Topic Discussion: Need for training in Kidney biopsies

Kidney biopsies are an integral part of Nephrology. In the last decade, nephrologists are slowly shying away from performing this procedure. Both in academia and private practice, the procedure is being slowly and surely diverted to dedicated hands of interventional radiology. In certain centers, the nephrologists still perform and teach fellows on doing this important procedure. Recently, 4 opinion articles in CJASN discuss the pros and cons on continuing to teach the kidney biopsy procedure to our fellows.

Bob Brown discusses a balanced form of approach. While the arguments for doing the kidney biopsy are obvious , the counterarguments that kidney biopsy performance should no longer be a requirement for nephrology certification are that about 65% of practicing nephrologists do not perform biopsies  and the standards for evaluating biopsy competency of graduating fellows are not defined despite the risk of the procedure. In United States nephrology training program directors survey, 45%–51% thought that biopsy competency should not be required for fellowship completion.

Stuart Shankland takes the con approach and discusses the reasons not to require fellows to be doing catheters and kidney biopsies. He takes a patient centered and safety approach.  Having the radiologists who do this on a daily basis perform the procedure provides a more safer environment than the nephrologists doing it.

Jeff Berns takes the pro approach and discusses the reasons that require the fellows to be doing catheters and kidney biopsies.

Suzanne Norby gives a program director’s perspective and provide a framework for the need for fellowship training.

Personally, I feel conflicted. As a fellow, I learnt doing kidney biopsies and enjoyed doing them. Since I am in teaching institution and part of a fellowship program,  I feel that teaching the fellows kidney biopsies is important and I make time for doing kidney biopsies and teaching fellows. If I was in community private practice, I doubt I would have done the same.  While it is a great asset to have, the time commitment is enormous from booking the room, getting supplies and setting up the table and so forth.  Divisions that have their own interventional nephrology suites or biopsy suites might have it easier and faster to perform these biopsies. A twitter conversation that started this discussion is very interesting to see. It adds to the 4 articles that were published in CJASN.  

Four editorials on "should renal fellows be doing kidney biopsies" @CJASN in the recent articles https://t.co/azsjqOkl1u Check it out!! Where do you stand on this? Should kidney biopsy procedural training be required during renal fellowship?

— Kenar Jhaveri (@kdjhaveri) June 16, 2018

Second set of tweets start a more interesting discussion

Interesting editorials on Pros/Cons of dialysis catheter and kidney biopsy requirements in Nephrology training @CJASN

🛑@StuartShankland https://t.co/sgxUUJwj12

✅@Jeff_Berns_POTD https://t.co/VIhQCkoPWi

— Matt Sparks (@Nephro_Sparks) June 15, 2018

I am impressed and congratulate CJASN on this amazing venture on such articles that really bring the tough questions to the table for nephrology. First set of tweets are an unofficial poll that was stated on this topic.