Best Nephrologist in New Cairo

What Are Kidney Diseases?

Kidney disease is any condition that weakens the kidneys' ability to filter the blood and keep fluids and salts in balance. The most important of them is chronic kidney disease, which progresses silently and is usually picked up on blood and urine tests before the patient feels anything at all. The two most common causes behind it are diabetes and high blood pressure, and alongside them come other causes such as obesity, certain inherited diseases, and overuse of anti-inflammatory painkillers (NSAIDs). Kidney infections and kidney stones, by contrast, do not pass silently: they usually announce themselves with pain, and with fever when infection is involved.

The kidneys are two bean-shaped organs that sit on either side of the spine as part of the urinary system, and they do several essential jobs in the body:

Filtering waste products and toxins out of the blood and clearing them in the urine.
Keeping fluids and minerals such as calcium, sodium and potassium in balance.
Producing hormones that regulate blood pressure and stimulate the formation of red blood cells, and activating vitamin D, which bone health depends on.

When the kidneys are damaged, these functions weaken gradually and waste products and salts build up in the blood. If the condition advances far enough it can reach kidney failure, at which point the patient needs regular dialysis or a kidney transplant. What matters more is that many cases never reach that stage if they are found early and the cause behind them is brought under control: in chronic kidney disease the goal is to slow the decline and preserve whatever kidney function remains.

Signs and Symptoms of Kidney Disease

The kidneys have a large functional reserve, which is why clear symptoms may not appear until a substantial part of that function has already been lost. That is what makes the early signs matter, and each one has a practical step attached to it rather than simply waiting to see what happens.

The Main Signs That May Point to a Kidney Problem, and What to Do About Each

A change in the amount or colour of your urine: dark urine, visible foam that does not clear quickly, or passing urine more often, especially at night. Note when the change began and how often it happens, and show it to a nephrologist or an internal medicine doctor for a complete urine test (urinalysis) and kidney function tests. Foam that keeps coming back can mean protein (albumin) is leaking into the urine, which is one of the earliest and most important signs of kidney injury.
Blood in the urine: this is never something to dismiss, even if it happened once and then stopped. That it came without pain is not reassuring; it makes assessment more important, not less. See a doctor without delay for a urine test and an ultrasound scan.
Burning or difficulty when passing urine: this may point to a urinary tract infection. The right step is examination and a urine test to identify the cause, not reaching for medicine left over from an old prescription or one written for someone else. Treating without a diagnosis hides the symptoms and delays getting to the real cause.
Swelling of the face or around the eyes, or swelling of the legs and feet: particularly after waking up, or after standing for long periods. Weigh yourself every morning; a rapid gain over a few days usually points to fluid retention and is worth showing to a doctor.
High blood pressure, or pressure that is hard to control despite treatment: measure your blood pressure at home and write the readings down to show your doctor. The relationship runs in both directions: high pressure harms the kidneys, and damaged kidneys push the pressure up.
Pain in the flank, or in the side below the ribs: kidney pain is usually felt in the side below the rib cage and may spread down towards the lower abdomen, and unlike muscular pain it does not ease when you change position. Muscular lower back pain is far more common than kidney pain. If the pain comes with a fever or with vomiting, it is urgent and cannot wait.
Unexplained fatigue, loss of appetite, nausea, or itchy skin: these are general symptoms that are easy to dismiss, but they are common as kidney function declines, and they justify a creatinine test and a urine test before being written off as ordinary tiredness.

Signs That Need Urgent Medical Assessment

Some situations cannot be put off: a fever with shivering, together with severe flank pain and vomiting; no urine at all, or a sharp drop in how much you are passing, within a single day; sudden swelling accompanied by shortness of breath; or visible blood in the urine with clots, or together with difficulty passing urine. These call for assessment at a hospital the same day, because judging them depends on clinical examination, laboratory tests and imaging, and cannot be done from a description of the symptoms alone.

Having one of these signs does not necessarily mean there is kidney disease, but it does mean the matter deserves assessment by a nephrology or internal medicine consultant, which usually starts with kidney function tests, a urine test and a blood pressure measurement.

Why Early Diagnosis Matters

Chronic kidney disease rarely announces itself at the beginning, and that is precisely what makes finding it early so important. In the earliest stages the underlying cause itself can be treated or controlled, and the decline in kidney function slowed for many years; finding it late narrows the available options considerably. The honest picture is this: in chronic disease, the kidney tissue that has already been lost does not come back, but the speed at which it is being lost can be changed a great deal, and that is what the patient and the doctor work on together.

For that reason, anyone with a risk factor is advised to have their kidney function checked at least once a year, even with no symptoms at all. The basic check is simple and inexpensive:

A blood test to measure creatinine, from which the estimated glomerular filtration rate (eGFR) is calculated, showing how efficiently the kidneys are filtering.
A urine test to look for protein (albumin), blood or pus, ideally measuring the albumin-to-creatinine ratio in a urine sample.
A blood pressure measurement.

Reading these numbers correctly matters just as much. The creatinine value is affected by muscle mass, by how much fluid is in the body, by strenuous exertion, and by eating a lot of meat shortly before the test, so a final conclusion is never built on a single reading. Diagnosing chronic kidney disease requires repeating the test and confirming that the abnormality has persisted, usually for three months or more, with the doctor reading the result in the context of the whole case. The opposite is also true: a normal creatinine on its own does not rule out early kidney disease, because albumin leaking into the urine often precedes any change in creatinine by years. That is why a blood test alone is not enough without a urine test alongside it.

Who Should Have the Yearly Check First

People with diabetes.
People with high blood pressure.
Anyone with a family history of kidney disease or of polycystic kidney disease.
Anyone who gets kidney stones or urinary tract infections repeatedly.
Anyone who takes anti-inflammatory painkillers (NSAIDs) frequently or over long periods.
Anyone who has previously had a sharp drop in kidney function, even if it recovered afterwards, since they are more likely to develop a chronic problem later on.
Anyone over sixty, people with heart disease, and people living with obesity.

Causes of kidney disease

Kidney disease has many causes, and most of them build up slowly over years. The two most common causes of chronic kidney disease are diabetes and high blood pressure, which in practice means that keeping blood sugar and blood pressure under control is the single most important thing that protects the kidneys over the long term.

The two most common causes

Diabetes (type 1 or type 2): years of raised blood sugar damage the small blood vessels inside the kidney. The first sign to appear is usually albumin leaking into the urine, before creatinine changes. That is why a person with diabetes is asked to have a urine albumin test every year, even when the blood test looks reassuring.
Long-standing high blood pressure: it strains the small vessels inside the kidney and reduces filtering efficiency over time. The more the kidney is damaged, the higher the blood pressure climbs, in a closed loop.

Other common causes

Inflammation of the kidney, such as glomerulonephritis or interstitial nephritis.
Polycystic kidney disease, an inherited condition in which multiple fluid-filled cysts form in both kidneys. It is not the same thing as the single simple cyst that sometimes shows up on an ultrasound scan as people get older and does not usually affect kidney function.
Long-standing obstruction of the urinary tract, caused by kidney stones, an enlarged prostate or some types of tumour.
Repeated infection in the kidney, which gradually wears down how well it works.
Reflux of urine back from the bladder towards the kidney.
Some autoimmune diseases that attack kidney tissue.
Obesity, which raises the risk of both diabetes and high blood pressure and adds to the load on the kidneys.

Painkillers and their effect on the kidneys

One of the most avoidable causes of kidney damage, and one of the least noticed, is overuse of painkillers from the group of non-steroidal anti-inflammatory drugs (NSAIDs). In Egypt these painkillers are sold at the pharmacy without a prescription, and many people take them for back pain, joint pain or headache for weeks and months with no medical follow-up. In fact, they reduce the blood flow inside the kidney and can cause a sharp drop in kidney function, or chronic damage with repeated use. In some cases they can cause inflammation in the kidney tissue itself, not merely a reduction in the blood reaching it. Taking one of these painkillers occasionally, when a person with healthy kidneys genuinely needs it, is a completely different matter from taking them continuously for weeks, and the difference between the two is what decides the size of the risk.

The risk clearly increases in the following situations:

Repeated or continuous use, rather than occasional use when needed.
Dehydration or a low fluid intake, an attack of gastroenteritis with vomiting and diarrhoea, or heavy exertion in the heat.
Having diabetes, high blood pressure, or kidney function that is already impaired.
Older age, or a chronic heart or liver condition.
Taking them at the same time as a diuretic and a blood-pressure medicine from the ACE inhibitor or ARB group. The three together are one of the best-known causes of a sudden drop in kidney function.

It is important to be aware that this group of painkillers goes into many of the cold-and-flu mixtures and combination pain remedies bought without a prescription. A person can therefore be taking an anti-inflammatory without realising it, and may take it alongside another painkiller from the same group, doubling the amount without meaning to. Read the ingredients before you buy, or ask the pharmacist.

The practical conclusion is that using these painkillers for extended periods without a doctor's opinion is not safe. If you have diabetes, high blood pressure or a kidney problem, ask your doctor about a suitable alternative for pain relief before buying anything from the pharmacy. The same caution applies to repeated pain-relieving injections and to herbal mixtures of unknown composition; both are a recurring cause of a sudden deterioration in kidney function.

Controlling blood sugar and blood pressure consistently, cutting down on salt, stopping smoking, and drinking enough water without going to excess remain the simplest things anyone can do to protect their kidneys before any complaint appears. For someone who already has advanced kidney impairment or heart failure, the right amount of fluid is decided by their doctor and may be limited rather than unrestricted. Drinking a lot of water does not wash the kidneys and does not improve how they work.

How is kidney disease diagnosed?

Diagnosing kidney disease does not rest on a single test, because the kidneys can lose a large part of their capacity before any clear symptom appears. The nephrologist therefore builds the diagnosis on a complete picture that brings together the medical history, the clinical examination, laboratory tests and imaging, then compares the results against each other and against earlier tests where they exist, because the direction the numbers are moving in over time matters more than any single reading on its own.

The steps in diagnosis

Medical history: kidney disease in the family, diabetes or high blood pressure, any change in urinary habits in terms of amount, frequency or colour, and repeated stones or urinary tract infections.
A review of everything the patient takes: prescribed medicines, painkillers bought without a prescription, supplements and herbal products, because some of them act directly on kidney function.
Clinical examination: measuring blood pressure and looking for swelling in the legs or around the eyes.
Blood tests: to measure how well the kidneys are working through creatinine, urea and the estimated glomerular filtration rate (eGFR), along with blood salts such as potassium and sodium, and a full blood count.
Urine test: to look for protein, blood or pus, plus the albumin-to-creatinine ratio in a urine sample, which is one of the most accurate ways of catching protein leakage early, and a urine culture when infection is suspected.
Ultrasound scan: to assess the size and shape of the kidneys and to detect stones, obstruction or cysts.
A sample of kidney tissue (biopsy): taken under local anaesthetic with ultrasound guidance, carried out in hospital with several hours of monitoring afterwards. It is only requested in specific situations where the doctor needs to know what kind of disease is present within the tissue itself.

What the kidney function numbers actually mean

The numbers that appear on a kidney function report confuse a great many patients, and understanding them in simple terms takes some of the anxiety out of the result and makes the conversation with the doctor much clearer:

Creatinine: a substance produced every day by the normal activity of the muscles, which the kidneys clear into the urine. If the kidneys become less efficient at clearing it, creatinine builds up in the blood and its level rises. In other words, a raised creatinine is an indicator that clearance is not working at its usual efficiency; it is not a disease in itself. Because it comes from muscle, the normal level also differs between a large-framed person and someone slight or elderly, and between men and women.
Estimated glomerular filtration rate (eGFR): an estimated figure calculated from the creatinine level together with the patient's age and sex, expressing how much blood the kidneys clean per minute. A fall in this number indicates a decline in filtering efficiency, and it is the number the doctor uses, alongside the urine albumin level, to define the stage of chronic kidney disease and to follow whether the condition is stable or deteriorating over time. It becomes less reliable when the creatinine itself is changing quickly during an acute illness, because the equation assumes the reading is relatively steady.
Albumin (protein) in the urine: healthy kidney filters keep protein in the blood, so protein appearing in the urine can be one of the earliest signs that something is wrong with those filters, and it sometimes precedes any change in creatinine. A single positive result is not enough on its own, though, because a high temperature, heavy exertion and a urinary tract infection can all cause temporary leakage that then goes away, which is why the sample is repeated to confirm.
Urea: a substance produced by the digestion of protein and cleared by the kidneys. It is also affected by dehydration and by how much protein is in the diet, so it is read together with the rest of the results rather than on its own.

Most important of all, a single reading is not a verdict. A high result may come down to dehydration, to strenuous physical effort before the test, to a passing infection, to a medicine the patient has taken recently, or to a difference in measuring method between one laboratory and another. There are also medicines that raise the creatinine reading on the report without actually weakening the work of the kidneys. This is why the disease is not described as chronic unless the abnormality persists on the blood tests or the urine test for three months or more. A sudden change, on the other hand, is assessed as an acute event with other causes behind it, and it may improve once that cause is treated. What matters to the doctor is the direction across more than one test, and how well it fits with the symptoms, the examination, the urine test and the ultrasound. For that reason a lab report is never interpreted by itself, and a decision to start or stop a medicine is never built on it alone.

Is kidney inflammation serious?

Kidney inflammation needs medical assessment without delay, and its main danger is that it can get worse quickly if it is left without proper treatment. Not every urinary tract infection reaches the kidney; many stay in the bladder and are treated by a doctor. Nor is it a single condition: it may be an infection travelling up from the urinary tract into the kidney (pyelonephritis), or inflammation of the kidney's own filters (glomerulonephritis), which is caused by an immune disorder rather than by an infection. The two are entirely different in how they are diagnosed and how they are treated, and that alone is reason enough not to self-treat.

Signs that mean seeing a doctor the same day

If any of the following appear, go to a doctor or to the emergency department the same day. Do not wait for it to settle on its own, and do not try a medicine at home:

Fever or shivering, together with pain in the flank — the side, just below the ribs — or on one side of the lower back.
A clear drop in the amount of urine, or passing none at all.
Blood in the urine, or urine that turns dark like strong tea.
Repeated vomiting that makes it impossible to keep fluids down or to take what the doctor has prescribed.
Severe pain that does not settle, or unusual exhaustion and a sense of collapse.
A drop in blood pressure, severe dizziness, a racing heartbeat or confusion — warning signs that the infection is spreading through the body.
Sudden swelling of the face or legs together with a rise in blood pressure.

The urgency is greater in pregnancy, in diabetes, when immunity is weakened, when there is a single kidney or a urinary catheter in place, or when impaired kidney function has already been diagnosed. While you are waiting to be seen, drink plenty of fluids unless your doctor has told you not to, avoid anti-inflammatory painkillers (NSAIDs) in particular, because they add to the load on a kidney that is already under strain, and tell the doctor everything you have taken before the visit.

Why kidney inflammation must not be left untreated

Inflammation that continues without proper treatment can lead to:

A decline in kidney function and a weaker ability to clear waste from the blood.
Spread of the infection into the bloodstream (sepsis), a life-threatening emergency that is usually accompanied by a fall in blood pressure rather than a rise.
A collection of pus inside or around the kidney, which may need a procedure to drain it alongside medical treatment.
High blood pressure and fluid retention, tied more closely to glomerulonephritis than to an infection travelling up from the urinary tract.
Permanent damage and scarring of kidney tissue where inflammation is repeated or neglected, particularly when there is an obstruction, a stone, or reflux of urine from the bladder.

How is kidney inflammation diagnosed and treated?

Diagnosis begins with a clinical examination, a urine analysis, a urine culture and blood tests. The doctor may add an ultrasound scan of the kidneys and urinary tract to look for an obstruction, a stone or a collection of pus, or immune blood tests if glomerulonephritis is suspected. Treatment — which treatment, and for how long — is a purely medical decision, taken by the doctor after examination and tests, and based on the type of inflammation, the culture result, the patient's overall condition and how well the kidneys are working. Some cases need monitoring or treatment in hospital.

It is never right to start a medicine on your own judgement, to repeat an old prescription, to use what is left over from an earlier treatment, or to act on advice from someone who is not a doctor. The wrong medicine can mask the symptoms without treating the cause, so the diagnosis is delayed while damage inside the kidney continues silently, and it can make the correct treatment less effective later on. Many medicines also need their dose adjusted to how well the kidneys are working, and that cannot be judged without examination and tests. It matters just as much to follow the plan the doctor has set through to the end, rather than stopping it the moment the symptoms disappear.

How kidney disease is treated

Treatment depends on the cause, on how far kidney function has been affected, and on how early the problem was found. It helps to be clear from the start. In acute kidney injury brought on by a temporary cause — severe dehydration, a medicine that harms the kidneys, a severe infection, or an obstruction in the urinary tract — function may recover fully or partly once that cause is treated. In chronic kidney disease, the damage already done to kidney tissue does not usually return to what it was, and the realistic aim of treatment is to slow the decline, preserve the function that remains, and control the complications. That aim is worth committing to: controlling blood pressure and blood sugar and reducing the amount of protein leaking into the urine slows the decline noticeably, and many patients stay stable for years with regular follow-up.

1. Changes to daily habits

The first step, and the one with the greatest long-term effect, comes from everyday adjustments:

Controlling blood pressure and blood sugar, and keeping to regular follow-up, since diabetes and high blood pressure are the two leading causes of chronic kidney disease.
Cutting down on salt, and watching for the salt hidden in pickles, processed and canned foods and ready meals.
Adjusting the amount of protein and saturated fat in the diet as your doctor or dietitian directs, rather than on your own judgement, because cutting protein back too far causes problems of its own.
Reducing foods high in potassium and phosphorus when needed and under medical guidance, usually in the more advanced stages.
Stopping smoking, losing excess weight, and taking regular physical activity.
Drinking enough water through the day, bearing in mind that advanced kidney impairment or fluid retention may mean the doctor sets a limit on how much fluid you take. Drinking extra water does not wash or cleanse the kidneys and does not improve the way they work.
Being careful not to overuse painkillers bought without a prescription, and being wary of herbs and supplements of unknown origin that are promoted as products that "clean the kidneys".

2. Medication

There is no single medicine that "treats the kidneys". Treatment is aimed at the cause and at the complications together, and the doctor selects it according to the diagnosis, the degree of impairment and the test results. The classes of medicine used include:

Kidney-protective blood pressure medicines, chiefly ACE inhibitors and angiotensin receptor blockers (ARBs), which reduce the leak of protein into the urine as well as lowering blood pressure. The two classes are not combined, and the doctor monitors creatinine and potassium after starting them or changing the dose.
Blood sugar medicines, some classes of which — SGLT2 inhibitors (sodium-glucose cotransporter-2 inhibitors) among them — carry an added kidney-protective benefit alongside lowering blood sugar; the doctor decides which of them suits each case.
Diuretics, to control fluid retention and swelling, with blood salts monitored.
Medicines that lower blood fats (statins), whose main role is to reduce the raised risk of heart and artery disease in kidney patients, not to repair kidney function itself.
Phosphate binders and vitamin D or calcium supplements, when the balance of calcium and phosphorus is disturbed — an imbalance that comes with kidney disease and affects the bones — and only on the doctor's decision, because too much calcium or vitamin D carries risks of its own.
Iron supplements and medicines that stimulate red blood cell production (erythropoietin), for the anaemia that goes with kidney impairment, once tests have confirmed the deficiency rather than on guesswork.
Medicines for high potassium or for excess acid in the blood, when they are needed, because these imbalances are among the most dangerous complications of kidney impairment and may occur with no clear symptoms.
Immunosuppressant medicines, in specific types of glomerulonephritis and in autoimmune diseases that attack the kidney.

All of these classes are dispensed and monitored on prescription and with regular tests, and many of them need the dose adjusted to the estimated glomerular filtration rate (eGFR). Changing or stopping any of them on your own can therefore do more harm than good. It is useful to keep a written list of every medicine and supplement you take and to show it to any doctor you see.

3. Dialysis and kidney transplantation

Most people found to have a mild or moderate decline in kidney function do not reach this stage, especially with blood pressure and blood sugar controlled and regular follow-up. But when the condition reaches advanced kidney failure, and diet changes and medicines are no longer enough to keep the body in balance, the treatments that take over the work of the kidneys come into play:

Dialysis on a regular basis, to clear waste and excess fluid and to control blood salts, either as haemodialysis or as peritoneal dialysis.
Kidney transplantation as a long-term solution if the patient is medically suitable for the operation and a suitable kidney is available; it requires immunosuppressive treatment afterwards and continuing follow-up.

The decision to start dialysis is not taken on a single number in a test result, but on a set of factors the doctor weighs together: how far the eGFR has fallen and whether it is still falling, symptoms of waste building up such as persistent nausea, loss of appetite and severe exhaustion, fluid retention that does not respond to medicines, and disturbance of blood salts or blood acidity to a dangerous degree. This is why preparation usually begins well before it is actually needed, so that dialysis does not have to be started as an emergency.

Finding the Right Nephrologist in Egypt | Town Hospital, New Cairo

When a patient sets out to find the best nephrologist in Egypt, what they are really looking for is a consultant who combines solid clinical experience with accurate diagnosis, and who sets out a clear treatment plan that fits their case – whether that is an early problem with kidney function or a condition that needs long-term follow-up, such as chronic kidney disease or kidney failure.

In practical terms, the right choice rests on three things: the doctor’s specialisation in kidney disease itself, having the tests and scans done and the results reviewed in one place, and regular follow-up after the first consultation – because kidney disease is managed through consistent follow-up far more than through any single visit.

At Town Hospital in New Cairo – Fifth Settlement, kidney cases are looked after by consultants specialising in nephrology and internal medicine, among them:

Dr Mostafa Abdel Naser Abdel Gawad

Consultant in Nephrology, Endocrinology and Diabetes.
Specialised in the diagnosis and treatment of chronic and acute kidney disease, and in kidney transplantation.
Consultant and Lecturer in Internal Medicine and Nephrology, Ain Shams University.
Member of the European Society and the Egyptian Society of Nephrology and Kidney Transplantation.

Combining nephrology with endocrinology and diabetes is useful in cases where diabetes, blood pressure and kidney function all need to be followed together – diabetes and high blood pressure are the two most common causes of chronic kidney disease.

When should you see a nephrologist?

It is advisable to see a nephrologist in any of the following situations:

Burning or difficulty when passing urine.
A change in the colour of the urine, or noticeable foam in it that comes back every time you pass it, not just once.
Swelling in the feet, legs or around the eyes, particularly on waking.
Blood pressure that is repeatedly high, or that remains difficult to control despite taking treatment regularly.
Persistent pain in the lower back or the sides, especially when it comes with a change in the urine.
A raised creatinine or urea result on an earlier test, or protein (albumin) appearing in the urine.
Living with diabetes or high blood pressure for years, even with no symptoms at all, because declining kidney function usually progresses silently, without any clear complaint.
A family history of kidney disease, such as inherited polycystic kidney disease or a relative on dialysis.
Repeated kidney stones or urinary tract infections.
Relying repeatedly on anti-inflammatory painkillers (NSAIDs) without medical supervision.

Any of these signs is a reason for early medical assessment with a nephrologist.

Other signs cannot wait for a clinic appointment and call for urgent medical assessment the same day: fever or chills together with pain in the side or the lower back, a clear drop in the amount of urine or no urine at all, visible blood in the urine, swelling accompanied by shortness of breath, or continuous vomiting with unusual drowsiness or difficulty concentrating.

Assessment usually begins with a blood pressure reading and kidney function tests, which include creatinine and the estimated glomerular filtration rate (eGFR) calculated from it, alongside a urine test and a measurement of albumin (protein) in the urine – because neither one completes the picture without the other. Depending on the case, the doctor may also request an ultrasound scan of the kidneys, or other imaging such as a CT scan, before settling on a treatment plan. It is equally normal for some tests to be repeated after an interval before any conclusion is drawn, because a single reading can be affected by dehydration, by a passing illness, or by a medicine the patient is taking temporarily. What matters is the direction the results take over time, not one isolated number on a lab report.

Nephrology department services at Town Hospital

Diagnosis of acute and chronic kidney disease.
Follow-up of kidney failure patients and preparation for dialysis programmes or kidney transplantation.
Management of the high blood pressure that accompanies kidney disease.
Management of complex cases such as polycystic kidney disease or chronic inflammation.
Regular follow-up programmes for patients with diabetes and high blood pressure, to reduce the complications these cause in the kidneys.
Reviewing the medicines and supplements a patient takes and their effect on kidney function.

Choosing the right doctor is the first step towards an accurate diagnosis and a clear treatment plan. At Town Hospital in New Cairo, kidney cases are followed up within the hospital itself, which has its own laboratory, radiology unit and internal medicine clinics, so tests and regular follow-up can be completed in one place without moving between several different providers.

Frequently asked questions about kidney disease

Which doctor treats kidney disease?

Kidney disease is treated by a kidney consultant (nephrologist), an internal medicine doctor who has completed further training in this field. A kidney consultant diagnoses and follows up acute kidney injury, chronic kidney disease, kidney inflammation, kidney-related high blood pressure and imbalances in the body's salts, and also oversees the preparation of patients for dialysis programmes or kidney transplantation and follows them up afterwards. Kidney stones, blockage of the urinary tract and surgical procedures are handled by a urologist instead, and the two doctors often work together on the same case. The clinics at Town Hospital in New Cairo, Fifth Settlement, include kidney and internal medicine consultants.

What are the early signs that something is wrong with the kidneys?

Chronic kidney disease very often begins with no clear symptoms at all. The earliest signs to appear are swelling of the feet or ankles, puffiness around the eyes on waking, persistent foam in the urine or a change in how much you pass, particularly needing to pass urine often at night, and blood pressure that is newly raised or hard to control despite treatment. Constant tiredness, pallor, poor appetite, nausea and long-standing itching of the skin usually belong to the more advanced stages rather than the early ones, so it is a mistake to treat their absence as reassurance. Pain in the lower back or the sides is not a usual sign of chronic kidney disease; it is more often linked to stones, infection or polycystic kidneys, and needs to be assessed for its own cause. None of these symptoms is specific to the kidneys, and each may have an entirely different cause, so symptoms alone cannot settle the question. What settles it is a kidney function test together with a urine albumin (protein) test, two simple tests that anyone with diabetes, high blood pressure or a family history of kidney disease should repeat once a year, even with no symptoms at all. Go to the emergency department without waiting for an appointment if there is visible blood in the urine, a sharp drop in the amount of urine or none at all, fever with severe pain in the flank, or rapid swelling with shortness of breath.

What do creatinine and eGFR on a kidney function test actually mean?

Creatinine is a normal by-product of muscle activity that the kidneys clear from the body, so a raised level in the blood is a sign that filtration is lower than expected. The estimated glomerular filtration rate (eGFR) is a calculated estimate of how well the kidneys are working, derived from the creatinine result together with age and sex, and read roughly as a percentage of normal kidney filtering capacity. A single high result is not a diagnosis on its own, because creatinine is affected by muscle mass, by dehydration, by hard physical effort shortly before the test, by a meal heavy in meat and by certain medicines, which is why diagnosing chronic kidney disease requires the reduced function to persist for three months or more. Waiting, however, is not always the right thing to do: a sudden, large rise in creatinine, particularly alongside reduced urine, vomiting or dehydration, or after starting a new medicine, may mean acute kidney injury that needs assessment within days rather than a repeat test in three months. Measuring albumin in the urine can also reveal early damage while creatinine is still within its normal range, which is why a kidney consultant reads the two tests together, alongside blood pressure and the patient's history. The numbers are never interpreted on their own.

Can kidney disease be cured, or can it only be slowed down?

The answer differs according to the type of case. In acute kidney injury, caused for example by severe dehydration, an infection, an obstruction or a medicine that is harmful to the kidneys, function often improves a great deal, or returns to what it was, if the cause is treated early; even so, anyone who has been through it stays more prone to kidney problems later on and needs kidney function measured again after recovery, even if they feel perfectly well. In chronic kidney disease, the damage already done to the kidney tissue cannot be reversed, but slowing its deterioration is possible and, to a large extent, effective: controlling blood pressure and blood sugar, reducing the protein leaking into the urine with medicines that the doctor prescribes and whose follow-up tests the doctor monitors once they are started, regulating salt and protein in the diet, stopping smoking, and avoiding medicines that harm the kidneys. These steps may push back the need for dialysis by many years, and the earlier they begin the greater their effect, which is why early detection matters no less than the treatment itself.

When does a patient need dialysis?

Dialysis is a late stage that most people found to have some reduction in kidney function never reach, and it is not a decision taken on one number in a test but on the patient's condition as a whole. The first consideration is symptoms that medicines and diet no longer control: fluid collecting on the lungs with shortness of breath, nausea, vomiting and severe loss of appetite, mental confusion caused by the build-up of toxins, and inflammation of the lining around the heart. Added to these are imbalances that medicines cannot correct, such as a dangerous rise in potassium or severe acidity of the blood. The estimated glomerular filtration rate (eGFR) is a supporting indicator: at a certain level the doctor begins preparation and discussion early, including preparing the arteriovenous fistula, choosing between haemodialysis and peritoneal dialysis, and assessing whether the patient is suitable for a kidney transplant, which in some cases may come before dialysis altogether. All of this is done before the need becomes pressing, because a planned start is far better than an emergency one. In acute kidney injury dialysis may be temporary, until the kidneys recover, unlike chronic kidney disease, where it is regular and long term.

Is kidney inflammation dangerous, and when is it an emergency?

Kidney inflammation is a condition to be taken seriously, because neglecting it can leave permanent damage in the kidney tissue, and the infection may spread into the bloodstream and cause sepsis, which is a life-threatening emergency. Medical assessment is essential here, because treatment differs radically according to the cause: inflammation caused by an infection travelling up from the urinary tract usually appears with fever, pain in the flank and urinary symptoms, whereas inflammation of the kidney filters (glomerulonephritis), which has an immune cause, may run with no fever at all and show itself instead as dark urine the colour of tea or cola, together with swelling and raised blood pressure. That second form is no less pressing, and it needs rapid assessment even without fever. Telling the two apart requires blood and urine tests and sometimes imaging, after which the doctor decides on the appropriate treatment and how long it should continue. The situation becomes urgent and cannot be put off when there is a high fever with shivering, severe pain in the flank, vomiting that stops the patient keeping fluids down, blood in the urine, a clear drop in the amount of urine, or when the patient is pregnant, diabetic, has a single kidney or has weakened immunity. The most important warning remains this: taking antibiotics left over from an earlier prescription, or bought without being examined, masks the symptoms, delays the diagnosis and increases drug resistance, without treating the real cause.

Which daily habits really protect the kidneys?

Protecting the kidneys depends on simple, sustained habits far more than on any supplement or remedy. The most important is controlling blood pressure and blood sugar, since diabetes and high blood pressure are the two most common causes of chronic kidney disease; anyone with either should have a kidney function test and a urine albumin test once a year, even without symptoms. Next comes drinking enough water, spread through the day, without overdoing it, although patients with kidney failure or heart failure are a different case, and their doctor sets the amount of fluid that is right for them, because for them taking in a great deal of fluid is harmful rather than helpful. After that come cutting down on salt and processed foods, stopping smoking, regular physical activity and keeping weight under control. The most dangerous habit, and a very widespread one, is relying again and again on anti-inflammatory painkillers (NSAIDs) bought from the pharmacy without being examined: taken repeatedly or over an extended period, they reduce blood flow inside the kidneys and may cause acute kidney injury or chronic damage, and the risk rises in older people, in states of dehydration, and alongside some blood pressure medicines and diuretics. Taking a painkiller once in a while for a clear reason is not the same as relying on it habitually for chronic pain, and that second situation calls for a review with a doctor to choose an alternative that is safer for the kidneys. The same rule applies to herbal supplements, to products promoted as kidney cleansers, and to muscle-building powders and injections, since the effect of many of them on the kidneys is unknown.

Does an internal medicine doctor treat the kidneys?

Yes, but within clear limits. A general internal medicine doctor is qualified to pick up early impairment in kidney function and to follow up the risk factors behind most cases, chief among them diabetes and high blood pressure, and many straightforward cases are managed entirely in their care. But once creatinine is raised repeatedly, protein keeps appearing in the urine, chronic kidney disease reaches an advanced stage, there is inflammation of the kidney filters, or the case is approaching the need for dialysis or a kidney transplant, follow-up becomes the field of a kidney consultant. At Town Hospital a patient can be referred between the internal medicine and kidney clinics according to what their condition requires.

If my kidneys are giving me trouble, which doctor should I see?

If you develop swelling of the feet or the face, a change in the amount or the colour of your urine, persistent foam in it, blood pressure that is high again and again, or raised results on a kidney function test (creatinine and urea), the right person to see is a kidney consultant. It is best to bring your most recent kidney function and urine tests with you, along with a written list of every medicine and supplement you take, because these save the doctor a great many steps and may point straight to the cause. If, however, all this comes with a high fever and severe pain in the flank, or the urine stops or drops sharply, the assessment is urgent, belongs in the emergency department, and cannot wait for a clinic appointment.

Who is the best kidney consultant in Egypt?

There is no single best consultant who suits every patient. The practical yardstick is the consultant's experience with the condition itself, whether that is chronic kidney disease, inflammation of the kidney filters, or follow-up after a kidney transplant, because each of these follows a different path. Added to that is your own ability to keep to regular follow-up, since kidney disease is managed over years rather than in one visit; then the clarity of the written treatment plan you leave the consultation with; and the availability of the laboratory and imaging inside the hospital itself, because that shortens the time it takes to reach a diagnosis. Town Hospital in New Cairo has kidney and internal medicine clinics, with a laboratory and a radiology unit inside the hospital.

Best Nephrologist in New Cairo | Town Hospital