Nephrology had its origins in academic medical and surgical units, emerging from the 1960s onwards as dialysis and transplantation gradually became realistic approaches to renal replacement therapy for end-stage renal disease.

In the academic units resided  the intellectual energy to innovate in renal care, and the human and physical resources to make dialysis and transplantation viable. Renal biopsy became a tool for renal investigation supported by academic pathologists. Research began to broaden beyond its established laboratory efforts to understand renal physiology and pathophysiology.  It is unsurprising that all Renal Association presidents from the 1960s to the 1980s were professors.

Most academic renal units quickly recruited NHS consultants who were clinically focused, and there was mutual respect. The strong ethos of  continuing holistic care for people with kidney disease was at the core of nephrology, and influenced recruitment.  Clinical academics and NHS staff often took equal shares in clinical workload including on-call rotas. Many units consciously espoused the philosophy that there should be no distinction between the status of university and NHS-funded consultants.

Delivering research in those early years in overstretched renal units required the whole  team’s commitment, lead investigators needed ‘buy-in’ from all, and senior authors were careful to ensure the ‘non-academics’ were appropriately  included in research proposals and publications.

Although the UK was slow to expand  clinical renal services compared to many other countries , our renal community punched above its weight in research quality, reflecting the vibrant equitable environment in most units, and the mutual respect between academic and NHS staff. By the 2020s the great majority of UK nephrologists were  NHS consultants working in units away from academic centres with large clinical workloads, and little or no time for research, although the UK’s impressive record of strong recruitment into clinical trials and other clinical studies reflects continuing strong relationships between academic and other centres.

There were some other features of UK nephrology contributed to the mutual respect of academic and NHS staff

• A single professional organisation, the Renal Association (RA) continued to represent nephrology from  the 1970s onwards until well into the 21^st century: an era when in many countries a split occurred: on the one hand a nephrology society with a strong focus on renal science; and an alternative group focused on clinical care and usually coalescing around an interest in  dialysis, which was an ever increasing part of daily work for clinical nephrologists. In the UK there was the beginnings in the 1970s of a ‘dialysis group’ among RA members which might have followed the example of other countries but happily a single organisation for nephrologists continued ..
• The UK retained RA as the one national forum where research findings were presented and debated, and RA’s small and well-connected  membership made meetings a fertile ground for camaraderie exchange and collaboration.
• After the turn of the century, the burgeoning renal multiprofessional team and its champions preferred the separate British Renal Society to emerge, a change not reversed until the amalgamation of the two into the UK Kidney Association in 2021
• There was no move in the UK to a model of care emerging in many other countries with free standing HD units (often privately run) staffed by a cadre of dialysis doctors who were often not fully accredited in nephrology. All UK dialysis units continued to be consultant-led, although in some units non-consultant career grade doctors (associate specialists or hospital practitioners) played a critical role in providing dialysis.

Last Updated on September 26, 2024 by John Feehally