Nephrologist or urologist?
Both work on the kidneys and urine, but one focuses more on kidney function and the other on the urinary tract and surgery. This article says which to start with for high creatinine, protein in the urine, resistant blood pressure and kidney stones, and how the two specialities complement each other.
“There is something wrong with my kidney. Which doctor should I see?” There is no simple answer, because a “kidney problem” can be several different things. This article explains the difference between the two specialities and suggests a way to decide. If you are not sure, starting with a general practitioner or family doctor is sensible, and they will refer you.
Who is a nephrologist?
NKF describes a nephrologist as a “kidney health specialist”. A nephrologist works mostly with kidney function and the cause of its damage: chronic kidney disease, protein or blood in the urine from disease of the filters, kidney-related blood pressure, follow-up of diabetes that has affected the kidneys, and planning for advanced stages. NIDDK says that in chronic kidney disease, when the situation is complicated, getting worse quickly or advanced, the primary care doctor may refer you to a nephrologist. One of the questions NKF suggests asking when eGFR is low is also: “Should I see a nephrologist?”
Who is a urologist?
NKF describes a urologist as a doctor who treats kidney and urinary problems such as kidney stones. With a kidney stone, the urologist monitors the stone with imaging or removes it by surgery (NKF). NIDDK names methods such as shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy as the urologist’s work.
Which one, when?
This table is only a general guide and does not replace a referral from your family doctor.
| Situation | Usually start with |
|---|---|
| High creatinine or low eGFR, chronic kidney disease | Nephrologist |
| Protein or blood in the urine with a kidney cause, swelling and foamy urine | Nephrologist |
| Diabetes or high blood pressure with kidney involvement, treatment-resistant blood pressure | Nephrologist |
| Pain from a stone attack, a stone that has blocked the urine | Urologist or emergency department |
| Repeated stones and finding the cause | Both, depending on your situation |
| Blood in the urine with an unclear cause | A doctor first, then referral to the right specialist |
| Bladder or prostate problems | Urologist |
Kidney stones: where both are needed
NKF says the urologist may refer you to a nephrologist for more specialised care in preventing stones. Prevention depends on the type of stone and a 24-hour urine test (NIDDK). That means the urologist removes the stone, and finding the cause and preventing recurrence may be followed by a nephrologist or by the same urologist. So you do not need to treat one as “right” and the other as “wrong” from the start.
Blood in the urine
NHS says blood in the urine has different sources (a urinary infection, a stone, an enlarged prostate and others) and any suspected blood should be checked. After examination and tests, the doctor decides on referral to a specialist. Do not decide yourself that you definitely need a urologist or a nephrologist. Let the urine test and imaging show the way.
What to bring
Whichever you see, the same things are needed: a full list of medicines and supplements, earlier creatinine and urine tests, ultrasound and CT, and a blood pressure record. See the guide “Your first visit and what to bring”.
When not to wait to choose a speciality
If you are passing no urine, have fever and chills with flank pain, have sudden swelling or shortness of breath, or there is a lot of blood in the urine, go to the emergency department (115 in Iran, Iran’s emergency number) and do not wait to choose a speciality. See the full list in the guide “When to get urgent help”.