Lessons from 20 Years of Leading a Pediatric Nephrology Program

Abstract

The patterns of patient referrals, the guidelines for diagnostic procedures and treatment, and the academic leadership have continued to change in the last two decades. The revolution brought about by molecular biology has dramatically changed the pace and direction of medical research during this period. In addition, the introduction of managed care competition in the past decade has dramatically challenged the practice of medicine. The effects of all these changes on nephrology and some lessons learned from developing and leading a regional pediatric nephrology program will be discussed. The role of the National Institutes of Health in changing research focus will be examined. These observations may be useful to those preparing to meet the challenges of clinical care and research in this competitive era.

Acute Kidney Failure

“…9 The clinical characteristics were as follows: slightly more male than female patients (60% vs 40% and 57% vs 43%, respectively). Comparing the first (1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988)) and second (1989-1998) decades, the ethnic distribution was, respectively, 53% and 54% white; 38% and 33% black; and 9% and 13% others.…”

“…The 228 patients with acute kidney failure represented 7% of all inpatient and outpatient referrals made to the pediatric nephrology service over these 2 decades. 9 The clinical characteristics were as follows: slightly more male than female patients (60% vs 40% and 57% vs 43%, respectively). Comparing the first (1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988) and second (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998) decades, the ethnic distribution was, respectively, 53% and 54% white; 38% and 33% black; and 9% and 13% others.…”

“…Among the survivors, the order of underlying causes for acute kidney failure hardly change between the 2 decades. (Table 3) Hemolytic uremic syndrome (HUS) 9 in the survivors was the leading cause of acute kidney failure in both decades, 38% and 22%, respectively. There was 1 death from HUS in the 2 decades, of a total of 49 patients, making the mortality rate 2% for this condition.…”

Obstructive Nephropathy in Children: Long-Term Progression After Relief of Posterior Urethral Valve

“…6 Over a 18.75-year period, we cared for 127 children with vesicoureteral reflux, hydronephrosis, and obstructive uropathy. 6,7 Posterior urethral valve is encountered in 1 of 10 000 to 25 000 births, making this one of the most common causes of congenital urologic malformations. 8 -10 Since the 1970s, the widespread use of prenatal ultrasonographic screening has changed the pattern of referrals.…”

Renal diseases in children in Venezuela, South America

“…The majority of published reports focus on specific pathologies, such as hemolytic uremic syndrome, hypercalciuria, urolithiasis, and chronic renal disease, among others [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16]. This lack of information presents an obstacle to the adoption of preventive measures and also for the organization of pediatric nephrology departments that require high technology equipment [17]. These issues have important economic implications and represent a challenge for countries with limited resources, many of which are located within this geographical area of the world [18,19,20].…”