Interviewee: Chen Min,
Professor and Deputy Director of Peking University Institute of Nephrology
Reporter: Zhang Fang
A six-story building inside the emergency campus of Peking University First Hospital(PUFH) is the Peking University Institute of Nephrology, the cradle of lots of great achievements in Nephrology. The Renal Division(Peking University Institute of Nephrology) is the first division to establish Nephrology major and doctoral program of Nephrology in China. Relied on its excellent disciplinary level, it has been ranked first in the list of China's Best Nephrology Specialty by the Hospital Management Institute of Fudan University for consecutive 11 years between 2010 and 2020.
The accurate diagnosis of a difficult case
Mr. Cao, who had been repeatedly tortured by his illness for nearly half a year, came to PUFH with a glimmer of hope. About six months ago, he presented with hyperpyrexia, chills, nausea and expectoration without obvious inducement, then he was confirmed with pneumonia by the local community hospital, after giving treatment, his hyperpyrexia was relieved, but then he presented with new symptoms like dark urine, reduced urine output, rash on both calves, obvious edema of lower limbs and face. And the tests result from the Renal Division indicated that Mr. Cao had hematuria, proteinuria, renal dysfunction, significantly elevated inflammatory indicators as well as cryoglobulinemia and hypocomplementemia. 10 days later, Mr. Cao had recurrent fever, chills and apathy, unable to communicate. The test revealed a further increase in his SCR to 292.4 mole/L and further aggravation of inflammatory markers. Therefore, the medical team reviewed his history and learned that Mr. Cao was diagnosed with intracranial hemangioblastoma and received a craniotomy in 2008. Due to the relapse of intracranial hemangioblastoma, he received a second craniotomy, but then he had postoperative hydrocephalus and received ventriculoatrial shunt. Based on the pathogenetic characteristics and his reaction to previous treatment, the team first suspected infection was the source. Knowing his history of ventriculoatrial shunt, the team believed that it was the postoperative infection of ventricular shunts causing the shunt nephritis with systemic symptoms. After hospitalization, the medical team completed his blood and CSF culture and microbiome metagenomics sequencing, whose results indicated that the patient was positive for staphylococcus in the above body fluids. And the treatment outcome proved the diagnosis right. With efforts from multiple disciplines, the patient who suffered from ventricular shunt infection and shunt nephritis eventually survived. Prof. Chen Min concludes that the treatment outcome depends on the accurate diagnosis, which is one of the strengths of the Renal Division.
Vision of the Renal Division: to overcome difficult cases and enrich talent pools
Kidney biopsy has long been the method to get accurate pathogenic diagnosis, but the Division has made continuous innovations and breakthroughs in diagnosis methods. Take primary small vasculitis as an example, it used to be almost unknown in China and could lead to severe symptoms such as pneumorrhagia and kidney failure, with a mortality rate of up to 80% to 90% within a year. In 1996, Prof. Zhao Minghui, current Director of Peking University Institute of Nephrology, established the standardized test method for anti-neutrophil cytoplasmic antibody (ANCA), the serologic marker for primary small vasculitis. And the method benefited lots of patients and gradually improved the 5-year survival rates to 90%. Meanwhile, the Division also establishes treatment methods or systems for difficult cases such as acute kidney injury, thrombotic microangiopathy, anti-glomerular basement membrane disease, etc.
Ranking top 1 in the list of China's Best Nephrology Specialty for decade
The Renal Division of PUFH is the first Chinese Nephrology Division established in the 1950s by Prof. Wang Shuxian, the founder of Chinese Nephrology. Over the past 70 years, the Division has witnessed the contributions of every leader, Prof. Wang Shuxian, Prof. Wang Haiyan and Prof. Zhao Minghui, and each of them was committed to the principle of integrating clinical development and scientific research. Through their efforts, a strong and excellent team was made.
Prof. Chen Min points out that from the beginning of the establishment, the leaders have been well aware of the importance of paying equal attention to clinical work and scientific research. In the 1980s, under the leadership of Prof. Wang Haiyan, the Division established a biospecimen bank to reserve kidney tissue, blood, urine and DNA from patients with renal biopsy, providing a database for future scientific research. Moreover, all the patients treated by the Division would receive lifelong medical follow-ups. It also sets up a follow-up green channel for senior patients, which greatly facilitates patients, but also helps collect data and specimens from follow-up studies. All the acts fully demonstrate the clinical mindset of the Division.
Another strength of the Division lies in talent cultivation. Prof. Chen Min adds that it attaches great importance to the cultivation of young doctors, it first classifies the strength of each doctor, then combines the division needs of the medical team to cultivate talents in specialized fields. Moreover, it will select excellence to further study overseas to ensure enough reserves in all professional directions. The Division owns a deep talent pool in all aspects, namely one leading expert of the National “Ten Thousands Talent Program”, two Changjiang distinguished professors, six winners of the National Science Fund For Outstanding Young Scholars and four winners of the National Science Fund for Excellent Young Scholars, gathering almost half of the Nephrology excellency in China. The Renal Division, PUFH, is widely considered as the leading institute of Nephrology in China, which its strong talent pool may account for.
The number of patients with kidney disease exceeds 100 million
In the past, the public’s understanding of kidney diseases was obviously insufficient, surprisingly they knew about some rare diseases but lacked an understanding of common diseases. But the condition has changed over decades, and these changes are mainly reflected in the following two aspects, said Prof. Chen Min.
First, increased number of patients and a low awareness rate. According to the National epidemiological survey from PUFH, the prevalence rate of chronic kidney diseases is 10.8%, but the awareness rate is 12.5% and the response rate is so low that almost one-third of patients have advanced to an irreversible stage of renal impairment by the time they first saw the doctor.
Second, the spectrum of diseases has changed markedly. Due to poor sanitary conditions, infection-related nephritis was the main cause of patients with nephropathy in the past. After the improvement of sanitary conditions, unhealthy lifestyle has gradually become the most important pathogenic factor, and the prevalence of metabolic nephropathy, especially diabetic nephropathy, has increased rapidly and has also become the primary cause of chronic kidney disease. Besides, the rise of industrialization has led to pollution-related kidney diseases like membranous nephropathy. In order to curb the prevalence of kidney diseases, people should improve their lifestyle, stop abusing nutrition supplements and drugs, control blood pressure, blood sugar and uric acid and other indicators, and have periodic medical examinations. If indicators such as urine tests and renal function are found abnormal, people should go to the Nephrologist in time.
Prof. Chen Min believes that no matter how the spectrum of kidney diseases changes, the main task of a Nephrologist is always to find an innovative and effective treatment method by combining clinical work and scientific research. The utmost aim of scientific research is to resolve practical problems in clinical work, which is also one of the most important responsibilities of a Nephrologist.