So you want to be a Nephrologist

What is Nephrology? Nephrology (literally the study of the kidney) has evolved over the last 60 years to become a major medical specialty. Early pioneering renal physiology experiments yielded insights into blood pressure regulation, electrolyte and acid-base balance. This physiological research, coupled with advances in immunology, was translated into effective life sustaining therapy for chronic kidney failure (dialysis and kidney transplantation). Nephrology now encompasses a wide range of clinical treatments for acute kidney injury, chronic kidney disease, end-stage renal failure, bone mineral metabolism, renal anaemia and prevention of kidney transplant rejection. Where is Nephrology goiNg as a specialty? Renal medicine has experienced unprecedented growth over the past 20 years driven in part by the rising number of persons with end-stage kidney failure needing dialysis and/ or renal transplantation. Visible evidence of the increased numbers of patients requiring renal replacement therapy is the development of multiple new renal units both in teaching hospitals and district general hospitals. hoW are Nephrologists traiNed? Training in nephrology follows the nationally agreed renal medicine curriculum and is competency based. Entry to training is by competitive multi-station interview and from 2010 applicants will need to have attained MRCP (UK) PACES or equivalent prior to application. Typically it will take a total of three years of clinical nephrology training to attain a CCT in Renal Medicine. During this period the specialist trainee will rotate between the sub-disciplines of nephrology including transplantation, dialysis, general nephrology and consult services with a minimum of 3 months acute kidney transplant experience (managing patients in the peri-operative and early phases of kidney transplantation). Procedural skill in placing ultrasound-guided central venous catheters for dialysis (Figure 1) is a mandatory component of training. Developing expertise in native and transplant kidney biopsy (Figure 2) is encouraged but is no longer an essential requirement of training. During training the Specialty Certificate Examination (SCE), organised by the Royal College of Physicians, must be passed. This is an MCQ exam based on the Renal Medicine Curriculum approved by PMETB caN i combiNe reNal mediciNe With other iNterests? A majority of trainees also enrol for training in general internal medicine to attain a dual CCT in medicine and nephrology. This is a pragmatic choice recognising that many nephrology posts are in hospitals where the consultant nephrologist contributes to the acute medical take in. Some nephrology trainees, and particularly those with a special interest in acute kidney injury, have combined …