An intro to nephrology and the growing demand for kidney care

A Q&A with Joseph Bast, MD, a nephrologist with Methodist Physicians Clinic – Nephrology

Thanks largely to escalating rates of diabetes, high blood pressure and obesity — and people simply living longer — kidney disease is on the rise. So, too, is the demand for nephrology, a clinical specialty that focuses on the kidneys and urinary tract.

In response to the growing need for nephrology services, Methodist Health System recently acquired Omaha Nephrology PC, which is now known as Methodist Physicians Clinic – Nephrology. That’s where I, along with 12 other providers, work to manage complex kidney conditions with the goal of reducing hospitalizations, improving transplant outcomes and giving patients the best possible quality of life.

A big part of our job — and perhaps one of the most rewarding — is educating people on what nephrology can do for them. My hope is that this article does exactly that for you or someone you know.

What is nephrology?

Nephrology is all things kidney! Nephrologists focus on the study, diagnosis, treatment and prevention of kidney disease. We are well versed in dialysis and the kidney transplant process but can also address electrolyte abnormalities, kidney stones, anemia and hypertension.

What makes the kidneys so fascinating?

The most fascinating thing about the kidneys is their resilience — the way they adapt and respond to various situations. For example, if your blood pressure goes up or down, the kidneys can adjust salt and water absorption/secretion, hormone secretion and blood vessel diameter to help regulate your blood pressure.

What signs or symptoms might suggest kidney damage or disease?

Changes in blood pressure, swelling, fatigue or frothy urine could signal a kidney issue.

That said, most kidney damage or disease is silent until the estimated glomerular filtration rate (eGFR) — or measurement of how well the kidneys are filtering waste from the blood — reaches very low levels. The eGFR is typically measured during routine labs, which stresses the importance of regular primary care/specialist appointments.

What kind of advances have been made in the treatment of kidney disease?

The most exciting advancement is the number of new drugs that can now be offered to patients to slow progression of chronic kidney disease (CKD). These include SGLT2 inhibitor, MRA and GLP-1 medications.

Although less common, some kidney diseases are caused by an autoimmune response. There are also new drugs that are aimed at targeting specific parts of the immune system and antibody production.

Through the Advancing American Kidney Health (AAKH) initiative in the U.S., there is encouragement for more home dialysis and transplant opportunities for end-stage kidney disease patients.

And, finally, work continues on the development of artificial kidney transplantation and reaching FDA approval for xenotransplantation (or the transplantation of an animal kidney for human use).

How can you take care of your kidneys over the long haul?

Seeking preventive health care is the most important thing you can do for your kidneys and overall health. You should establish care with a primary care provider and make appointments to see them regularly.

Also, because extra weight forces the kidneys to work harder and can lead to damage over time, work to maintain a healthy weight with diet and exercise or through medical assistance when necessary.

If you have hypertension — which can put a lot of pressure on blood vessels and ultimately reduce blood flow to the kidneys — diabetes or another chronic issue, work with your provider and specialists to keep these conditions controlled. 

If you have kidney disease, limit or avoid the use of NSAIDS and talk to your provider before starting any new medications. Work with your provider and educate yourself on what lab results you should be aware of as well as all your transplant and home dialysis options.

Kidney disease doesn’t have to be scary. When the focus is on a better quality of life, better outcomes often follow.

Dr. Joseph Bast, a nephrologist at Methodist Physicians Clinic – Nephrology, is particularly interested in helping patients navigate in-home dialysis. To schedule an appointment with Dr. Bast or another Methodist provider, visit bestcare.org/providers.