"The kidney is the soul of the body," one of my closest mentors would proclaim as I went through my medical school and residency training. Several of my colleagues would roll their eyes hearing this mantra, and after residency pursued career paths other than nephrology. Many stayed in general pediatrics; others went onto ICU fellowships, hematology/oncology, and other honorable disciplines.
I went into pediatric nephrology for the same reasons as my mentors and colleagues. We are nerdy, love renal physiology, and appreciate the role of the kidney as the master regulator of homeostasis. A read through Burton Rose during my clinical years lifted this shroud of mystery that vexed so many of us during our pre-clinical year lectures. The complex yet elegant nature of how the kidneys work to attain a fine balance of the milieu intérieur fascinated me, and I knew I wanted to learn more.
I quickly discovered that kidney disease is not just about hematuria and proteinuria - topics commonly taught in chalk talks and powerpoint slides. Being a good pediatric nephrologist requires the clinical acumen to recognize how kidney dysfunction in children can manifest in a multitude of ways. I took care of many patients in residency with diverse presentations, in which kidney dysfunction was at the core – recurrent facial paresthesias in a child with hypokalemia from Gitelman syndrome, failure to thrive and short stature in a child with nephronophthisis, and hypertensive encephalopathy in an adolescent with post-streptococcal glomerulonephritis, among others. Each time the mantra rang more true.
The purpose of Ins & Outs is to teach core pediatric nephrology principles in a way that engages readers and dispels the notion that nephrology is insurmountable. We will provide thoughtful commentary on hot topics in nephrology research and the latest clinical practice guidelines that are pertinent to the practicing clinician. We will walk through sample cases and approaches to the child with kidney disease, to hone readers' clinical reasoning skills. Through this blog and the use of social media, we aim to fill the void in nephrology education and mentorship that precludes more trainees from pursuing this rewarding specialty.