What Is a Kidney Specialist Called? Everything You Need To Know

Are you curious about “What Is A Kidney Specialist Called”? A kidney specialist is called a nephrologist. At WHAT.EDU.VN, we provide answers to all your questions about nephrology, renal care, and kidney health, clarifying medical jargon and helping you understand this vital area of medicine. Explore our site for free insights and connect with a community eager to share knowledge. Whether you are researching renal disorders, kidney failure, or simply want to understand the role of a nephrologist, we offer a platform to have all your questions answered, providing valuable information on renal function, hypertension management, and electrolyte imbalances.

1. Understanding the Role of a Kidney Specialist

A nephrologist is a medical doctor specializing in kidney care and the treatment of kidney diseases. The term comes from the Greek word “nephros,” meaning kidney, and “ologist,” referring to someone who studies. Nephrologists, also known as kidney doctors, are experts in internal medicine who undergo specialized training to treat patients with kidney disorders. These specialists commonly manage chronic kidney disease (CKD), polycystic kidney disease (PKD), acute renal failure, kidney stones, and high blood pressure. They are also knowledgeable about kidney transplantation and dialysis.

1.1. What Does a Nephrologist Do?

Nephrologists handle a variety of tasks related to kidney health, including:

  • Diagnosing and treating kidney diseases
  • Managing conditions like high blood pressure and metabolic disorders related to kidney function
  • Ordering and interpreting blood and urine tests
  • Performing kidney ultrasounds and biopsies
  • Prescribing treatment plans and medications
  • Referring patients to renal dietitians, social workers, and nurses
  • Overseeing dialysis treatments and kidney transplants

1.2. Who Should See a Nephrologist?

You may need to see a nephrologist if you experience any of the following:

  • Acute renal failure
  • Stage 4 or 5 chronic kidney disease
  • A rapid decline in kidney function
  • Chronic urinary tract infections
  • High blood pressure unresponsive to medication
  • A glomerular filtration rate (GFR) of 30 or lower
  • Recurrent kidney stones
  • Blood or protein in the urine

2. The Path to Becoming a Kidney Specialist

Becoming a nephrologist requires extensive education and training. The process involves several stages:

2.1. Medical School and Residency

Aspiring nephrologists must first graduate from an accredited medical school. Following medical school, they complete a three-year residency in internal medicine. During this residency, they gain a broad understanding of various medical conditions, including those affecting the kidneys.

2.2. Certification Exam

After completing their residency, doctors must pass the American Board of Internal Medicine (ABIM) certification exam. This exam ensures they have a strong foundation in internal medicine before specializing in nephrology.

2.3. Nephrology Fellowship

Following the ABIM exam, doctors must complete a two- to three-year fellowship in nephrology. This fellowship must be accredited by the Accreditation Council for Graduate Medical Education (ACGME). During the fellowship, they receive in-depth training in all aspects of kidney care.

2.4. Key Areas of Study During Fellowship

During their nephrology fellowship, aspiring kidney specialists learn about a variety of disorders and treatments, including:

  • Glomerular/vascular disorders: These disorders affect the glomeruli, which are clusters of blood vessels in the kidneys. Nephrologists learn how to slow the progression of these disorders to preserve kidney function.
  • Tubular/interstitial disorders: These disorders affect the tubules of the kidneys and the surrounding tissues. Nephrologists learn to recognize the symptoms and provide appropriate treatment.
  • Hypertension: High blood pressure is a leading cause of end-stage renal disease (ESRD). Nephrologists learn how to manage hypertension through medication, diet, and exercise.
  • Dialysis: Nephrologists learn about hemodialysis and peritoneal dialysis to match patients with the best treatment option for their health and lifestyle.
  • Kidney transplantation: Nephrologists become knowledgeable about all aspects of kidney transplantation to help patients understand and prepare for the procedure.
  • Mineral metabolism: Nephrologists learn how to manage mineral metabolism disorders to ensure patients receive the minerals they need for healthy growth and bodily function.
  • Management of acute kidney failure: Nephrologists learn to treat reversible conditions that cause acute kidney failure, such as kidney stones, infections, and blood loss.
  • Management of chronic kidney disease: Nephrologists study the five stages of CKD and learn how to manage each stage to slow the progression of the disease.
  • Nutrition: Nephrologists learn about the nutritional needs of kidney patients to help them maintain their health and slow the progression of kidney disease.
  • Interpretation of diagnostic tests: Nephrologists learn to interpret the results of x-rays, sonograms, and other tests to make accurate diagnoses.
  • Surgical Procedures: Nephrologists become familiar with surgical procedures such as vascular access and catheter placement.

2.5. Research

Many nephrology fellowships require one to two years of clinical or laboratory research. This allows physicians to become experts in specialized areas of study within nephrology.

2.6. Pediatric Nephrology

Doctors who wish to specialize in pediatric nephrology, caring for children with kidney disorders, must complete additional courses and pass another exam.

3. Common Conditions Treated by Kidney Specialists

Nephrologists treat a wide range of kidney-related conditions. Here are some of the most common:

3.1. Chronic Kidney Disease (CKD)

Chronic Kidney Disease (CKD) is a progressive condition where the kidneys gradually lose function over time. There are five stages of CKD, with stage 5 being the most severe, also known as end-stage renal disease (ESRD).

According to the Centers for Disease Control and Prevention (CDC), about 15% of U.S. adults, or 37 million people, have CKD. Early stages of CKD may have no noticeable symptoms, making it crucial to get regular check-ups, especially if you have risk factors such as diabetes, high blood pressure, or a family history of kidney disease.

Nephrologists play a vital role in managing CKD by:

  • Diagnosing the stage of CKD: Through blood and urine tests, nephrologists can determine the extent of kidney damage.
  • Slowing the progression of CKD: Treatments may include medications to control blood pressure, manage diabetes, and lower cholesterol.
  • Managing complications: CKD can lead to complications like anemia, bone disease, and fluid retention. Nephrologists provide treatments to address these issues.
  • Preparing patients for dialysis or kidney transplant: When CKD progresses to ESRD, nephrologists discuss and coordinate dialysis or kidney transplant options.

3.2. Acute Renal Failure

Acute renal failure, also known as acute kidney injury (AKI), is a sudden loss of kidney function that can occur within hours or days. It can be caused by various factors, including:

  • Reduced blood flow to the kidneys: This can be due to dehydration, blood loss, or heart problems.
  • Direct damage to the kidneys: This can be caused by infections, medications, or toxins.
  • Urine blockage: Conditions like kidney stones or an enlarged prostate can block urine flow.

Nephrologists are crucial in managing AKI by:

  • Identifying and treating the underlying cause: Addressing the cause of AKI is essential for recovery.
  • Providing supportive care: This may include fluids, medications, and temporary dialysis to support kidney function.
  • Monitoring kidney function: Regular blood tests are necessary to track kidney recovery.

3.3. Kidney Stones

Kidney stones are hard deposits made of minerals and salts that form inside the kidneys. They can cause severe pain as they pass through the urinary tract.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), about 1 in 10 people will develop a kidney stone at some point in their lives. Risk factors include dehydration, diet, obesity, and certain medical conditions.

Nephrologists help manage kidney stones by:

  • Diagnosing the type of kidney stone: Different types of stones require different treatment strategies.
  • Providing medical management: This may include medications to help dissolve the stones or prevent new ones from forming.
  • Referring for surgical intervention: If stones are too large to pass on their own, nephrologists may refer patients to urologists for procedures like lithotripsy or surgery.
  • Providing dietary and lifestyle recommendations: Nephrologists offer advice on how to prevent future kidney stones.

3.4. Polycystic Kidney Disease (PKD)

Polycystic kidney disease (PKD) is a genetic disorder characterized by the growth of numerous cysts in the kidneys. These cysts can enlarge the kidneys and impair their function.

According to the Polycystic Kidney Disease Foundation, PKD affects approximately 600,000 people in the United States. There are two main types of PKD: autosomal dominant PKD (ADPKD) and autosomal recessive PKD (ARPKD).

Nephrologists play a key role in managing PKD by:

  • Diagnosing and monitoring PKD: Regular imaging tests are used to track the growth of cysts.
  • Managing high blood pressure: Hypertension is a common complication of PKD.
  • Treating infections: Kidney infections are more common in people with PKD.
  • Slowing the progression of kidney disease: Medications and lifestyle changes can help slow the decline of kidney function.
  • Managing pain: PKD can cause abdominal and back pain.
  • Preparing patients for dialysis or kidney transplant: As PKD progresses, patients may eventually need dialysis or a kidney transplant.

3.5. Hypertension (High Blood Pressure)

Hypertension, or high blood pressure, is a condition in which the force of the blood against the artery walls is too high. It is a significant risk factor for heart disease, stroke, and kidney disease.

According to the American Heart Association, nearly half of adults in the United States have high blood pressure. Many people with hypertension are unaware of their condition because it often has no symptoms.

Nephrologists are involved in managing hypertension, especially when it is related to kidney disease, by:

  • Identifying secondary causes of hypertension: Kidney disease can cause or worsen hypertension.
  • Prescribing medications: Nephrologists use a variety of medications to lower blood pressure.
  • Providing lifestyle recommendations: This includes advice on diet, exercise, and weight management.
  • Monitoring kidney function: Nephrologists monitor kidney function to prevent further damage from hypertension.

3.6. Glomerular Diseases

Glomerular diseases affect the glomeruli, which are tiny filtering units in the kidneys. These diseases can cause protein and blood to leak into the urine, leading to kidney damage.

There are several types of glomerular diseases, including:

  • Glomerulonephritis: Inflammation of the glomeruli.
  • Nephrotic syndrome: A condition characterized by high levels of protein in the urine, low levels of protein in the blood, swelling, and high cholesterol.
  • Focal segmental glomerulosclerosis (FSGS): Scarring of the glomeruli.

Nephrologists manage glomerular diseases by:

  • Diagnosing the specific type of glomerular disease: This often requires a kidney biopsy.
  • Prescribing medications: Treatments may include corticosteroids, immunosuppressants, and blood pressure medications.
  • Managing complications: Glomerular diseases can lead to kidney failure.

3.7. Electrolyte Imbalances

Electrolytes are minerals in the blood and other body fluids that carry an electric charge. They play a crucial role in many bodily functions, including nerve and muscle function, hydration, and blood pH.

Kidney disease can disrupt electrolyte balance, leading to conditions like:

  • Hyperkalemia: High potassium levels.
  • Hypokalemia: Low potassium levels.
  • Hypernatremia: High sodium levels.
  • Hyponatremia: Low sodium levels.
  • Hyperphosphatemia: High phosphate levels.
  • Hypocalcemia: Low calcium levels.

Nephrologists manage electrolyte imbalances by:

  • Identifying the cause of the imbalance: This may involve blood tests and other diagnostic procedures.
  • Providing treatments to restore balance: This may include medications, IV fluids, and dietary changes.

3.8. Kidney Infections

Kidney infections, also known as pyelonephritis, are a type of urinary tract infection (UTI) that affects the kidneys. They can be caused by bacteria that travel up the urinary tract from the bladder.

Symptoms of a kidney infection can include:

  • Fever
  • Chills
  • Back or side pain
  • Nausea and vomiting
  • Frequent urination
  • Painful urination

Nephrologists manage kidney infections by:

  • Diagnosing the infection: This involves urine tests and blood tests.
  • Prescribing antibiotics: Antibiotics are used to kill the bacteria causing the infection.
  • Identifying and addressing underlying causes: This may include kidney stones or other structural abnormalities.

3.9. Acid-Base Disorders

Acid-base balance is the balance between acids and bases in the body. The kidneys play a crucial role in maintaining this balance by regulating the levels of bicarbonate and other electrolytes in the blood.

Kidney disease can disrupt acid-base balance, leading to conditions like:

  • Metabolic acidosis: A condition in which there is too much acid in the body.
  • Metabolic alkalosis: A condition in which there is too much base in the body.

Nephrologists manage acid-base disorders by:

  • Identifying the cause of the disorder: This involves blood tests and other diagnostic procedures.
  • Providing treatments to restore balance: This may include medications, IV fluids, and dialysis.

3.10. Anemia

Anemia is a condition in which the body does not have enough red blood cells. It is a common complication of kidney disease because the kidneys produce a hormone called erythropoietin, which stimulates red blood cell production.

Nephrologists manage anemia in kidney patients by:

  • Identifying the cause of anemia: This may involve blood tests and other diagnostic procedures.
  • Prescribing medications: This may include erythropoiesis-stimulating agents (ESAs) and iron supplements.

3.11. Bone and Mineral Disorders

Kidney disease can disrupt the balance of calcium, phosphorus, and vitamin D in the body, leading to bone and mineral disorders. This can cause bone pain, fractures, and other problems.

Nephrologists manage bone and mineral disorders in kidney patients by:

  • Monitoring calcium, phosphorus, and vitamin D levels: This involves blood tests.
  • Prescribing medications: This may include vitamin D supplements, phosphate binders, and calcimimetic agents.

3.12. Kidney Transplant Management

Nephrologists are essential in the management of kidney transplant patients. They work closely with transplant surgeons to:

  • Evaluate patients for kidney transplant: This involves a thorough medical evaluation to determine if a patient is a good candidate for transplant.
  • Manage immunosuppression: After a kidney transplant, patients must take immunosuppressant medications to prevent rejection of the new kidney.
  • Monitor kidney function: Regular blood tests are necessary to track the function of the transplanted kidney.
  • Treat complications: Nephrologists manage complications such as infections and rejection.

Nephrologists are vital in managing a wide array of kidney-related conditions. Their expertise ensures patients receive comprehensive and specialized care, improving their quality of life and overall health.

4. What to Expect During Your First Visit to a Kidney Specialist

Your first visit to a nephrologist typically involves a thorough review of your medical history and a physical examination. The nephrologist will likely order blood and urine tests to assess your kidney function. Additional tests, such as a kidney ultrasound or biopsy, may be necessary depending on your condition. The doctor will discuss your diagnosis and create a treatment plan tailored to your specific needs.

4.1. Review of Medical History

The nephrologist will ask detailed questions about your medical history, including:

  • Current and past medical conditions
  • Medications you are taking
  • Allergies
  • Family history of kidney disease or other related conditions

It’s important to provide accurate and complete information to help the nephrologist understand your overall health.

4.2. Physical Examination

The physical examination may include:

  • Checking your blood pressure
  • Listening to your heart and lungs
  • Examining your abdomen for any tenderness or swelling
  • Checking for swelling in your legs and feet

The physical examination provides valuable clues about your kidney health and any potential complications.

4.3. Blood and Urine Tests

Blood and urine tests are essential for assessing kidney function. Common tests include:

  • Serum creatinine: A measure of creatinine levels in the blood, which is a waste product that kidneys filter out.
  • Blood urea nitrogen (BUN): Another measure of waste products in the blood.
  • Glomerular filtration rate (GFR): An estimate of how well your kidneys are filtering waste from your blood.
  • Urinalysis: A test to detect protein, blood, and other abnormalities in the urine.
  • Urine protein-to-creatinine ratio: A measure of protein levels in the urine.

These tests help the nephrologist determine the extent of kidney damage and monitor kidney function over time.

4.4. Additional Tests

Depending on the results of the initial tests, the nephrologist may order additional tests, such as:

  • Kidney ultrasound: An imaging test that uses sound waves to create pictures of your kidneys.
  • Kidney biopsy: A procedure in which a small sample of kidney tissue is removed for examination under a microscope.

These tests help the nephrologist make an accurate diagnosis and guide treatment decisions.

4.5. Discussion of Diagnosis and Treatment Plan

After reviewing your medical history, physical examination findings, and test results, the nephrologist will discuss your diagnosis and treatment plan. The treatment plan may include:

  • Medications
  • Dietary changes
  • Lifestyle modifications
  • Dialysis
  • Kidney transplant

The nephrologist will explain the benefits and risks of each treatment option and work with you to develop a plan that meets your specific needs and preferences.

5. The Importance of Early Detection and Intervention

Early detection and intervention are crucial in managing kidney diseases. Many kidney conditions, such as CKD, may not cause noticeable symptoms in their early stages. Regular check-ups and screenings, especially if you have risk factors like diabetes or high blood pressure, can help identify kidney problems early. Early intervention can slow the progression of kidney disease and prevent complications.

5.1. Risk Factors for Kidney Disease

Several factors can increase your risk of developing kidney disease, including:

  • Diabetes: High blood sugar levels can damage the kidneys over time.
  • High blood pressure: Hypertension can damage the blood vessels in the kidneys.
  • Family history of kidney disease: Genetic factors can increase your risk.
  • Older age: Kidney function naturally declines with age.
  • Obesity: Excess weight can strain the kidneys.
  • Smoking: Smoking can damage the blood vessels in the kidneys.
  • Cardiovascular disease: Heart disease and stroke can increase the risk of kidney disease.
  • Certain medications: Some medications can damage the kidneys.
  • Race/ethnicity: African Americans, Hispanics, and Native Americans are at higher risk of developing kidney disease.

If you have any of these risk factors, talk to your doctor about getting screened for kidney disease.

5.2. Screening for Kidney Disease

Screening for kidney disease typically involves:

  • Blood pressure measurement: To check for hypertension.
  • Serum creatinine test: To estimate GFR.
  • Urinalysis: To check for protein and blood in the urine.

These tests can help identify kidney problems early, even before symptoms develop.

5.3. Benefits of Early Intervention

Early intervention in kidney disease can:

  • Slow the progression of kidney damage
  • Prevent complications like heart disease and anemia
  • Improve quality of life
  • Reduce the need for dialysis or kidney transplant

By detecting and treating kidney problems early, you can protect your kidney health and overall well-being.

6. Innovations in Kidney Care

The field of nephrology is constantly evolving, with new technologies and treatments emerging to improve patient outcomes.

6.1. Artificial Kidneys

Researchers are working on developing artificial kidneys that can replicate the functions of a healthy kidney. These devices could potentially eliminate the need for dialysis or kidney transplant.

According to the University of California, San Francisco, the Kidney Project is developing a surgically implanted artificial kidney that would filter blood and perform other functions of a natural kidney.

6.2. Regenerative Medicine

Regenerative medicine aims to repair or replace damaged tissues and organs. Researchers are exploring ways to regenerate kidney tissue using stem cells and other techniques.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) supports research on regenerative medicine approaches for kidney disease.

6.3. Personalized Medicine

Personalized medicine involves tailoring treatments to individual patients based on their genetic makeup and other factors. This approach could lead to more effective and targeted therapies for kidney disease.

6.4. Telehealth

Telehealth uses technology to deliver healthcare remotely. Telehealth can improve access to nephrology care, especially for patients in rural areas or with limited mobility.

The Centers for Medicare & Medicaid Services (CMS) has expanded telehealth coverage for kidney disease patients during the COVID-19 pandemic.

These innovations offer hope for improving the lives of people with kidney disease.

7. Living with Kidney Disease: Tips for Managing Your Health

If you have kidney disease, there are many things you can do to manage your health and improve your quality of life.

7.1. Follow Your Treatment Plan

It’s essential to follow your nephrologist’s treatment plan, which may include medications, dietary changes, and lifestyle modifications.

7.2. Manage Your Blood Pressure and Blood Sugar

Controlling blood pressure and blood sugar is crucial for slowing the progression of kidney disease, especially if you have diabetes or hypertension.

7.3. Eat a Healthy Diet

A renal dietitian can help you develop a meal plan that meets your nutritional needs while protecting your kidneys.

7.4. Stay Active

Regular exercise can improve your overall health and help you manage kidney disease.

7.5. Quit Smoking

Smoking can damage the blood vessels in the kidneys and worsen kidney disease.

7.6. Limit Alcohol Consumption

Excessive alcohol consumption can harm the kidneys.

7.7. Get Regular Check-Ups

Regular check-ups with your nephrologist can help monitor your kidney function and adjust your treatment plan as needed.

7.8. Join a Support Group

Connecting with other people who have kidney disease can provide emotional support and valuable information.

7.9. Stay Informed

Learn as much as you can about kidney disease and its management.

8. Key Questions to Ask Your Kidney Specialist

When you visit a nephrologist, it’s important to ask questions to understand your condition and treatment options.

8.1. What is My Diagnosis?

Understanding your diagnosis is the first step in managing your kidney health.

8.2. What Stage of Kidney Disease Do I Have?

Knowing the stage of your kidney disease can help you understand the severity of your condition.

8.3. What are My Treatment Options?

Discuss your treatment options with your nephrologist and weigh the benefits and risks of each option.

8.4. What are the Potential Side Effects of the Treatments?

Be aware of the potential side effects of your treatments and discuss any concerns with your doctor.

8.5. What Lifestyle Changes Should I Make?

Your nephrologist can recommend lifestyle changes, such as dietary modifications and exercise, to improve your kidney health.

8.6. How Often Should I Come in for Check-Ups?

Regular check-ups are essential for monitoring your kidney function and adjusting your treatment plan as needed.

8.7. What are the Long-Term Outlook and Potential Complications?

Understanding the long-term outlook and potential complications can help you prepare for the future.

8.8. When Should I Consider Dialysis or a Kidney Transplant?

If your kidney disease progresses to end-stage renal disease, you may need to consider dialysis or a kidney transplant. Discuss these options with your nephrologist.

8.9. What Resources are Available to Help Me Manage My Condition?

Your nephrologist can refer you to resources such as renal dietitians, social workers, and support groups.

8.10. Are There Any Clinical Trials That I Might Be Eligible For?

Clinical trials can offer access to new and innovative treatments for kidney disease.

9. The Role of Technology in Modern Nephrology

Technology plays an increasingly significant role in modern nephrology, enhancing diagnostic accuracy, treatment efficacy, and patient care.

9.1. Advanced Imaging Techniques

Advanced imaging techniques such as MRI and CT scans provide detailed views of the kidneys, enabling nephrologists to diagnose kidney diseases with greater precision.

9.2. Electronic Health Records (EHRs)

EHRs allow nephrologists to access patient information quickly and easily, improving coordination of care and reducing the risk of errors.

9.3. Remote Monitoring

Remote monitoring technologies enable nephrologists to track patients’ vital signs and other health data remotely, allowing for timely intervention and preventing complications.

9.4. Artificial Intelligence (AI)

AI is being used to develop new diagnostic tools and treatment strategies for kidney disease. AI algorithms can analyze large datasets to identify patterns and predict patient outcomes.

9.5. 3D Printing

3D printing is being used to create custom-made devices for kidney dialysis and transplantation.

10. Debunking Common Myths About Kidney Health

There are many misconceptions about kidney health that can lead to confusion and anxiety. Let’s debunk some common myths:

10.1. Myth: Drinking a Lot of Water Will Cure Kidney Disease.

While staying hydrated is essential for overall health, drinking excessive amounts of water will not cure kidney disease. Kidney disease requires medical management and specific treatments.

10.2. Myth: Kidney Stones Are Caused by Drinking Hard Water.

The type of water you drink does not directly cause kidney stones. Kidney stones are primarily caused by dehydration, diet, and certain medical conditions.

10.3. Myth: Protein is Bad for Your Kidneys.

While people with kidney disease need to manage their protein intake, protein is not inherently bad for the kidneys. A balanced diet with appropriate protein levels is important for overall health.

10.4. Myth: All Kidney Diseases Are Genetic.

Not all kidney diseases are genetic. While some kidney diseases like Polycystic Kidney Disease (PKD) are inherited, many other kidney conditions are caused by factors such as diabetes, high blood pressure, and infections.

10.5. Myth: If You Have Kidney Disease, You Can’t Exercise.

People with kidney disease can still exercise, but they need to do so safely and under the guidance of their healthcare provider. Regular exercise can improve overall health and well-being.

10.6. Myth: Dialysis Cures Kidney Disease.

Dialysis is a life-sustaining treatment that helps filter the blood when the kidneys fail, but it does not cure kidney disease. Dialysis is a bridge to kidney transplantation or a long-term treatment option.

10.7. Myth: You Can Only Get Kidney Disease if You’re Old.

Kidney disease can affect people of all ages, including children and young adults. While the risk of kidney disease increases with age, it is not solely a condition of the elderly.

10.8. Myth: If You Have Kidney Disease, You Can’t Travel.

People with kidney disease can still travel, but they need to plan carefully and work with their healthcare provider to ensure they have access to necessary medical care and medications.

10.9. Myth: If You Have Kidney Disease, You Can’t Have Children.

Women with kidney disease can still have children, but they need to work closely with their nephrologist and obstetrician to manage their condition and ensure a safe pregnancy.

10.10. Myth: All Kidney Diseases Lead to Kidney Failure.

Not all kidney diseases lead to kidney failure. With early detection and appropriate management, many kidney conditions can be controlled and kidney failure can be prevented.

If you have any questions or concerns about your kidney health, don’t hesitate to consult with a nephrologist for accurate information and personalized guidance.

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