A nephrologist is a doctor who specializes in the kidneys. The word comes from the Greek nephros, for kidney. It is pronounced neh-FROL-uh-jist.
That is the dictionary answer. The more useful one is what we actually do, how it differs from a urologist, and when it is worth seeing one.
What a nephrologist does
The kidneys filter blood, balance salt, water, and minerals, help control blood pressure, keep the blood from turning too acidic, and make hormones for red blood cells and bone health. Nephrologists treat problems with any of those jobs:
- Chronic kidney disease, at every stage
- Acute kidney injury, a sudden drop in kidney function
- High blood pressure that is hard to control or may have a hidden cause
- Electrolyte problems: sodium, potassium, calcium, magnesium, and acid levels
- Protein or blood in the urine and glomerular diseases
- Diabetic kidney disease
- Prevention of kidney stones that keep coming back
- Polycystic kidney disease and other inherited conditions
- Dialysis, and care before and after a kidney transplant
Most of this is medical, not surgical. We use blood and urine tests, imaging, medications, and sometimes a kidney biopsy.
How a nephrologist is trained
In the United States, a nephrologist finishes four years of medical school, three years of internal medicine residency, and then two or more years of nephrology fellowship. Board certification in nephrology comes from the American Board of Internal Medicine, which you can look up for any physician.
That internal medicine base matters. Kidney problems rarely travel alone. They come with diabetes, heart disease, high blood pressure, and long medication lists, and a nephrologist is trained to manage the whole picture.
Nephrologist vs. urologist
This is the most common confusion, and it costs people weeks.
| Nephrologist | Urologist | |
|---|---|---|
| Type of doctor | Medical specialist | Surgeon |
| Focus | How well the kidneys work | The plumbing: kidneys, bladder, prostate, urethra |
| Typical problems | Kidney disease, blood pressure, electrolytes, protein in urine, dialysis | Stones that need removal, blockages, prostate, tumors, bladder problems |
| Typical tools | Labs, medications, biopsy, dialysis | Scopes, surgery, procedures |
| Kidney stones | Finds out why they form and prevents the next one | Removes the stone that is stuck now |
Some people need both. A kidney stone patient might see a urologist to remove the stone and a nephrologist to stop the next one.
When to see a nephrologist
You do not have to wait for kidney failure. In fact, the earlier the better. Consider a nephrologist if:
- your eGFR has been below 60 for three months or more
- your eGFR is falling quickly, by more than 5 points a year
- your urine albumin-to-creatinine ratio is above 30, and especially above 300
- you have blood and protein in your urine together
- your blood pressure stays high on three or more medications
- your potassium or sodium keeps coming back abnormal
- you keep forming kidney stones
- someone in your family has polycystic kidney disease or needed dialysis young
- you had acute kidney injury in the hospital and nobody rechecked your kidneys afterward
Seeing a nephrologist does not mean you need dialysis
Patients often arrive scared, because the referral sounds like bad news. Most people we see never need dialysis. The point of seeing a nephrologist early is to slow kidney disease down, often by a lot, with blood pressure control and medications like SGLT2 inhibitors that did not exist a decade ago.
What happens at the first visit
Expect a detailed history, a review of every medication and supplement you take, a physical exam, and a look at your past lab results. We usually order blood work, a urine test, and often a kidney ultrasound. You should leave with an explanation of your kidney numbers in plain language and a plan.
Bring your pill bottles, any lab results from other doctors, and a list of questions. A few worth asking:
- What stage is my kidney disease, and is it stable or changing?
- What is causing it?
- Which of my medications should I stop, change, or start?
- How often should my kidneys be checked?
Do you need a referral?
It depends on your insurance. Many plans let you book directly. Some HMO and Medicare Advantage plans require a referral from your primary care doctor. Our office can check before your visit.
If you are in the Houston area, our nephrology service and our guide on when to see a nephrologist in Houston cover our locations and how to book.
How to choose a nephrologist
A few things worth checking, all of them public or easy to ask:
- Board certification in nephrology , which you can look up on the American Board of Internal Medicine's website.
- Hospital privileges at a hospital you would actually go to.
- Which dialysis units they round at , if dialysis is on the horizon. You want your own nephrologist following you there.
- Whether they talk to your other doctors. Kidney care touches blood pressure, diabetes, heart, and pain medications. A nephrologist who never sends notes back to your primary care doctor leaves gaps.
- Whether you will see the same doctor each time. Kidney disease is followed over years, and continuity matters.
Seeing a nephrologist in Houston
Remix Medical is a physician-owned practice. Uday Khosla, MD, a board-certified nephrologist, sees patients in Montrose near the Texas Medical Center, East Houston, Katy, and Groesbeck, and by video visit anywhere in Texas. Our primary care, pain, and lung physicians share the same chart, so kidney care stays connected to everything else. Most plans are accepted, including Medicare, Medicare Advantage, and Texas Medicaid. Book an appointment or ask for a video visit.