hypertension is another condition which can gradually damage the kidneys and eventually lead to end stage renal disease. High blood pressure in the arterioles of the kidney can cause scarring which will eventually compromise the function of the organ. Primary care physicians caring for patients with hypertension may consult nephrologists when managing the hypertension to slow the progress of the glomerulosclerosis. Nephrologists may begin to provide complete care of these patients when the disease has progressed towards end stage renal disease.

Glomerulonephritis
Glomerulonephritis is not a single disease, but rather a grouping of inflammatory diseases which damage the kidneys and cause them to allow the passage of blood and protein into the urine. The etiologies of these diseases are broad – including hereditary, autoimmune, vasculitis and post-infectious. Nephrologists often diagnose these conditions by performing and interpreting renal biopsies which then guides their subsequent management. Some of these disease can progress quite rapidly – it is therefore important that the attending nephrologists recognize and treat these diseases to avoid complete deterioration of the kidney.

End stage renal disease and renal replacement therapy
Nephrology is a unique specialty in medicine because the function of a kidney can be replaced by several means once a degenerative disease process has rendered the kidney unsuitable to sustain the rest of the body. This is achieved by either transplanting a kidney, performing hemodialysis or peritoneal dialysis. A nephrologist therefore spends a great deal of time slowing the progress of chronic kidney failure while planning for end stage renal disease. This involves coordinating with transplant programs to determine eligibility and cross matching with possible donors. It also involves establishing how a patient would like to replace renal function before a transplant becomes available – whether that is hemodialysis or peritoneal dialysis. Preparing the necessary tools and medical interventions required for these procedures is also within the scope of a practicing nephrologist.

Further Advanced Training Opportunities

Once the three years of core internal medicine and two years of nephrology training has been completed, additional training is available for those looking to advance their knowledge. These can be done within Canada or worldwide and include fellowships in transplantation, interventional nephrology, advanced dialysis, and advanced training in glomerular disease.

Gender Breakdown
76 responses (2014 National Survey Results)

Age Breakdown
76 responses (2014 National Survey Results)
Hours Breakdown (Excluding on-call activities)
67 responses (2014 National Survey Results)

Activity Hours Worked (mean)
Direct patient care without a teaching component 27.11
Direct patient care with a teaching component 8.35
Teaching/ educating without direct patient care 2.31
Indirect patient care 7.55
Health facility committees 1.29
Administration 2.69
Research 1.39
Managing your practice 1.21
CME/ CPD (Continuing Professional Development) 3.43
Other actvities 1.19
Total Hours 56.52

Average number of on-call work hours per month: 103.09
66 responses; reported as mean (2014 National Survey Results)


Adult Nephrology Programs in Canada

Contact information for Program Directors can be accessed on the Royal College’s website here: Open in new tab

University of British Columbia
Vancouver, British Columbia

Queen’s University
Kingston, Ontario

University of Calgary
Calgary, Alberta

University of Ottawa
Ottawa, Ontario

University of Alberta
Edmonton, Alberta

McGill University
Montréal, Quebec

University of Saskatchewan
Saskatoon, Saskatchewan

Université de Montréal
Montréal, Quebec

University of Manitoba
Manitoba, Winnipeg

Université de Sherbrooke
Sherbrooke, Quebec

Université Laval
Laval, Québec

Western University
London, Ontario

Dalhousie University
Halifax, Nova Scotia

McMaster University
Hamilton, Ontario

University of Toronto
Toronto, Ontario

Memorial University of Newfoundland
St. John’s, Newfoundland

Page Author(s): Brandon Harvey (2018)
© 2017 Internal Medicine Interest Group (IMIG) - Schulich School of Medicine and Dentistry