Nephrology: A Revival for 2012
A time-honored tradition in nephrology: mentor and trainee examine the urinary sediment. Image from Parker AJKD review.
Today is World Kidney Day. This is a special day for individuals burdened by kidney disease and their caretakers. World Kidney Day first began in March 2006. Although the study of kidney disease dates back many centuries, nephrology was not recognized as a discrete subspecialty until the mid-1940s.
Currently, many countries, including the United States, are facing a workforce shortage in this field of medicine. This will lead to fewer physicians caring for patients with chronic kidney disease, end-stage renal disease, and kidney transplants.
Let’s take this moment to inspire young students to explore our field of medicine. Renal medicine has:
1. Excitement: Managing acute issues like hyperkalemia, acid-base disorders, hypertensive crisis, and acute rejection in the kidney transplant.
2. Novelty: Transplant immunology is growing rapidly, and new agents are coming to the surface to make the field more and more exciting. The fact that dialysis machines may soon be portable is amazing. Organs are even being developed and created via stem cells.
3. Variety: From glomerular diseases to dialysis, electrolyte disorders to hypertension management, and acute kidney injury to complex rapidly progressive vasculitis, nephrology has something for everyone.
4. Future: Interventional nephrology, geriatric nephrology, onco-nephrology, transplantation, and other special fields, something everyone can master in this exciting specialty.
5. Mind boggling: Always makes you think! The “thinkers” as the other colleagues refer to us as. Even Dr. Gregory House of the television series is marketed as a nephrologist!
6. Empathy: As we assist patients through some their lives greatest challenges, nephrologists are kindhearted and compassionate individuals.
We have gathered below a few comments from nephrologists about what inspired them to choose nephrology, and we invite all nephrologists to share why they chose this field of medicine. Please respond with your comments.
Kenar D. Jhaveri, MD
eAJKD Blog Editor
Dr. Matt Sparks, eAJKD advisory board member: Nephrology to me was the only remaining subspecialty in internal medicine that took care of patients throughout so many diverse time courses of life. First, nephrologists help manage a chronic illness with many covariables that affect the long term outcome. Second, we can provide a life-sustaining service for patients with single organ failure in renal replacement therapy or kidney transplantation. Lastly, nephrologists help uncover unique and difficult diagnoses in patients with renal failure and fluid/electrolyte disorders. Ultimately, I made the decision to enter nephrology after exposure to mentors with true passion for the field.
Dr. Richard Barnett: A-B, fluid/lyte disorders, especially in the critical care units.
Dr. Mala Sachdeva: Nephrology is a fascinating field. It is fun and interesting and I never get bored of it! It encompasses every organ system and incorporates a whole slew of medicine. There is wide variety in this field and I enjoy taking care of patients ranging from chronic kidney disease to dialysis to transplantation. Happy World Kidney Day!
Dr. James Chevalier: I had to pick a specialty that interested me enough to keep me enjoying going to work day after day.
Dr. Abdulla Salahudeen: I chose nephrology because I could do something for my patients, and nephrology is intellectually rewarding from all aspects.
Dr. Michael Gitman: I did a nephrology rotation and was motivated by an incredibly knowledgeable attending.
Dr. Sidharth Sethi, eAJKD advisory board member: During my residency days in Pediatrics, there were just a couple of Pediatric Nephrologists in our country, and none in our Institute. All our Pediatric and Neonatal patients, would be seen by us and Adult Nephrologists too. I was already interested in the renal hemodynamics and tubular functions I used to read and enjoy working up patients with tubular disorders. There was a huge need for Pediatric Nephrology specialty in our country. Though still there are just a few Pediatric Nephrologists in our country (one per state!), we are trying our best to provide the services to these patients. In such a huge nation, children with ESRD mostly die and rarely get transplanted. Even the best of the transplant centres in the country, transplant few children every month. This World Kidney Day, I would like to thank the AJKD team for helping spread awareness of Childhood renal disorders to the population.
I initially wanted to be an opthalmologist. However when i attended my first nephrology course in medical school I was fascinated by the science. I then cared for a patient on hemodialysis and was again impressed by the life saving aspect of the field and satisfied by the opportunity it gave me to bond with my patients. I think nephrology is great because it allows to be an internist and fuels my passion about medicine. I am blessed to be involved in such a field and privileged to take care of such patients who continue to inspire me and teach me every day.
No great discovery was ever made without a bold guess
It was the mentors, always. Bruce Koeppen, a great physiologist at UConn Med School made the nephron fascinating. Jerome Kassirer was my ward attending for my first medical intern rotation – my first exposure to a renal physiology giant. Nick Madias, Andy Levey, and John Harrington, among others influenced my residency thinking, so, of course, I had to stay at Tufts for fellowship. Mentorship beyond training? Jon Himmelfarb as my colleague and chief for 9 years. Now, I’m the chief and I try to be that same positive role model and influence for my students, residents, fellows, and junior faculty. That’s how we’ll keep the pipeline going – through the personal touch.
I thought the nephrologists were the smartest and best teachers in my medical school. Electrolyte and acid base disorders were the hardest to understand, and my teachers made them seem easy. I wanted to be like them!!
If an experiment works, something has gone wrong
The intellectual challenge presented to the clinician on a daily basis is perhaps the single most compelling reason that I chose to subspecialize in nephrology. Additionally, the field encompases many different elements of general medicine, and therefore requires a deeper understanding than most other specialties. During the blogging era, there has been further excitement and new methods of discovery/learning/teaching that has captured my interest.
The intellectual challenges presented to the clinician on a daily basis is what compelled me to subspecialize in nephrology. Additionally, the integration of several different specialties with nephrology requires a deep understanding of general medicine, making the nephrologist truly a complete physician. Recently, the excitement generated through the blogging era has shown us new methods to teach, learn and discover – this was an unforeseen bonus.
Initially, I was fascinated by acid-base and electrolytes. It amazed me that the body could almost always maintain homeostasis, even with tremendous changes in intake. I still find that element exceptionally interesting but I have also come to love the continuity of dialysis care and the relationships and teamwork among the nephrologist, the patient and the whole dialysis unit involved in providing this care. I don’t think there is any other field in medicine where you have the opportunity to really get to know your patients as well.
I loved the challenge of diagnosis in nephrology, especially fluid and electrolyte disorders.
Like a man on a bicycle science cannot stop; it must progress or collapse
My father was a nephrologist, so I had no choice. In order to add some humor, there`s a saying in German that goes like that: “War dein Vater ein Saeufer, wirst du auch einer sein” Appreciate any English translation to celebrate World Kidney Day.
Cristina Gluhovschi,
Timisoara, Romania
I had a fabulous teacher in nephrology while in medical school. She made acid base and electrolyte management so interesting. This seemed to be a specialty for the thinking person and I felt I would never be bored. Since becoming a nephrologist, some of the aspects I like are the team approach to patient care, and that one can follow patients longitudinally over many years and really play an important role in helping them manage a chronic illness. Much of what I do with patients is teaching, and permits patient centered care.
Dear Mrs. Piraino,
You`re a world-reputed scholar in renal replacement therapies. You have chaired a session I`ve attended some while ago in San Diego. How do you start your lessons to patients or students on RRT? Here`s how`s the Associate Professor I work with starts it:
What is the artificial kidney, when you come to think of it, but an ingenious machine for turning, with infinite artfulness, death into life?
If the members of this blog agree I`ll send you the quote she starts all her lessons with.
Looking forward to hear input from the distinguished company I have just joined.
Happy World Kidney Day.
Here in Romania we celebrate also International Women`s Day.
Best regards,
cristina
I am a renal patient. I was diagnosed with Congential Renal Dysplasia aged 2-months. I have a long clinical history, but received my 4th renal transplant in 2007 and thus far all is well. I am also currently doing my doctorate exploring young people coping with CKD (stages 4-5). I hope to have a few papers published surrounding my research in due course. I have also presented at several conferences, respectively.
Academically I struggled in my early years, but after my research, I actually aim to study Medicine after and hope to one day be a practising paediatric nephrologist, since I have contributed to this specialty ‘on and off’ wards by being involved in working groups and patient panels.
I think one of the other elements that in association to my wonderful Mother and Father, I had two great paediatric nephrologists who cared for me and they literally taught me Nephrology without even knowing it and for over 30 years my understanding of paediatric nephrology specialty would overwhelm those nephrologists who are practicing currently….simply because I have been there!
Renal Tx: Quote:
What is NOW proved was ONCE only i m a g i n e d . ”
Please think also of the European pioneers of Renal Tx like Rene Kuess
Good luck. Kidney disease can affect any of us. We`re a step closer to God than most other people.
Echoing others’ comments, I was inspired to go into nephrology by the nephrologists I was exposed to during medical school (John Barasch, Qais Al-Awqati) and residency (Phil Klemmer, Ron Falk, Romulo Colindres). It’s a great day to celebrate mentors!
Good idea. Another quote fromanother lesson of one of my mentors:
Microscopes and telescopes,
in actual fact, confuse man’s
innate clarity of mind.
Check out the video reply by Dr. Joel Topf, eAJKD advisory board member:
Mesmerizing video. Didn`t have time to watch till the end but added it to My Favorites. Here`s one of my mentors` quote on the introductory lesson on Renal Immunopathology:
Chaos was the low of nature;
Order was the dream of man
Happy World Kidney Day!
Best regards,
Cristina
There was no such speciality as nephrology when I came to the University of Leeds as a reseach fellow interested in thyroid disease in January 1958, but Leeds had the pioneering acute dialysis unit set up in 1956 by Drs. Frank Parsons and Brian McCracken. A few days later Brian had to leave for the United States suddenly because of a family tragedy and I took his place in a program which at that time covered dialysis for acute renal failure for the north of England, Scotland and Northern Ireland. We read the ASAIO reports on the Scribner shunt and treated a couple of chronic patients rather unsuccessfully in the spring of 1961 and so when I was awarded an NIH Fellowship from the Medical Research Council I chose to come to Seattle to work with Dr. Scribner at the University of Washington in 1963. I’ve been around dialysis ever since.
Chose nephrology to help the suffering of individuals from complex kidney disease. There is long term relationship with kidney patients and the trust they develop in you due to this is very rewarding for me.
Here’s a comment from Dr. Mitchell Halperin: I was attracted to the area of renal physiology because hypotheses and theories lent themselves to a quantitative analysis; this differed from my original field of interest, endocrinology. Moreover one could readily discover things that were relevant at the bedside.
I was initially attracted to nephrology because nephrology deals with all aspects of medicine in addition to kidney disease. These same themes lead me to my career choice in transplantation. Where else are you able to treat renal failure, see acid base disorders, treat acute rejection, cure diabetes and at the same time manage cardiac and rare infectious diseases? But perhaps even more satisfying is experiencing the profound change a patient’s life goes through after transplantation. When someone tells you with a look of amazement how it feels to wake up expecting to go through the agony of dialysis – only to realize that they now have a functioning transplant, or when they still cannot believe that after 30 years of diabetes they no longer have to check their blood sugar or watch their diet – those are the moments when I know for sure, that nephrology was the right career choice for me.
Vinay Nair, DO
eAJKD advisory board member
The only field where you may diagnose the medical condition without ever seeing a patient by just checking the numbers.The only field where you can keep a patient alive for years despite having one of their vital organs(kidneys) completely shut.
Dr. Maria Ferris from UNC says “I loved nephrology as a medical student because I had a great physiology teacher…I did not know it was supposed to be challenging until others told me so…I liked caring for adolescents and young adults with CKD because of their great survival and their ability to cope with the challenges life has dealt to them.”
During my days as a medical student at the Aga Khan University in Karachi, I thought Nephrology was the most challenging field in medicine and I enjoyed trying to resolve acid base and fluid electrolyte equations with my dedicated teachers. I have been equally impressed with the nephrologists I had the pleasure of working with in the US, and especially the ones who inspired into public health aspects of nephrology for the greater good.
I was inspired by a renal pathologist in medical school. Following that in residency, mentors showered their enthusiasm and passion for nephrology. This sparked an interest to do an elective and then another one leading to a confirmation that this was the best field in medicine. Thank you to Drs. Paul Shanley, John Forrest, Mark Perazella, Susan Crowley, Aldo Peixoto, Ashgar Rastegar, Madhu Bhaskaran for inspiring me to this wonderful field of medicine.
As a final year medical student in 1988 came across patients in emergency and in the ward with renal failure and felt their pain and suffering. one of such patient with post Partum bleed and AKI had acute PD which I had the chance to participate in management and patient improved to my surprise. I told myself that I will be a kidney doctor. At that time nephrology and unfortunately still Nephrology is in infancy in Pakistan.
During my IM residency at UIC, Chicago the nephrology team included Daugirdas, Jose Arruda, JP Lash and S. Leitz who inspired me with their critical thinking and clinical acumen, to finally choose Nephrology as my specialty. I have no regrets.
I agree with Dr. Piraino, great teachers “push” you into nephrology. My passion for nephrology started in medical school as well. Dr. Romero Lino, the most brilliant internist I knew happened (as usual) to be a nephrologist too. He was and had been the internal medicine clerkship director for years stimulating many students into specializing in internal medicine and nephrology. During my residency at UTMB, I had the privilege to meet, Dr. William Mitch, a magnificent teacher, scientist, and now a long time friend and mentor. I worked with him in the lab and in the consult service. Because of him, I love nephrology. When you see a patient, you don’t have to dig deep to see renal physiology in action. Examining something so common and uninteresting for many (not for me) as a urine specific gravity gives you a whole and complete idea about the state of vasopressin in the body. I can go on for days with examples like that. Nephrologists are one of the few subspecialists that keep their ABIM internal medicine certification current (different from GI or Cardiology), nephrologists are really “super internists”.
My entry in nephrology could not be more bewildering. As a Resident I worked in a small hospital located in a rural area with just the basics. I like all the clinical branches in medicine and I couldn’t make up my mind, but for sure I knew I did not want anything surgical. Time was running out and the deadline for the application for postgraduate studies was close. During a night that I was on duty in the emergency room, I had to call a traumatologist for a complicated fracture. While I was helping him in the operating room I thought out loud about my indecision and he says you ought to do nephrology. I asked him why?? And he says because you always are wondering how the internal environment will be, blood gases, electrolytes, if you will be doing parenteral hydration properly and always complaining about not having the necessary lab test. I wasn’t so convinced that night, nephrology in my country at that time was a very young specialty. I guess I don’t have to say the date but otherwise I graduated very young from medical school too. The next day he gave me a book called “El Riñon” by Jan Brod, a professor from Czechoslovakia who was initiated in nephrology for Dr. Hans Papper in Vienna. I opened the book and in the counter cover was a summary of his curriculum vitae … remarkable … he was the president of the II ISN Congress in Prague and so on, and the content makes look so pale my classes of renal physiology in medical school. I think as well as Dr. Brod would pale if he saw the advances in nephrology at this moment in time. I fell in love with the book right away (I still have it), and without hesitation send my application to nephrology. And here I am. When I look retrospectively, I don’t see myself doing anything else.