In a series focusing on medical specialties: Nephrologist

Inside Medicine: Nephrologist
Saturday, 22 December 2007
BBC NEWS

In a series focusing on medical specialties, the BBC News website meets nephrologist Richard Fluck.

Nephrology is the branch of medicine which deals with the study of the function and diseases of the kidney.

WHAT IS YOUR JOB?

I am a consultant renal physician at Derby City General and the clinical director of renal services for the hospital.

We manage patients with all forms of kidney problems, covering an area with a population of about 750,000 as we are a regional centre.

Renal services at the hospital are based around a 26-bed inpatient area (including a four-bed high dependency area), and a 55-station chronic dialysis unit. This provides dialysis treatment for nearly 300 people.

"A person on dialysis at 30 has the average life expectancy of an average 80 year old."
--- Richard Fluck

We also have a very active research programme within the department, looking at ways to improve patient care.

My particular area of interest is in the prevention of infection, particularly catheter-related infection (CRI). Infection remains a major cause of illness and death in patients receiving dialysis.

WHAT IS THE MOST COMMON CONDITION?

That would have to be chronic kidney disease - the gradual and usually permanent loss of kidney function over time.

It is estimated that between one in 10 and one in 20 of the population has chronic kidney disease.

Often this is related to diabetes or heart disease affecting the kidneys but rarer conditions such as lupus may also causes kidney problems.

WHAT IS THE MOST COMMON PROCEDURE?

The most common practical procedure is dialysis.

Of the patients we see, a small number are on dialysis. In Derby this is about 300.

About a third of these have their treatment at home but we also carry out about 3,000 dialysis treatments here at the hospital every month.

The department also carries out between 150-200 renal biopsies per year and places 150-200 catheters under X-ray guidance.

WHAT IS THE HARDEST THING ABOUT YOUR JOB?

The part I find the most stressful is talking to someone who has been suddenly diagnosed with end stage kidney disease.

At that moment they have had no warning about the problem, although it has been present for a long time.

They are then told that they have to go onto dialysis and their life expectancy is seriously reduced. Some patients on dialysis will get kidney transplants but every year one in six patients waiting will die.

It emphasises why we need to improve the early diagnosis of kidney disease. This will allow the kidney problem to be assessed and complications, such as anaemia, to be treated.

WHAT IS YOUR MOST SATISFYING CASE?

Any time you manage to slow down the progression of chronic kidney disease and delay the person needing to go onto dialysis.

A person on dialysis at 30 can expect only as many years more life as the average 80-year-old.

If we can prevent that, then that is worthwhile. For example, if we can treat anaemia, a common complication of kidney disease, that can profoundly improve someone's quality of life.

Recently I had a young man present with kidney disease and profound anaemia. He could not work and found it difficult at home with his young baby - he was exhausted.

Using EPO (Erythropoietin) - a hormone naturally produced by the kidneys - transformed his life. He is back at work and he is able to enjoy being a dad. His kidney function is now stable and the need for dialysis is reduced.

WHY DID YOU CHOOSE THIS SPECIALITY?

Quite simply because it offered me variety.

We deal with all sorts of conditions and how they affect the kidney.

There is the contrast of research and clinical care, the contrast of acute emergency work and the attention to detail that long term care requires.

IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALTY?

No, I made the right choice! As I have mentioned, I like the variety, and whilst the progression to a consultant has been hard work, it remains challenging and rewarding.

WHICH SPECIALTY WOULD YOU HAVE GONE INTO IF NOT YOUR OWN?

It would probably have been cardiology or intensive care because again they deal with a wide range of complex cases.

HOW DO YOU SEE YOUR ROLE DEVELOPING IN THE FUTURE?

It would probably be seeing the area of nephrology being taken from its "ivory tower" in teaching hospitals into primary care to enable the spotting of kidney problems early.

Locally, when you are medical students you only get three weeks on nephrology and it is often less in other teaching hospitals. There is a need to educate both doctors and the public about chronic kidney disease.

We need to work with the GPs more and to support them to refer the people who need specialist care.

In fact, GPs do an excellent job promoting the simple measures that for most people are enough to protect the kidneys - good lifestyle, control of blood pressure and looking after diabetes.

Our role is to deal with more complex cases, those with complications and those who may need dialysis or transplantation.

CV - Mr Richard Fluck
1985: Qualified London Hospital Medical School
1987: First Renal post - SHO at the London Hospital
1990: Appointed Research Fellow, Department of Nephrology St Bartholomew's
1996: Appointed Consultant Renal Physician, Derby

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/6970663.stm

Published: 2007/12/22 00:02:15 GMT