My Journey to Nephrology

  • 1 Silvi Shah, MD, is currently a transplant nephrology fellow at the University of Alabama at Birmingham. She will join the University of Cincinnati as Assistant Professor of Clinical Medicine in the Division of Nephrology in July 2016.
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My grandmother’s struggle with chronic kidney disease (CKD) motivated me to consider, and ultimately choose, medicine as a career. During medical school, I had the opportunity to work with a nephrologist and attend renal clinics with him. I was intrigued by the complexity of patients with kidney disease and felt pulled toward a career in internal medicine and nephrology, which brought me to the University at Buffalo for my internal medicine residency.

My decision to become a nephrologist was reinforced throughout my residency. During my nephrology elective, I liked the fact that it was both challenging and comprehensive. I felt that nephrologists were among the smartest physicians; they inspired me. The teachings of a stepwise approach to diagnose hyponatremia and the physiology of diuretics have been helpful to me to this day. And my research on the prevalence of clinical inertia in the management of cardiovascular risk factors in renal transplant clinic made me aware of the challenges faced by kidney transplant patients.

As a third year medical resident, I attended my first ASN meeting as part of the ASN Kidney STARS program. I was overwhelmed and thrilled to see eminent people from around the world all in one place. I attended clinical lectures and research sessions, which exposed me to career paths available to trainees.

My first poster presentation at Kidney Week 2012 in San Diego allowed me to showcase my research in front of distinguished people in an international forum. ASN meetings have given me a platform to present my research and interact with nephrologists from all around the world, further strengthening my decision to pursue nephrology as a career.

I went to Cleveland Clinic for my general nephrology fellowship. While there, I was excited to see my first case of ANCA vasculitis and my first case of Von Hippel Lindau syndrome. It was fascinating to find out how a simple test like urine microscopy could help determine the cause of kidney dysfunction. Late evenings, I sat at my desk trying to figure out the etiology of metabolic acidosis in a patient with symptoms of dry eyes, and was thrilled to find out that Sjogren’s syndrome was the cause. I felt an adrenaline rush during my first call when I started a patient on continuous dialysis following cardiac arrest. I liked the grueling discussion during rounds about the utility of statins in preventing contrast-induced nephropathy. Nephrology consults involved a lot of critical thinking, problem solving, and an eye for detail. The complexity and diversity of cases I saw, including acute kidney injury, glomerulonephritis, electrolyte abnormalities, kidney stones, CKD, end stage renal disease, and kidney transplant made my fellowship a very enriching experience.

I was always drawn to the field of kidney transplantation. A close friend of mine donated a kidney to his father and soon afterward lost his solitary kidney to antibiotic-induced acute interstitial nephritis. He ended up getting his own kidney transplant. I saw his journey from shock to acceptance, and finally to happiness. I researched outcomes in living kidney donors and the impact of histological abnormalities in time-zero biopsies on graft outcomes in renal transplant recipients. The American Society of Transplantation gave me the opportunity to present my work at its national meeting and doing so helped me decide the next phase of my career—my transplant nephrology fellowship at the University of Alabama at Birmingham. During this time, I also became interested in the use of social media for promoting education in nephrology and became part of the nephrology social media internship. In addition to all the learning I received from participating in NephMadness and online biweekly nephrology journal clubs, I had the opportunity to interact with this dynamic group of innovative educators.

At the end of the day, the gratification I receive from my patients is what I find most rewarding from my choice of nephrology as a career. With six years of training behind me, I have decided to join academic medicine to enable me to practice clinical medicine, do research, and teach. I see myself evolving as a clinical investigator.

Nephrology is at an important crossroads currently with the increasing global burden of kidney disease and fewer people choosing it as a career. Nephrology continues to be one of the most diverse fields in internal medicine, encompassing the excitement of electrolyte disorders, physiology of dialysis, and immunology of glomerulonephritis. The practice of nephrology ranges from care of the sickest patient in the intensive care unit to the healthiest kidney transplant patient. There is the opportunity to do an additional year of transplant nephrology, interventional nephrology, palliative care nephrology, or critical care medicine (among others). Like any other fellowship, nephrology is tough but is very rewarding intellectually and professionally. Academics, private practice, and administration are among the possible career paths following fellowship. I would recommend that all students and residents follow their passion, which I believe is imperative to stay happy and content. It is important to stay motivated, identify your goals early, and reach out to mentors to help you achieve those goals.

As I look back, training to be a nephrologist has been a long journey. I can see my transition and growth from a naïve medical student to a confused intern to an excited resident and finally to a knowledgeable fellow. I have learned a lot at each phase of my career and am grateful for the fantastic training and the excellent mentorship I have received. Training in three different reputable institutions, interacting with my mentors, and attending national conferences exposed me to the diversity of the kidney field and helped me identify my goals. I eagerly look forward to my next transition and to furthering my ability to contribute to the nephrology profession in a meaningful way.