Both specialists deal with the kidneys, which is why the difference is confusing. A simple way to think about it: the nephrologist looks after the kidney as a filter, and the urologist looks after the pipes and plumbing that carry urine out of the body.
Side-by-side comparison
| Nephrologist | Urologist | |
|---|---|---|
| Main focus | How well the kidneys filter blood, and diseases of the kidney tissue | Structure of the urinary tract: kidneys, ureters (tubes from kidney to bladder), bladder, urethra and prostate |
| Training | Internal medicine, then specialist training in kidney disease | General surgery training, then specialist training in urology |
| Common reasons to see one | Low eGFR, protein in the urine, chronic kidney disease, kidney problems from diabetes or high blood pressure, kidney failure | Kidney stones that block urine, trouble passing urine, enlarged prostate, blood in the urine needing a bladder check, tumours of the urinary tract |
| Tests they often use | Blood creatinine with eGFR, urine ACR, urinalysis, blood minerals, kidney ultrasound, sometimes a kidney biopsy | Ultrasound, CT scan, urine tests, cystoscopy (a camera look inside the bladder) |
| How they treat | Monitoring, medicines, blood pressure and diabetes plans, diet guidance, dialysis care, transplant follow-up | Procedures and surgery, stone removal, prostate treatment, some medicines |
| Do they operate? | Usually no | Yes |
When a nephrologist is more likely to help
- Your eGFR is low or falling over time.
- Your urine ACR shows protein leaking into the urine, especially if it stays raised.
- You have diabetes or high blood pressure and your kidney results are changing.
- You have swelling of the feet or legs together with abnormal kidney results. See swollen feet.
- You have been told you have chronic kidney disease, or you may need dialysis in future.
When a urologist is more likely to help
- A scan shows a kidney stone that is blocking urine, or stones that cause repeated pain.
- You have difficulty passing urine, a weak stream, or need to pass urine very often at night, especially in older men.
- You have visible blood in the urine, and a doctor wants the bladder and urinary tract checked.
- A scan shows a growth or a structural problem in the kidney or bladder.
When you might see both
Some problems sit between the two specialities. With kidney stones, a urologist may remove a stone, while a nephrologist may look at why stones keep forming and how they affect kidney function. With blood in the urine, a urologist often checks the bladder and urine tubes, and a nephrologist becomes involved if the cause seems to be inside the kidney filters, especially when protein is also present. Kidney transplant care also involves both surgeons and nephrologists.
This is common and does not mean something has been missed. Specialists often refer to each other.
Not sure which one you need?
You do not have to decide alone. A GP or internal medicine physician can look at your symptoms and results, arrange first tests such as a urinalysis or a kidney ultrasound, and point you to the right specialist. In Mombasa, many people start this way at a clinic near home in areas such as Likoni, Changamwe or Bamburi before travelling to a specialist.
You can also use our Not sure what you need? pathway, or read about changes in urination if that is your main concern.
When to get medical help urgently
Go to the nearest hospital emergency department, or call 999 / 112, if you cannot pass urine at all, pass very little urine, have blood in the urine with fever or severe pain, or have severe pain in the side or back with vomiting or fever.
Common questions
Should I see a nephrologist or a urologist for kidney stones?
A urologist usually treats a stone that is blocking urine or causing repeated pain. A nephrologist may be involved if stones keep coming back or if your kidney function is affected. Many people see both at different times.
Who should I see for blood in my urine?
Start with a GP or physician, who can repeat the urine test and check for infection. Depending on the findings, they may refer you to a urologist to check the bladder and urine tubes, or to a nephrologist if the kidney filters may be involved.
Does a nephrologist do kidney transplants?
No. The transplant operation is done by a transplant surgeon. Nephrologists help assess whether a transplant is suitable and look after people before and after the operation.
Sources
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): Kidney disease. niddk.nih.gov
- National Kidney Foundation. kidney.org
- Urology Care Foundation (American Urological Association). urologyhealth.org
- KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. kdigo.org
This page explains what kidney care involves in general terms. It is not a diagnosis and does not replace advice from a doctor who knows your history. Your results should be interpreted together with your symptoms, other tests and a clinical assessment. Medical disclaimer.