Dr Allyson Egan, President of the Nephrology Section at the Royal Society of Medicine, is a Consultant Nephrologist and Physician at Trinity Health Kidney Centre, Tallaght University Hospital, Dublin. Dr Egan’s specialist interests include autoimmunity and education.
The identification of patients with renal disease has become a major issue. Why is this?
There are over 850 million people worldwide with renal disease and the number is rising. The kidneys are amongst the core organs affected by many of the prevalent systemic diseases, with diabetes, hypertension and immune diseases all having a huge impact on kidney health and function.
For people to be aware of and understand how their kidneys work is the starting point and there are several global initiatives underway. Education is a primary priority. Indeed, part of the ethos of the RSM Nephrology Section is to get the conversation started about kidneys by raising awareness of renal disease through undergraduate and postgraduate education.
We encourage everyone with an interest in nephrology to join our events. They may not necessarily be planning to become nephrologists and may go on to become rheumatologists or cardiologists for instance, but those early connections and integrated learning will be important for their career professional development and high standards in patient care.
What does integrated care look like from a nephrologist’s perspective?
Integrated care is fundamental to how we look after our patients because renal disease is very much a multi-systemic disease for patients and how they experience it. How we integrate care and provide nephrology services are pivotal to shared experience and best outcomes.
It is a patient-centred approach, with patients knowing all members of the team looking after them, in hospital and back in their community after they leave hospital. We are one team, with doctors, specialist nurses, physiotherapists, pharmacists, social workers, psychologists, and dieticians all in clinical practice together and united in learning together.
We are looking at a collaborative and continuous service model where decision-making is close to the community we serve. Integrated care builds on existing successful local structures and, when patients visit hospital, allows a seamless transition between the multidisciplinary team, as patients go to the various focal points for their treatment.
What is the educational focus for the RSM Nephrology Section?
In nephrology we have a very large range of patients with different health care needs, depending upon their kidney function, including kidney transplantation, dialysis, acute and chronic kidney disease. Consequently, the education programme covers a very broad range of topics. For example, our advances in renal genetics programme last December provided a comprehensive update on the clinical management of genetic and inherited kidney diseases, such as cystic and basement membrane disorders, podocytopathies and tubulopathies.
We collaborate with various renal charities and run a series of events biannually, such as the two-day conference on glomerulonephritis (inflammation of the kidneys) which is coming up in September 2023. Together with the Kidney Research UK Glomerulonephritis Clinical Study Group we will be bringing together scientists, clinicians, and trialists from around the UK showcasing updates on research, novel advances, targeted therapies, and experimental medicine, all of which will generate exciting conversations that will help address future therapeutic and service needs for patients.
A highlight of the Nephrology Section’s year is the annual Presidents Prize Day. Running for more than a decade, the vibrant action-packed programmes showcase undergraduate and postgraduate clinical and basic science research, highlighting innovation, education and newer strategies for tackling unmet needs in the field of nephrology.
We have a global following for our nephrology meetings at the RSM, which grew significantly during the pandemic. To make our programmes accessible to our international audiences many of our events are run in hybrid formats, both in-person and online. We’re also hoping to introduce a series of evening webinars, aligned with our in-person full day meetings, which will focus on hot topics in nephrology.
How do you see nephrology developing in the future? Are there potential advances in treatment and care that are going to make big differences to patients?
A major area of expansion for nephrology is home therapy. We are teaching patients how to undertake renal replacement therapy at home, with both haemodialysis and peritoneal dialysis treatment options possible in the home setting. It’s wonderful for patients to be in their own environment, with the autonomy to look after their own care, empowered by the support of their carers and peer networks.
There’s also a big focus on preventative medicine – identifying renal disease early and preventing it from progressing. For example, the SGLT2 inhibitor class of drugs to control sugar metabolism in diabetes has been found to be protective in renal and cardiac disease. The data is exciting, indicating that we can potentially minimise the development of kidney disease. Education and clinical trials in this particular area are being run by different specialties, with cardiologists, nephrologists and endocrinologists all connecting with each other. It’s another great example of the integrated approach, this time with preventative medicine.
What are the current hot topics for nephrologists and their patients?
One of the important areas, which was looked at recently during a Nephrology Section meeting at the RSM, is data science and the influence of big data sets on renal disease. Our understanding of real-world data, clinical trials, registries and large data sets is a research array that we’ve learnt so much from.
The flexibility to be able to move quickly in a connected framework and to put research findings into registry-style data demonstrated during the pandemic how data can guide clinical practice when we need it most. Through data science, we’ve seen fundamental advances that will influence clinical research and patient care in the future.
What is it about nephrology that makes it of interest to the wider RSM community?
Understanding the anatomy, physiology and immunology of renal medicine is central to appreciating the role of kidneys in health and disease. Our multidisciplinary audiences relish the different educational formats we offer in our meetings, from lectures and case-based learning, to panel discussions and debates. I would encourage anyone who is interested in learning about kidney health and disease, along with management strategies, to join an RSM Nephrology Section event and experience the spirit of the RSM in action.