ENKidney disease stays silent for a long time: raised creatinine turns up by chance in a blood test, protein in the urine at a routine check-up, while swelling and fatigue appear late.
Kidney treatment in Germany is the task of the nephrologist, an internal medicine specialist for kidney disease: in Germany, nephrology is a branch of internal medicine, not surgery. Stones, tumours and kidney removal are surgical problems for urologists, covered on the page about urology in Germany. Below: the diseases nephrologists treat, tests, slowing the disease, dialysis and transplantation, hospitals and AlenMed’s role.
Which kidney diseases nephrologists treat
Nephrologists treat chronic kidney disease, glomerulonephritis, polycystic kidney disease and other conditions that impair kidney function. Chronic kidney disease is a slow loss of the kidneys’ ability to filter the blood; according to the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), its most common causes in adults are diabetes and high blood pressure.
Glomerulonephritis is inflammation of the glomeruli, the kidney’s tiny filters, and is often caused by the body’s own immune system, as in lupus. Polycystic kidney disease is inherited: many fluid-filled cysts grow in the kidneys.
Kidney stones and kidney tumours have pages of their own, on kidney stone treatment and on kidney cancer treatment.
How kidney function is tested
Kidney function is tested with blood and urine tests and an ultrasound scan. Blood creatinine gives the estimated glomerular filtration rate (eGFR), an estimate of how much blood passes through the kidney filters each minute; the urine is checked for albumin, a protein a healthy kidney hardly lets through. Results over months or years say more than a single value: they show whether the disease is stable and treatment is working.
If the cause is unclear, the nephrologist may recommend a kidney biopsy: under local anaesthetic, a thin needle guided by ultrasound removes a tiny piece of tissue, and the microscope shows which kind of inflammation is present. A genetic test is done if an inherited disease is suspected. The nephrologist decides what each patient needs.
How to slow kidney disease
Slowing kidney disease rests first on good control of blood pressure and blood sugar. Some of the medicines also help the kidneys: ACE inhibitors and ARBs (sartans) may slow kidney disease even without high blood pressure, and SGLT2 inhibitors (gliflozins), first developed to lower blood sugar, slowed the loss of kidney function in studies of people with and without diabetes. Anti-inflammatory painkillers such as ibuprofen and naproxen can damage the kidneys and should only be taken with a doctor’s agreement.
In glomerulonephritis, treatment that calms an overactive immune system is added and chosen according to the biopsy result. Salt and protein intake are agreed with the nephrologist; less salt can help blood pressure medicines work better. The aim is to preserve the remaining kidney function for as long as possible.
Dialysis and kidney transplantation
When the kidneys have almost stopped working, dialysis cleans the blood, or a donor kidney is transplanted where possible. In haemodialysis a machine pumps the blood through a filter outside the body, usually several times a week at a dialysis centre; in peritoneal dialysis, done at home, the lining of the abdomen (peritoneum) serves as the filter. A patient on dialysis can travel to Germany only with a dialysis place booked in advance, or treatment would be interrupted; see the page on dialysis in Germany.
Transplantation is governed by the German Transplantation Act (Transplantationsgesetz). Organs from deceased donors are allocated by Eurotransplant on medical criteria only, above all urgency and the chances of success. A living donor’s kidney may only go to someone close to the donor — a first- or second-degree relative, a spouse or registered partner, a fiancé or fiancée, or another person evidently close to them — and only after a living donation commission has checked that consent is voluntary and that no organ trading, which the law prohibits, is involved. Whether a transplant is realistic for a foreign patient can only be assessed by a transplant centre after reviewing the records; the centre also decides on admission to the waiting list, so no one can promise an operation in advance. More on the page about kidney transplant in Germany.
Where kidney disease is treated in Germany
Adults are treated in the nephrology departments of general and university hospitals, children in paediatric nephrology units. Nephrology usually sits within internal medicine, with dialysis attached; university hospitals add biopsy, an immunology laboratory and a transplant centre, and transplant patients have dedicated rehabilitation. Choose by the task, not by a famous name: glomerulonephritis needs a hospital that performs biopsies and selects immune-suppressing treatment, guest dialysis a centre near where you stay, a transplant a transplant centre.
A few examples. The III. Department of Medicine at University Medical Center Hamburg-Eppendorf covers nephrology, kidney transplantation, rheumatology and endocrinology; its director is Prof. Tobias B. Huber. At Essen University Hospital, kidney disease is treated by the Department of Infectious Diseases and Nephrology. At Helios Hospital Berlin-Buch, Prof. Henning T. Baberg is medical director and chief physician of cardiology and nephrology. Rhön-Klinikum Campus Bad Neustadt has a dialysis and nephrology unit led by chief physician Gholam Nabi Fakeri. Rehabilitation after a kidney transplant is offered by the m&i Specialty Clinic Bad Heilbrunn, where Dr Doris Gerbig heads internal medicine (nephrology and post-transplant care). Children are treated in the paediatric nephrology unit of Dr. von Hauner Children’s Hospital (LMU, Munich), headed by Prof. Bärbel Lange-Sperandio. Partner hospitals are found across Germany.
Frequently asked questions
When should I see a nephrologist?
When tests show the kidneys are working less well: creatinine rising or the filtration rate falling, protein or blood in the urine. Swelling, blood pressure that medication fails to bring down, and diabetes with changes in the urine test are also reasons to go. A referral does not mean the disease is serious: the nephrologist looks for the cause.
Can chronic kidney disease be cured?
Advanced, long-standing chronic kidney disease usually cannot be reversed, but its progression can be slowed, and the sooner it is found, the sooner the kidneys can be protected from further damage. Much depends on the cause: with diabetes and high blood pressure, control of sugar and pressure comes first; in glomerulonephritis, treatment aims to calm the inflammation.
Do I need a hospital stay for kidney tests?
Usually not: blood and urine tests, the ultrasound scan and the consultation are done on an outpatient basis. A stay is mainly needed for a biopsy, after which the patient is observed for several hours and sometimes overnight. Admission may also be necessary if kidney function suddenly worsens or treatment has to start on the ward; the nephrologist decides.
How much does kidney treatment in Germany cost?
It depends on what is needed: a consultation with tests and ultrasound, a biopsy with a hospital stay, adjusting treatment, or guest dialysis. AlenMed’s reference prices: a consultation with a doctor on the results — from €130, ultrasound — around €130–150. Biopsy, hospital stay and dialysis follow the hospital’s cost estimate (Kostenvoranschlag). Dialysis and transplantation costs have their own pages.
How AlenMed arranges kidney treatment in Germany
AlenMed starts with the documents — blood and urine results over time, ultrasound and nephrology reports, biopsy results and the medication list — has them translated and sends them to the nephrology department of a partner hospital suited to the diagnosis, such as those above.
AlenMed then books the appointments, reserves a guest dialysis place if needed and provides an interpreter. The AlenMed office is in Munich, the partner hospitals are across Germany, and the hospital invoices the patient directly.
This material is for reference only and is not an offer. Treatment is decided by the nephrologist at an in-person consultation.