La formación de especialistas médicos: el caso de los nefrólogos / Medical specialists training: the case of nephrologists

Specialists must be trained in properly certified university centers. There are established applicant selection programs and mechanisms and faculties maintain a favorable learning environment. The careful selection of teachers must be based in their personal attributes, their interest and dedication to academic work and their real concern about ethical issues. The center's technologal equipment, as a mean to favor the action of future specialists, is considered important. Several critical aspects of the training centers that, at the present time threaten post graduate training, are mentioned. The teaching activities of scientific societies and private and public helath organisms should concentrate around training centers to reinforce their academic work, favoring their scientific and practicing activities. The interest of faculties and Ministry of Health medical centers should be made compatible for their own benefit. Medical specialties are closely interrelated. Therefore, the boundaries of nephrology should be stablished to define a training program. A common environment for pediatric and adult nephrology should be created, training centers should be accredited and specialists should be certified using common criteria. Our country has a deficit of nephrologists and scientific societies should encourage cooperative actions between the different training centers

Nefropatía por IgA (enfermedad de Berger): experiencia en 78 casos / Ig-A nephropathy

We studied 78 patients with a diagnosis of IgA nephropathy. Renal biopsy was indicated in 69 patients by the presence of macroscopic hematuria (52%), microhematuria or renal failure (14%) or hephritic syndrome (1%). Nine were healthy subjects being studied as live kidney donors. An association with IgG and/or IgM was present in 92% of patients. Serum IgA was elevated in 36% of patients. Hypertension was present in 30% and decreased renal function in 29%. Patients with serum creatinine above 1,5 mg/dl tended to be older (33.8 vs 28.7 years) and to have hypertension (52% vs 19%). among 25 pátients followed for more than 12 months renal function remained stable in 44%, deteriorated in 20% and 36% developed renal failure. the latter was associated to older age, hypertension, abscense of macroscopic hematuria and nephrotic syndrome. The 9 live donors had no clinical manifestations of renal disease. Thus, IgA nephropathy is a highly variable clinical manifestations and its prognosis. An asymptomatic course is demonstrated in some subjects