Renal medicine is an exciting specialty offering the challenge of looking after both acutely ill patients and those with a chronic disease requiring long term care with the help of a multidisciplinary team. The majority of trainee renal physicians receive training as specialist registrars in both Renal and General Internal Medicine, although consultant renal physicians in tertiary centres generally do not undertake acute general medical duties. General medical problems in patients on renal replacement therapy (transplant or dialysis patients) who are admitted are generally managed by nephrologists. Nephrology works closely with many other medical specialities which reflects the breadth and diversity of medical problems that renal patients have. From working alongside anaesthetists managing the sickest patients in the hospitals, to immunologists discussing intricacies of mismatches for transplant patients, to rheumatologists balancing immunosuppressant therapy in systemic vasculitis. The diversity of the clinical work is what most trainees enjoy.
All renal physicians take charge for patients with end stage renal failure requiring long term renal replacement therapy either by dialysis or transplantation. This gives nephrologists the opportunity to get to know patients extremely well whilst offering a specialised and unique services. Severe ‘single-organ acute kidney injury/AKI’ should be managed by renal medics and we aim to get these patients promptly to the ward to assess, diagnose and treat efficiently. Often these patients require dialysis acute via temporary vascaths. If the diagnosis of the AKI is not immediate apparent or we suspect glomerular pathology then a renal biopsy is performed by the renal registrars. Both these core procedures you will receive training in by senior registrars and consultants. AKI is also a common component to general medical admissions and it generates a frequent request for a renal referral which the renal registrars undertake under the supervision and support of the duty consultant.
Renal transplantation is performed in tertiary centres with most patients continuing long term follow up, by nephrologists from their referring hospital. Throughout your training you will spend a minimum of six months as the medical transplant registrar working alongside surgical colleagues on the acute transplant ward. You generally will have a minimum of 2.5 years at Oxford doing exclusive renal medicine with the other 2yrs spent in Reading or Oxford doing renal and acute general medicine. Over your clinical years there are many opportunities for research either laboratory based (underlying mechanisms of renal disease, immunology of transplantation); clinical based (examining effects of treatment on various renal conditions), or epidemiological (looking at incidence of various renal diseases in different populations which impact on the planning and delivery of renal services). The opportunity to undertake research is a strength of Oxford deanery and TPDs support and encourage out of programme time for this.