www.mddus.com Q&A


Dr Sian Griffi n, consultant nephrologist based in Cardiff


What fi rst attracted you to renal medicine? I rotated to nephrology when meandering through my medical SHO rotation with no clear plan and was immediately hooked. I’ve been lucky to work from the beginning with a group of committed and inspirational registrars and consultants. I was attracted by the uniquely close and lifelong relationship between patients with renal disease and their doctors, and the need to clearly understand both clinical and laboratory medicine. It was also very appealing to have available a blood test to tell you just how bad the situation was and access to a big shiny machine to fi x it!


What do you enjoy most about the job? Having dialysis or receiving a kidney transplant can be overwhelming for people. I enjoy providing an explanation and reassurance so patients and their relatives can regain a feeling of control over their situation. My research area has been renal immunology, and applying this to optimise the opportunities for renal transplantation and their outcome is very exciting. The impact of renal disease reaches beyond the patient into many areas of their and their family’s lives. Being part of a cohesive team that works to address these issues is one of the most rewarding aspects of the job.


What do you fi nd most challenging? Finding enough hours in the day!


Has anything surprised you about the specialty?


haemodialysis patients will also regularly visit a dialysis unit, either within the main renal unit or at a satellite unit. This can take up to half a day each week. In larger renal units, consultant nephrologists


often spend fi xed blocks of time on-call looking after all renal inpatients on behalf of all the nephrologists in the unit. These arrangements typically last around two weeks, but vary depending on the size of the unit. A growing aspect of the work of renal


physicians, in partnership with primary care and some secondary care specialties, is the early detection of kidney problems and the prevention and management of progressive kidney disease. There is currently a national drive to improve the recognition and management of acute kidney injury (AKI). Specialists work as part of a multidisciplinary team, particularly with renal nurses, pharmacists, dieticians, psychologists and social workers. There is also close involvement with other specialties such as vascular access and renal transplant surgeons, cardiologists, paediatricians, diabetologists and palliative care physicians. Patients with acute renal failure are often jointly managed with intensive care physicians and anaesthetists. Renal patients are also prone to conditions such


as sleep problems, weak bones, joint problems and depression and specialists will be expected to recognise and manage these appropriately.


The curriculum calls on doctors to appreciate


that “patients have physical, social, spiritual and psychological needs”, highlighting the importance of promoting good communication with the patient and their family. While the majority of people with chronic


kidney disease will not develop progressive kidney failure, some will progress to end-stage kidney failure. It is in circumstances such as this that renal physicians must be able to off er the information and support that is needed by patients and families facing death. The curriculum states that “renal physicians


deliver eff ective patient-focussed care for patients with kidney disease throughout the patient journey from diagnosis to end-of-life care. This enhances patient care and facilitates high quality complex long-term decision making.”


Sources/Useful links: • Joint Royal Colleges of Physicians Training Board - www.jrcptb.org.uk/specialties/ renal-medicine


• The Renal Association – www.renal.org


• NHS Medical Careers - www. medicalcareers.nhs.uk


Dr Alison Brown is a consultant nephrologist and secretary of The Renal Association


On the plus side - the rapid progression of legislation to allow altruistic organ donation, and the number of selfl ess individuals who have donated a kidney to a stranger. On the downside – I’ve been optimistically anticipating a cure for diabetes and hence the disappearance of diabetic nephropathy for years, but I think it’s still going to be the leading cause of end-stage renal failure for some time yet.


What do you consider the most important attributes of a good renal medicine specialist? A nephrologist needs to be able to combine the ability to keep a clear head and make quick decisions in emergency situations, but also maintain long-term interest and engagement with patients. You need to work well with members of the multi-disciplinary team, and medical colleagues from many other specialties.


Is there any advice you could give to a fi nal year or FY trainee considering renal medicine?


Do it! The specialty off ers the opportunity to develop skills in the management of both acute, life- threatening emergencies and chronic disease. There are unrivalled opportunities for research and working abroad – which might involve epidemiological studies, the unravelling of complex ethical issues, cutting edge clinical and basic science or disaster response. There’s never a dull moment.


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