Nephrology

2016-11-14

Introduction

The Nephrology Department of Zhongshan Hospital affiliated to Fudan University was one of the main founders of China’s blood purification technology. It is a key discipline of the Ministry of Education, and the ancillary institution of Shanghai Institute of Kidney and Dialysis and Shanghai Key Laboratory of Renal Diseases and Dialysis, as well as an important medicine, research, education and training base of kidney diseases in China. It consists of nephrology wards, blood purification center, nephrology outpatient clinic and kidney disease laboratory. The department was the first in China to carry out procedures such as hemodialysis and allograft renal transplantation etc.. With the great strength in clinical treatment and research of blood purification, acute renal injury and other critical illnesses, the department takes the lead in its field domestically with certain international influence.  

The department has a glorious history with honorable traditions. In 1973, Kidney Disease and Dialysis Unit under the General Internal Medicine was founded. In the same year, the unit successfully developed the first standard plate-type dialysis machine in China. In 1982, the Unit became the independent Department of Nephrology. The department is a significant clinical and research ground for renal internal medicine and blood purification in China, playing a leading role in the country in both overall medical practice and scientific research. The following are the milestones of the department:

  • In 1973, the department participated in the development of China’s first plate-type dialysis machine, and carried out China’s first dialysis treatment.
  • In 1975, the department successfully performed China’s first cadaver donor renal transplantation.
  • The department was the first in Shanghai or in China to carry out the following new diagnostic and treatment techniques: the first peritoneal dialysis in Shanghai (1966), the first to treat uremia with dialysis in China (1973), blood perfusion (1979), treating acute renal failure with  continuous renal replacement therapy (CRRT) (1985), improved CRRT (Daytime CRRT in 1994; high-volume replacement therapy in 1999; prolonged daily replacement therapy in 2000), Citrate Anticoagulation Dialysis (1995), Double-filtration Plasma Exchange (1999), MARS Artificial Liver Therapy (2001), Protein A Immunoadsorption (2003), Blood Purification with Combined ECMO and CRRT (2008) in China. At present, most of the above-mentioned techniques have been popularized in China, which play an important role in routine and rescue treatments of kidney diseases and special non-renal diseases, generating great social and economic benefits.
  • In 1979, the department began kidney needle biopsy.
  • In 1983, we first reported non-oliguric acute renal failure and rapidly progressive glomerulonephritis in China, and put forward key points of diagnosis and treatment.
  • In 2002, the department was approved by the State Commission of Education as a national key discipline.
  • In 2011, the department was approved by the Ministry of Science and Technology as a Major New Pharmaceuticals Evaluation Platform for Cardiovascular and Kidney Diseases.
  • In 2012, the department was included as a key clinical specialty of the Ministry of Health.
  • In 2014, Shanghai Institute of Renal Disease and Dialysis and Shanghai Key Laboratory of Renal Disease and Blood Purification were founded.
  • In 2015, the department became an ancillary institution of Shanghai Dialysis Quality Control Center. 

Medical Practice

Under the leadership of Director Ding Xiaoqiang, the department has 35 full-time physicians, including 3 with senior professional title, 7 with secondary senior professional title, 15 with intermediate professional title, 6 with primary professional title, 7 laboratory technicians and 3 hemodialysis engineers. Among them, one physician is an executive council member of the International Society for Hemodialysis (ISHD), one is a young committee member of the Chinese Society of Nephrology, one vice president of Chinese Nephrologist Association, one committee member of Kidney and Blood Purification Expert Committee of China Medical Women’s Association, one former director, three committee members and one young committee member of Shanghai Society of Nephrology, one group leader of Blood Purification Group and one member of Renal Pathology Group of Shanghai Society of Nephrology.  

As an important kidney disease medical center in China, the department undertakes a lot of treatments and consultations for patients with intractable and critical diseases. Every year, the outpatient service receives over 140,000 patients while the expert outpatient service about 50,000. The department has 59 beds in total, which receive over 2,550 inpatients per year. Specialty outpatient clinic open all day from Monday to Saturday. We also offer attending physicians’ Follow-up Clinic and Specialized Disease Clinic for patients with conditions and needs such as diabetic nephropathy, hypertensive nephropathy, urinary tract infection, outpatient peritoneal dialysis, uremia, hyperuricemia, uric acid nephropathy, renal biopsy follow-up, lupus nephritis, edema, and renal diet, etc. as well as 30 half-day Expert Clinic and one half-day Government Officials Health Clinic per week.

The Blood Purification Center has an 1800-square-meter dialysis room with 96 advanced blood purification machines, which makes our center one of the largest blood purification centers with the most comprehensive techniques in China. We deliver isolated ultrafiltration, plasma exchange,blood perfusion, CRRT, molecular adsorbent recirculation, etc., which are not only utilized in the treatment of critical kidney diseases, but also in the emergent rescue treatment of poisoning, various autoimmunity diseases, adult respiratory distress syndrome,septicemia, severe hepatitis and multiple organ failure. At present, we receive over 500 routine maintenance dialysis patients, and deliver about 80,000 dialysis, 20,000 hemofiltration and 3,000 CRRT cases every year. The long-term survival rate of the maintenance dialysis patients has reached international advanced level. Meanwhile, we provide short-time dialysis to a large number of patients from Shanghai and from all over the country with intractable or critical end-stage kidney diseases. The peritoneal dialysis group is one of the first peritoneal dialysis model training bases authorized by the Ministry of Health, which has peritoneal dialysis wards and well-equipped outpatient clinic, delivering different types of peritoneal dialysis treatment, with over 500 maintenance peritoneal dialysis patients.                   

Teaching Achievements

The department cultivated China’s first group of clinical doctors of nephrology. So far, 53 doctors, 89 masters and 3 post-docs have graduated from here. We receive a great number of visiting physicians from Shanghai and over 30 provinces around the country for further training, and have trained over 100 physicians to date. The department has participated in the compiling of Internal Medicine, an important textbook (national planned textbook for 7/8-year students, 2002, 2006, and 2010), Medical Encyclopedia of China (responsible for the chapter Dialysis, 1982), Pharmacopoeia of People’s Republic of China: Part 2 (Clinical Guide for Pharmaceuticals, the First and the Second Edition; Diuretics and Water, Electrolyte and Acid-base Balance Drugs). Prof. Liao Lvtan was the deputy editor of Practice of Internal Medicine 11-13thedition, and Prof. Ding Xiaoqiang was the deputy editor of the 14thand 15thedition of the book.       

Other Achievements 

Since 1985, thedepartment has held 22 national academic conferences and continuing education programs concerning blood purification and kidney diseases with over 6,000 participants. We have also been the co-host with ISHD for International Hemodialysis Conference every year since 2013, greatly promoting the development of China’s hemodialysis. The department has presided over 14 major or key national and Shanghai regional projects, 16 national multicenter clinical studies. The results of some of the studies were published in the top nephrology journals, playing an important role in the popularization and improvement of China’s kidney disease prevention and treatment. Thedepartment has presided over or participated in major healthcare health projects. Moreover, we have drafted or participated in the formulation of several guidelines and specifications in China, including three books compiled by the Ministry of Health: Standard Operation Guidelines for Blood Purification (deputy editors, Standard Operation Guidelines for Hemodialysis (drafter),and  Clinical Pathway for Acute Renal Injury (drafter); Clinical Pathway for Maintenance Dialysis (drafter), Clinical Skills and Procedure Guidelines: Nephrology Chapter (People’s Military Medical Press, 2009) compiled by Chinese Medical Association (deputy editors and final draft editor), Expert Consensus on the Application of Glucocorticoid in Kidney Disease (2008 & 2010 editions) compiled by Chinese Society of Nephrology (drafter), and Diagnosis and Treatment Guidelines for Renal Diseases compiled by Shanghai Bureau of Health and Shanghai Medical Association (chief editor). In addition, the department has offered professional consultation on some important decisions of both Shanghai municipal and national health administrations, thereby playing an active role in the major medical and academic developments of Shanghai and China.