Challenges in interventional nephrology.

Lately, there has been a progressive decrease in the interest of nephrology as a medical sub-specialty reflected primarily in the decreasing number of renal fellows. Rising costs in establishing and running dialysis clinics and the lost of nephrologic procedures previously performed by nephrologists are among the many reasons for this disillusionment with the specialty. The care of chronic kidney patients frequently involve many diagnostic and interventional radiological procedures such as: diagnostic renal ultrasonography, ultrasound-guided kidney biopsies, placement of tunneled hemodialysis catheters or peritoneal catheters, sonographic and radiological investigation of vascular access dysfunction, etc. Most of these procedures are nowadays performed by radiologists, vascular surgeons and surgeons in general. This fragmentation does not optimize medical care and it is inconvenient to the patient. This has led many nephrologists to introduce a new paradigm in kidney patients management, often referred as interventional nephrology (IN). This new breed of nephrologists have acquired diagnostic and interventional skills for procedures usually done by others with an added clinical perspective. To train nephrologists in these procedures and avoid the fragmented care of renal patients, the American Society for Diagnostic and Interventional Nephrology was established in 2000 and the International Society of Nephrology in 2004 introduced a new committee to address the issues of IN. It is hoped that concerted efforts will help to rescue these activities for the nephrologists and improve quality of patient care.