There is a
recent paper published in KI1 with the astonishing title “Is
nephrology specialty at risk?” The authors provide the readers with a rational
explanation for the waning interest in nephrology among internal medicine
residents worldwide. Kalloo et al dissect this issue to conclude that embracing
interventional nephrology and formally incorporating it into nephrology
training programs may be a critical step in helping to attract more highly
qualified trainees.
Interventional
nephrology is based on catheter placement and kidney biopsy. It is true that
many Nephrology Departments had transferred these procedures to Radiology.
However, those Nephrology Departments that retained interventional procedures
do not seem to be superior to the others regarding their capacity for
attracting highly qualified fellows. In my opinion the main reasons causing “nephrology
crisis” are more profound and probably the lack of interventional procedures in
the specialty is a “symptom rather that the etiology of the disease”.
Nephrologists
are currently spending a lot time and making a big effort treating and investigating
some non-renal pathologies affecting renal population. Meanwhile, kidney
disease is a global health care epidemic; the number of controlled clinical trials,
new drugs, and innovative devices in nephrology is below average and even
research on kidney diseases gets less funding in comparison with other
diseases. It is hard to believe since Nephrology was born as a very innovative
specialty: glomerular diseases, dialysis and last but not least kidney transplantation.
Of course,
interventional nephrology matters, but Nephrology needs nephrologists focusing
on kidney disease. Nephrologists should investigate kidney pathophysiology,
should generate new knowledge by applying new platforms and technology, should
increase clinical trial research for generating evidence-based data and test
innovative drugs and should develop innovative devices.
We should return
to the roots.
(1) Kalloo SD et
al. Is nephrology specialty at risk? Kidney Int 2016.
