Nephrology needs "true" Nephrologists

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.