Psychonephrology is an appreciation of the psychological and social issues that affect people living with the physical burden of kidney disease.
People who have kidney disease often experience changes within themselves, as well as in their external relationships. These can then affect patients’ self-perceptions and identity, which can lead to emotional disturbances that may develop into illnesses that require treatment (e.g., depression or anxiety). Kidney disease can also affect patients’ relationships with other people, including with their family, colleagues and wider community.
Consequently patients and families are urged to seek care beyond the treatment related to their kidneys, from a range of practitioners including social workers, psychiatrists, nutritionists, physical therapists, as well as counselors, who may be social workers and/or psychotherapists.
Illnesses can be divided into two groups: acute and chronic. Acute illnesses eventually resolve themselves, either with medical therapy (such as putting a cast on a broken bone) or without medical intervention (such as a cold).
Chronic illnesses, by contrast, are defined by the World Health Organization as requiring ongoing management over a period of years or for the rest of one’s lifetime.
A chronic condition may require ongoing medical supervision and interaction with a multidisciplinary team, often composed of physicians, nurses, social workers, dietitians, pharmacists and possibly including a chaplain and psychiatrist. Most chronic illnesses cannot be cured completely but can be controlled through treatment, medication, diet and exercise. Chronic kidney disease also requires regular long-term follow-up in a specialty clinic.
By their nature, chronic illnesses pose challenges for the emotional and mental health of patients and families. Serious illness can cause major changes in lifestyle, limiting an individual’s independence, affecting self-esteem and confidence, and posing uncomfortable questions about the future. Coping with the mental and emotional challenges of a chronic illness requires, most importantly, recognition of these factors, by patients, families and caregivers.
While receiving care, kidney function may continue to decline, reaching a stage when consideration has to be given to additional treatments, including dialysis, possibly organ transplant or discussions of conservative therapy.