Expert Witness Journal Issue 64 December 2025 - Flipbook - Page 17
What does a Nephrologist do?
by Dr. Michael Robson
Nephrologists specialise in the diagnosis and
treatment of conditions a昀昀ecting the kidneys.
There are many causes of acute and chronic
kidney disease. Acute kidney injury is a term used
to describe a recent decline in kidney function,
which may or may not be reversible. Causes include
infections, gastrointestinal bleeds, heart attacks,
autoimmune diseases and medication. If the cause is
not clear, a kidney biopsy may be needed. Chronic
kidney disease refers to an established reduction in
kidney function; and it is considered irreversible.
Many patients with chronic kidney disease can be
monitored in primary care. Indications to see a
nephrologist include the possibility of a treatable
condition and kidney disease approaching a stage
when planning for dialysis and transplantation
is needed. Nephrologists are expert at treating
blood pressure and may see patients with di昀케cult
to treat hypertension. They also provide what is
known as ‘renal replacement therapy’ for patients
with end-stage kidney disease. This comprises
haemodialysis, peritoneal dialysis, preparation for
renal transplantation and post-transplant care.
Clinical negligence questions that need an
opinion from a nephrologist
When a patient discovers their kidney function is
reduced, they may ask if it could have been avoided.
There may be several factors leading to acute kidney
injury or chronic kidney disease, and that can be
a di昀케cult question to answer. However, the job of
a nephrology expert is to determine whether it is
more likely than not that the outcome would have
been di昀昀erent, and to explain their reasoning.
Breach of duty questions may relate to nephrology
care but often the question of liability leading to the
kidney problem relates to primary care, a physician
who is not a nephrologist, or a surgeon. In these
cases, an opinion on breach of duty may require
a di昀昀erent expert, though a nephrologist could
still opine on causation. An opinion on the care of
patients receiving renal replacement therapy may
also be requested from a nephrologist. For example,
this might be regarding blood pressure control on
dialysis because poor blood pressure control could
lead to strokes or hypertensive eye disease. Other
matters that a nephrologist may be instructed
to consider are the diagnosis and treatment of
complications in arteriovenous 昀椀stulae, preparation
for renal transplantation or posttransplant care.
Nephrologists work closely with urologists who
are kidney surgeons. They also work closely with
transplant surgeons and specialist nurses because
the care of patients with end-stage kidney disease
is multidisciplinary. Access to the circulation
is needed for haemodialysis and that is usually
achieved by surgically joining an artery and vein
in the arm, known as an arteriovenous 昀椀stula. This
operation can be performed by a transplant surgeon
or vascular surgeon. Surgeons also insert tubes into
the abdomen for peritoneal dialysis. Nephrologists
and transplant surgeons usually jointly manage
kidney transplant recipients, before and after the
transplant.
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Nephrologists may provide condition and prognosis
reports for people with kidney disease, or people
who have sustained kidney damage due to trauma
to a kidney or ureter. Irreversible kidney damage
can occur if urine out昀氀ow is obstructed. That might
be due to ureteric injury during pelvic surgery or
other causes. Such cases may require an opinion
on breach of duty from a gynaecologist or urologist
and an opinion on condition and prognosis from
a nephrologist. Patients with kidney disease have
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DECEMBER/JANUARY 2025-2026
