Considering paediatric nephrology as a career, but unsure what working in the field is like? Paediatric nephrology is a diverse specialty with many avenues to pursue. Several paediatric nephrologists across Canada contributed a short profile describing their own path and their day-to-day work.
These profiles were written in 2014. Positions, institutions and programmes have changed since, and some contributors have moved or retired. They are kept here because the career paths they describe are still the point. To reach any of the contributors, email contact@capneph.ca.
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Allison A. Eddy, MD, FRCPC
Professor and Head, Department of Pediatrics, University of British Columbia, Vancouver
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Dr. Eddy is a graduate of McMaster University Medical School. After completing a paediatric residency at Montreal Children’s Hospital, McGill University, and a fellowship in paediatric nephrology at the University of Minnesota in Minneapolis, she joined the faculty at the University of Toronto and was a nephrologist at SickKids for 12 years. In 1997 she was recruited to Seattle as Professor of Pediatrics at the University of Washington and Head of the Division of Pediatric Nephrology at Seattle Children’s Hospital. During her tenure the division grew from 4 to 11 paediatric nephrologists and was ranked the second paediatric nephrology program in the country by US News and World Report. Her clinical practice spans the scope of paediatric nephrology, with a particular interest in immune-mediated glomerular and interstitial diseases. She was named one of Seattle’s Best Doctors.
Dr. Eddy has a long-standing interest in training nephrology subspecialty residents and fellows. She has directed paediatric nephrology fellowship programs for over 20 years, overseeing the training of more than 60 fellows. In Seattle she was principal investigator of an NIH-funded research training grant in paediatric nephrology and program director of an NIH-funded Child Health Research Center.
She has been an independent basic science investigator since 1985 and is internationally recognised for her work on the cellular and molecular mechanisms of kidney fibrosis, the final common pathway leading to chronic and end-stage kidney disease. Her work has been funded by the Medical Research Council of Canada, the NIH and several research foundations. For 10 years she was project director for an NIH-funded Pediatric Center of Excellence in Nephrology with Vanderbilt University, and she was the first Director of the Tissue and Cell Sciences Research Center at Seattle Children’s Research Institute from 2007 to 2012. From 2001 to 2007 she was Deputy Editor of the Journal of the American Society of Nephrology, and she later served as an Associate Editor of Pediatric Nephrology. In 2009 she was elected to a six-year term on the Council of the International Society of Nephrology, where she is active in the fellowship program providing training opportunities for physicians from developing countries, work done in partnership with the International Society of Pediatric Nephrology. She has a longstanding interest in global health and published an epidemiological study on acute kidney injury in hospitalised children in Kampala, Uganda.
In 2012 Dr. Eddy returned to Canada as Professor and Head of the Department of Pediatrics at the University of British Columbia, where she makes time between administrative work to see nephrology patients, teach and take part in research.
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Colin White, MD, MMEd, FRCPC
Clinical Associate Professor, Department of Pediatrics, University of British Columbia, Vancouver
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I was in training long before GPS, and my wandering career path proves it. I chose to do a full four years of paediatrics training, then a year as a clinical assistant in NICU to assist with debt management, and followed that with what became the first three of an eventual six years of paediatric nephrology fellowship, in London and then Vancouver. During the later part of those fellowship years I also completed coursework in medical education to assist in the roles I took on in the undergraduate and eventually postgraduate curriculum. Eventually all this training led to a real job, starting here in Vancouver in July 2003.
Currently, as a Clinical Associate Professor in Pediatrics, my position would likely be classed as a clinician-educator. I spend about 40 per cent of my week on direct and indirect patient care, the dictations, lab follow-up and phone calls included, with my practice revolving around CKD and dialysis patients. Another 20 to 40 per cent of the week, depending on the academic calendar, goes to running the fellowship program and my involvement in the undergraduate medical school. I am also a national examiner for general paediatrics. The remaining 20 to 40 per cent is split between nephrology and education committees and research projects, mainly centred on dialysis.
If I had one piece of advice for career planning it would be never to believe someone who says you can’t get there from here. And if I had one piece of advice for career advancement it would be to always try to help people out if they need a favour. You never know when something you did off the side of your desk to help a colleague might come back as a chance to do something big and important a few months, or even years, later.
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Bethany Foster, MD, MSCE, FRCPC
Associate Professor, Department of Pediatrics, Montreal Children’s Hospital, Montreal
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I am a paediatric nephrologist and clinician-scientist at the Montreal Children’s Hospital and Associate Professor of Pediatrics at McGill University. I also have a master’s degree in epidemiology and am an associate member of the McGill Department of Epidemiology and Biostatistics. I spend about 75 per cent of my time on clinically oriented research and 25 per cent on clinical care, combined with resident and student teaching. I teach small groups of medical students both renal physiology and epidemiology, and have taught epidemiology courses at the graduate level.
My primary research interest is the long-term outcomes of children and young adults with kidney transplants. I do both patient-oriented and database research. My research team is small: one full-time research coordinator and two part-time statisticians, and I currently supervise one epidemiology master’s student. My research time is divided between leading conference calls for multi-centre studies, meeting with students and research personnel, and writing grants and manuscripts. I also hold a couple of leadership positions at our research institute.
I completed medical school at the University of Ottawa in 1994 and a paediatrics residency at McGill in 1998, including a year as chief resident. I did my paediatric nephrology training at McGill, finishing in 2001. After my clinical training I went to the University of Pennsylvania to do a master’s in clinical epidemiology and a research fellowship at the Children’s Hospital of Philadelphia. I completed the master’s in 2003 but was in Philadelphia for three years, from 2001 to 2004. During that period I did no clinical work at all, focusing exclusively on research. It was a great experience and I could easily have stayed another year or two. I returned to McGill in 2004, and in 2006 obtained a KRESCENT New Investigator Award, which provided further training and networking opportunities.
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Indra Gupta, MD, FRCPC
Associate Professor, Department of Pediatrics, Montreal Children’s Hospital, Montreal
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Indra R. Gupta is a clinician-scientist and paediatric nephrologist. She received her medical degree in Edmonton at the University of Alberta and completed her paediatric residency in Hamilton at McMaster University. During her residency she had the opportunity to work with Dr. Brian Steele, who first inspired her to consider paediatric nephrology as a subspecialty. She completed her paediatric nephrology training at the Hospital for Sick Children, University of Toronto. After her clinical fellowship she completed a further four years of postdoctoral research training at the University of Toronto with Dr. Karl Skorecki and Dr. Norman Rosenblum as supervisors.
Dr. Gupta’s research focuses on the gene defects that lead to congenital kidney and urinary tract malformations in children. Her laboratory explores three themes: a common congenital urinary tract defect, vesicoureteric reflux, and the associated reflux nephropathy, using mouse models and genetic characterisation of paediatric cohorts; the role of the Rho family of GTPases in heritable and non-heritable forms of nephrotic syndrome; and the role of the tight junction family of proteins, the claudins, during kidney development and in children with congenital renal malformations.
Dr. Gupta considers herself fortunate to have worked with an outstanding team of trainees and research personnel over the 15 years since she started her laboratory. Her research has been supported by the March of Dimes, the Kidney Foundation of Canada and the Canadian Institutes of Health Research. Her advice to future trainees: be curious and keep asking questions. It will take you far in research.
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Kristen Pedersen, MD, FRCPC
Associate Professor, Department of Pediatrics, Winnipeg Children’s Hospital, Winnipeg
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I’ve been a paediatric nephrologist for just over 10 years working in Winnipeg. I trained across Canada to get here: undergraduate BSc at McGill, medical school at the University of Calgary, paediatric residency at Memorial University of Newfoundland and then fellowship at SickKids in Toronto. A total of 13 years of postgraduate training, and a great experience living in so many places across Canada.
I moved to Winnipeg in October 2013 and joined a group of three paediatric nephrologists. With the addition of my position, the workload was divided into separate coverage for transplant, dialysis, inpatients and general nephrology outpatients. I was involved in opening our stand-alone paediatric haemodialysis unit and wrote all the initial protocols for the program. Since then we have moved from a group practice to individual physician clinics, and our group is now five.
My current job is multi-faceted. I am still director of the dialysis and CKD program and program director for paediatric nephrology. I am heavily involved in the paediatric residency training program; for a year I was assistant program director for paediatrics, and for six years I chaired the academic subcommittee, through which I developed and organised the academic half-day curriculum. I am the educational liaison for trainees rotating through paediatric nephrology, a Royal College examiner in nephrology, and was involved in creating a syllabus for nephrology training. Clinically I cover 26 weeks of dialysis and 16 weeks as inpatient consultant, a half-day general nephrology clinic each week, and share coverage of a renal rheumatology clinic.
My work here is very diverse and a great balance between clinical, administrative and educational interests.
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Rachel Pearl, MD, FRCPC
Community Clinical Paediatric Nephrologist, Department of Pediatrics, Osler Health Sciences Centre and the Hospital for Sick Children, Toronto
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I work a day and a half a week in my own nephrology clinic at Brampton Civic Hospital, out of the paediatric clinic. I work one day a week in the nephrology clinic at the Hospital for Sick Children doing stones, renal malformations or hypertension clinic. I do four 24-hour calls a month for the paediatric department at Brampton Civic, where we attend emergency consults, deliveries and any admitted NICU or paediatric patient who becomes more unwell. Eight weeks a year I am the patient care team doctor responsible for admitted patients in the NICU and paediatrics. I also have a general office where I see hospital follow-ups and some new consults, and I do primary care for babies born at less than 32 weeks.
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Susan Samuel, MD, MSc, FRCPC
Assistant Professor, Department of Pediatrics, Alberta Children’s Hospital, Calgary
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Dr. Susan M. Samuel is a clinician-scientist and paediatric nephrologist at the Alberta Children’s Hospital and an Assistant Professor in the Departments of Pediatrics and Community Health Sciences at the University of Calgary. She obtained her undergraduate medical training at the University of British Columbia, and completed a paediatrics residency and nephrology fellowship at SickKids in Toronto. She also obtained an MSc in clinical epidemiology from the University of Toronto and completed postdoctoral training in health services research at the University of Calgary. She was appointed a clinician-scientist in 2009 and is supported by salary awards from the Canadian Child Health Clinician Scientist Program and KRESCENT.
Her research goals are to improve care and outcomes for children with kidney disease and kidney failure. She leads the multi-centre Canadian Childhood Nephrotic Syndrome Project, a national initiative to improve care of children with nephrotic syndrome, and the Transition to Adult Care Working Group within Alberta Health Services, working to improve health services for youth with special health care needs moving to adult care. Her research is funded by the Canadian Institutes of Health Research and the Kidney Foundation of Canada.
She serves as Chair of the Paediatric Group of the Canadian Society of Transplantation and Chair of the Paediatrics Committee of the Canadian Kidney Knowledge Translation and Generation Network, and is an Associate Editor of the Canadian Journal of Kidney Health and Disease. She has received awards for research and community contributions, including the University of Calgary Petro Canada Community Innovator Award and Avenue Magazine’s Top 40 Under 40 in Calgary. She is a mother of two and volunteers for the Kidney Foundation, community church groups and international mission organisations.
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Norman D. Rosenblum, MD, FRCPC
Physician Scientist and Associate Dean, Physician Scientist Training, Hospital for Sick Children, Toronto
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I am a clinician-scientist trained in paediatric nephrology and developmental nephrology. I am particularly interested in the genetic and molecular mechanisms that control normal and disrupted mammalian renal development and clinical outcomes in affected humans. I have a major interest in the education and career development of clinician-scientists, at both an individual and a programmatic level.
My clinical work is concentrated in paediatric nephrology with a particular focus on renal malformations. I attend on the renal consultative service at the Hospital for Sick Children and provide consultative and continuity care to infants and children with renal malformations. I teach medical students, paediatric core residents and nephrology subspecialty residents in the context of my clinical activities.
The major focus of my research is the molecular and cellular mechanisms controlling renal development in humans and mice. As a Senior Scientist in the Program in Developmental and Stem Cell Biology at SickKids and a Canada Research Chair in Developmental Nephrology, my team and I investigate the functions of signalling pathways controlled by bone morphogenetic proteins, Sonic hedgehog and WNT proteins during normal kidney formation and in the pathogenesis of renal malformation.
My interest in the training and career development of clinician-scientists is currently expressed through my role as Associate Dean, Physician Scientist Training, in the Faculty of Medicine. I am also a member of the steering committee of the Pediatric Scientist Development Program and of the board of the EUREKA Institute for Translational Medicine.
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Verna Yiu, MD, FRCPC
Vice President and Chief Medical Officer, Alberta Health Services; Professor of Pediatrics, Stollery Children’s Hospital, Edmonton
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Dr. Verna Yiu is Vice President, Quality and Chief Medical Officer for Alberta Health Services, the only single provincial healthcare system in Canada and the largest employer in the country, providing 24/7 service with over 100,000 employees including more than 7,000 physicians. Before taking up this role in August 2012 she was Interim Dean of the Faculty of Medicine and Dentistry at the University of Alberta, preceded by senior positions in the dean’s office since 2000.
Dr. Yiu is an alumnus of the University of Alberta and Harvard University and is a Professor of Pediatrics in the Division of Pediatric Nephrology at the University of Alberta. Since returning to the university in 1994 as a paediatric nephrologist, she led the division for eight years as divisional director. Her leadership roles have spanned clinical programs and medical education reform, with 15 years of leadership in health administration across both the healthcare delivery system and the academic setting.
Her role at AHS is to help oversee the integration and coordination of a complex end-to-end health delivery model for the province, through five accountability functions: quality and healthcare improvement, strategic clinical networks, clinical informatics and information systems, medical affairs, and partnerships with academic institutions and other physician-led organisations. A key mandate places strong emphasis on engagement, leadership development and the relationship between medical staff and the health care system. Despite the schedule, Dr. Yiu remains clinically active with her colleagues at the Stollery Children’s Hospital in Edmonton.
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Vladimir Belostotsky, MD, PhD, FRCPC
Assistant Professor, Pediatrics, McMaster University, Hamilton
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Working at McMaster Children’s Hospital, one of the top paediatric academic health centres in Canada, is truly inspiring. We are a medium-sized paediatric nephrology unit staffed by three physicians, and together we serve a community of 2.3 million people. We provide a full range of nephrology services including peritoneal and acute and chronic haemodialysis. We maintain an excellent relationship with SickKids in Toronto, where kidney transplant surgery is performed and patients are usually transferred back to McMaster within two weeks for follow-up care. Physicians run individual clinics for general nephrology patients and share the care of CKD stage 3 to 5 patients in chronic and transplant clinic. This model allows for joint care and promotes team decision-making around complex issues. Side-by-side clinics with paediatric urology and joint weekly meetings with radiology and urology create opportunities for optimal management. Inspired by a culture that encourages special interest initiatives, last year I started a monthly clinic dedicated to children with nephrolithiasis.
McMaster is a world-renowned centre for medical education through problem-based learning, with ample opportunity to develop teaching skills, and our division is heavily involved in teaching medical students and paediatric residents. We work closely with St. Joseph’s Healthcare Hamilton, one of the largest adult nephrology units in Canada, to train their clinical fellows during paediatric nephrology rotations. Research is well supported by McMaster’s Department of Pediatrics and Hamilton Health Sciences. Within my first two years at McMaster I was awarded a $40,000 New Investigator Fund grant from HHS to study trace elements in CKD patients. The tenure and promotion process is well structured and actively supported by the department, which is particularly important for foreign-trained physicians like me.
Before developing an interest in paediatric nephrology and coming to McMaster, I started my career in Moscow, where I graduated from medical school and completed a PhD. I then went to the UK, where I finished residency and fellowship in general paediatrics and completed paediatric nephrology training at Royal Manchester Children’s Hospital and Great Ormond Street Hospital in London, before a locum fixed-term consultant post at Leeds Teaching Hospital. In July 2011 I came to Canada as an Assistant Professor in Pediatric Nephrology at McMaster University and a physician at McMaster Children’s Hospital.
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Manjula Gowrishankar, MBBS, FRCPC
Associate Professor, Pediatrics, University of Alberta, Edmonton
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I am an academic paediatric nephrologist at the University of Alberta with a special interest in medical education. Having completed training in paediatric nephrology, I undertook further training to understand fluid, electrolyte and acid-base disorders. This became my main area of focus for clinical practice and teaching in the early years of my career.
Realising that I wanted to be an educator and not just a teacher, I trained in medical education to enhance my knowledge and skills. This helped me develop new curricula complete with assessment tools. One example is the creation of a new paediatric nephrology training program at the University of Alberta.
My interest in education and training has expanded from postgraduate trainees to include physician colleagues in the Faculty of Medicine and Dentistry, through the roles of Director of Faculty Development for the Department of Pediatrics, member of the faculty development committee, and Director of the Mentorship Program.
As a clinician, my main focus is fluid, electrolyte and acid-base disorders, kidney disease associated with non-renal solid organ transplantation, and hypertension.
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Robin Erickson, MD, PhD, FRCPC
Clinical Assistant Professor, Pediatrics; Head, Paediatric Nephrology, University of Saskatchewan, Saskatoon
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I am a Clinical Assistant Professor of Pediatrics at the University of Saskatchewan and the job I have is unique in the country. Here’s how I got here. As an undergraduate at the University of Alberta I caught the research bug, and after a BSc (Honours) in physiology I went to the University of Michigan and did my PhD in the laboratory of Dr. Ormond MacDougald. It was a fantastic experience and I enjoyed being in the lab. But I realised at the end of it that I wanted to be involved with the clinical side of science too, so I returned north of the border to the University of Alberta for medical school. It was there that I had my first exposure to paediatric nephrology, with Dr. Manjula Gowrishankar as a small group preceptor, and I subsequently did a research project with her. I went on to my paediatrics residency at Alberta Children’s Hospital in Calgary fully intending to do paediatric nephrology, and nothing came close to convincing me otherwise. I then did my paediatric nephrology fellowship in Winnipeg at the University of Manitoba, where I had the privilege of working with a great group of paediatric nephrologists who taught me well clinically and were also excellent examples of how to work with one another and with the many allied health professionals in nephrology.
That brings me to Saskatoon. When I finished my fellowship there were a number of opportunities in Canada, but the one in Saskatoon intrigued me. At that time there was only locum paediatric nephrology coverage and they were interested in establishing a full-time program. I saw this as a chance to use all the skills I had developed, and a great challenge. For the past three years I have been the sole paediatric nephrologist at the University of Saskatchewan, with the opportunity to define the provincial paediatric nephrology program from the ground up. A large amount of my time is spent on administration: I am the division head, and I also serve on the Department of Pediatrics Executive Committee, the Saskatoon Health Region Pediatrics Operations Committee, and as Medical Director of the Pediatric Outpatient Department. I am a member of the provincial CKD Steering Committee and the provincial Dialysis Working Group, and have become very involved in the planning and design of the new Children’s Hospital of Saskatchewan. Being at the table with all of these groups has allowed me to advocate for the care of paediatric nephrology patients in Saskatchewan.
I now have a provincial paediatric nephrology inpatient and outpatient consult service with nursing and dietician support for general nephrology and CKD patients. I collaborate with my PICU colleagues to run a CRRT program and tag team with neighbouring centres in Winnipeg, Edmonton and Calgary to provide post-transplant care for children from Saskatchewan. I teach in the medical school in the renal systems, ethics and clinical skills courses, and I enjoy having residents and medical students do clinical rotations with me. Research is a very small amount of what I do, but I have been developing collaborations with other paediatric nephrologists in Canada to include Saskatchewan patients in their studies. So when the dust settles, which it rarely does, I do a lot of different things, and my job is never boring.
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Guido Filler, MD, PhD, FRCPC
Professor and Chair, Pediatrics, Western University, London, Ontario
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Dr. Filler is Professor and Chair of the Department of Paediatrics at the University of Western Ontario and Chief of Paediatrics at the Children’s Hospital, London Health Sciences Centre, since 2006. He is also Vice Chair of the Medical Advisory Committee at London Health Sciences Centre. Early in his career he sought international experience and spent a year in Phoenix, Arizona, where he completed high school. He earned his undergraduate and medical degrees from Hannover Medical School in Germany and completed his specialty training in paediatrics at the same institution. In 1988 he won a prestigious scholarship from the Deutsche Forschungsgemeinschaft, the German equivalent of CIHR, and spent part of his subspecialty training and research at the Hospital for Sick Children at Great Ormond Street in London, UK.
After returning to Germany in 1990 he became a consultant paediatric nephrologist in Hannover and Berlin. He completed a PhD in clinical pharmacology at the Charité Hospital, Humboldt University in Berlin, and was promoted to Associate Professor. In 1997 he became acting head of the Division of Paediatric Nephrology at the Charité, where he was principal investigator of the first published randomised controlled clinical trial in paediatric transplantation, comparing cyclosporine microemulsion and tacrolimus. In 1999 he took up the role of Chief of the Division of Nephrology at the Children’s Hospital of Eastern Ontario in Ottawa and was promoted to Professor, cross-appointed to the Departments of Medicine and of Pathology and Laboratory Medicine.
Despite the administrative workload he continues to hold grants and publish, with over 240 peer-reviewed publications and 14 book chapters. He is deputy editor of Pediatric Transplantation and sits on numerous editorial boards, and is engaged with the Paediatric Chairs of Canada and its US equivalent, AMSPDC.
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Christoph Licht, MD
Associate Professor, Pediatrics, Hospital for Sick Children, Toronto
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I am a clinician-investigator in the Division of Nephrology at the Hospital for Sick Children and Senior Associate Scientist in the Program in Cell Biology of the SickKids Research Institute. The focus of my research is complement-mediated kidney diseases, including atypical haemolytic uraemic syndrome and membranoproliferative glomerulonephritis. My research program has a translational character, combining clinical and basic components. I have established a registry with biorepository for patients with complement-mediated kidney disease, embedded in a website offering information for patients, families and healthcare professionals. In collaboration with SickKids Genetics I have established comprehensive genetic testing for these diseases, and we are transitioning from target gene to whole exome sequencing.
The focus of my lab is the pathomechanism of thrombotic microangiopathy, and we have established an ex vivo model to study patient-derived endothelial cells, platelets and neutrophils under static and dynamic conditions. An exciting new aspect of our research is the role of complement in chronic proteinuric kidney disease. As a team we took a lead role in the first prospective treatment trial using the complement inhibitor eculizumab in patients with aHUS, and we study the long-term outcome of these patients through an international aHUS registry, for which I serve as scientific advisory board chair.
Why am I doing what I’m doing? At some point I fell in love with a job that allows me, unlike any other, to combine service to others with cutting-edge academic and scientific activity and the role of a teacher. When I left my previous home in Germany for my new position at SickKids, one of my former patients asked me not to forget about him and to find something that would help him. That personal moment with a patient who years earlier had marked the beginning of my clinical and research interest speaks to my motivation better than my own words could: a patient who needs help, a physician who has no answer yet, and the desire and mandate to overcome that. The consequence was to become seriously interested in complement biology, and those insights have led to the development, testing and establishment of specific treatments, a development that has truly changed the lives of patients.
And who allowed me to pursue this career path? My teachers, mentors, colleagues, patients and my family. Without them I could not have done it. They deserve all the merit.