Nephrology is the medical specialty aimed at preventing, diagnosing and treating kidney diseases. Definition, role of a nephrologist, conduct of a consultation, price and reimbursement… Discovery with Drs Flora Brunner and Aldjia Hocine, nephrologists.
Definition: what is a nephrologist?
A nephrologist is a medical specialist in charge of the diagnosis and treatment of all kidney diseases (or nephropathies), which affect blood filtration, the primary function of the kidneys. Management extends from the most basic and early symptoms (such as the presence of blood or protein in the urine) to more serious complications such as chronic renal failurewhich may require dialysis or transplant renal. “Nephrologists follow kidney transplant patients and patients on dialysis in consultation, says Dr. Aldjia Hocine, nephrologist at the Clinique du Landy in Saint-Ouen (93), practitioner attached to the Bichat hospital in Paris and President of the Club of Young Nephrologists. When the renal function is very degraded, the nephrologist accompanies the patient and his entourage towards so-called replacement treatments. These are treatments aimed at replacing the work of the kidneys which no longer function properly. The treatments are: kidney transplantation, dialysis treatments which can be carried out at home (hemodialysis and peritoneal dialysis) and in a center (hemodialysis with schedules and degrees of medicalization adapted to the personal and clinical situation of the patient).All practitioners are closely linked to a university hospital center who coordinates registration on the kidney transplant list as soon as necessary depending on the deterioration of kidney function and the clinical condition of the patient“.
Indications: when to see a nephrologist?
After consulting your doctor, you should go to a nephrologist for all pathologies affecting the kidneys. Other specialists (cardiologists, endocrinologists, diabetologists, etc.) can refer you to the nephrologist. “It also happens that it is the occupational physician which detects a blood or protein problem on the urine dipstick therefore requiring a specialized opinion from the nephrologistcontinues Dr. Flora Brunner, nephrologist at the Clinique Bouchard in Marseille (13) and deputy general secretary of the Club of Young Nephrologists. The prevention and early detection of chronic kidney disease is one of the cornerstones of nephrology care in order to slow down the deterioration of kidney function”. The reasons for consulting a nephrologist are:
- Elevated creatinine found on a blood test
- Presence in the urine of blood (haematuria) or proteins (proteinuria), chronic renal failure (CRI)
- High blood pressure
- Ionic disorders: calcium, potassium, sodium
- Renal colic,
- Recurrent urinary tract infections
“The nephrology consultation is an opportunity to give the patient nephroprotection recommendations adapted to his clinical situationinsists Dr. Aldjia Hocine. Recommend appropriate diet and fluid intake, improved control of blood pressure and other cardiovascular risk factors”.
After having questioned his patient precisely, the nephrologist proceeds to a clinical examinationbefore prescribing Additional tests. “The evaluation of the renal function is done thanks to the blood test by dosing creatininewhich then allows the calculation of the glomerular filtration rate, the urine analysis also makes it possible to provide other elements to complete the diagnosis of kidney disease”, explains Dr. Brunner. “Si at the end of the paraclinical and biological assessment, it is necessary to deepen the investigations, the nephrologist can suggest other examinations, adds Dr. Hocine. Among others:
- performing a kidney biopsy which will require a short hospital stay and will provide details on the existence of nephropathy and will guide the treatment best suited to your situation
- renal functional explorations in a specialized unit: measurement of the glomerular filtration rate, assessment of ionic disorders (calcium, potassium, sodium for example), assessment of calculations”.
“It is always interesting tobring your complete medical file (for example, consultation reports from other specialists such as your cardiologist or diabetologist) as well as list of your usual medications to allow the nephrologist to have an overall view of your state of health“, recognizes Dr. Flora Brunner.
What is the price and reimbursement of a nephrologist?
Specific care pathways dedicated to patients with chronic renal failure from stage 4 have been implemented since 2020
“Whatever the place of consultation, the vast majority of nephrologists in France are contracted in sector I, the duration of a consultation is an average of 30 minutes“, says Dr. Hocine. Consultation fees are as follows:
- 50 euros : patient referred by his attending physician for a one-time opinion or follow-up consultation and in coordination with the attending physician with an appointment more than 4 months apart.
- 30 euros: follow-up of a patient in coordination with the attending physician with an appointment less than 4 months apart.
- 60 euros: first summary consultation of a patient with progressive renal insufficiency with a view to referral to a renal transplant team.
The basis of reimbursement is that of consultations with sector I contracted specialists: 70% when the consultation is done as part of the coordinated care pathway. “Specific care pathways dedicated to patients with chronic renal failure from stage 4 have been put in place since 2020 which make it possible to support patients in the management of their pathology by calling on a set of caregivers in complementarity with the consultation with the nephrologist: nephrology nurses, dieticians, social workers.”adds Dr. Hocine.
To become a nephrologist, the student must obtain a diploma of specialized studies (DES) in nephrology. After his baccalaureate, he must first 6 years of medical school. At the end of the 6th year, students take the national ranking tests to access boarding school. Depending on their ranking, they will be able to choose their specialty and their place of practice. The internship in nephrology now lasts 5 years (recent reform of the 3rd cycle) and ends with the obtaining of the DES of nephrology after validation of a memory of nephrology. “Finally, in order to be able to practice as a nephrologist and bear the title of doctor, the student also supports a medical thesiscompletes Dr. Hocine. It is not uncommon for nephrologists to complete their training with a science course (Master 2), some continue to the science thesis which opens the door to hospital-university careers. Like all practitioners, continuing medical education is essential to stay up to date with new developments in our specialty.“.
What is the salary of a nephrologist?
The average salary for a nephrologist is 112,800 euros gross per year (either 5,950 euros net per month).
Thanks to Dr Flora Brunner, nephrologist at the Clinique Bouchard in Marseille (13) and Deputy General Secretary of the Club of Young Nephrologists and to Dr Aldjia Hocine, nephrologist at the Clinique du Landy in Saint-Ouen (93), practitioner attached to the Bichat Hospital in Paris and President of the Club of Young Nephrologists.