Paediatric nephrology - sub-specialty

Paediatric nephrologists work with children and young people with chronic and acute kidney disease, including the provision of dialysis and kidney transplantation.

This page is for those exploring, applying to or already in this sub-specialty training programme! We have insights from current specialists on what it's like working in paediatric nephrology, opportunities to try out the sub-specialty and links to the relevant groups and other contacts.

Each sub-specialty has its own syllabus as part of Progress+ which you can download from this page, plus get details of the College Specialty Advisory Committee (CSAC) managing this sub-specialty.

1. What makes a paediatric nephrologist?

A paediatric nephrologist is a clinician who deals with the diagnosis, investigation and management of chronic and acute kidney disease, including the provision of dialysis and renal transplantation. Paediatric nephrologists have detailed knowledge of renal physiology, including fluid management and disturbances in electrolytes and acid-base balance.

They are skilled in the management of acute kidney injury (AKI), which may be managed conservatively or with kidney replacement therapy (KRT), including peritoneal dialysis (PD), haemodialysis (HD), and continuous venovenous haemodialysis (CVVHD) and continuous venovenous haemodiafiltration (CVVHF). They are also skilled in the management of chronic kidney disease (CKD), including the pre-dialysis phase, peritoneal dialysis, haemodialysis and transplantation.

Paediatric nephrologists also develop expertise in the management of children and infants with:

  • congenital anomalies of the renal tract
  • nephrotic syndrome
  • glomerulonephritis
  • vasculitis
  • inherited and acquired forms of tubulopathy
  • urinary tract infection (UTI)
  • vesicoureteric reflux (VUR)
  • renal stone disease
  • hypertension
  • inborn errors of metabolism
  • inherited nephropathies.

CKD is a life-long condition and paediatric nephrologists are frequently involved in the care of patients from birth all the way through to the successful transition into adult renal care.

2. A day in the life of a paediatric nephrologist

By Dr Ihab Shaheen, Consultant Paediatric Nephrologist in Glasgow

"As a paediatric nephrologist, my home life will be relatively balanced and organised. By keeping some level or organisation at home allows for the unpredictability of work. It only needs one unwell patient requiring emergency treatment to upset any plans of getting ‘ that paperwork finished’ or attending ‘that educational meeting’. However, these days are usually rewarded with a grateful family and a child who is ‘so much better than they would have been’ if they hadn’t had your expertise.

"I will always want to try and put some order into these chaotic days by knowing not only that the renal function was stable but the actual value of the creatinine; that the child did not look overloaded but by how much their weight had changed in grams!

"The MDT are invaluable as without their expertise I am unable to treat a child with renal failure. The understanding that we are all working together to improve the lives of children with renal failure is felt by the joy in the department when a child receives a renal transplant.

"Of course, like most paediatrics, there is always the monotony of doing clinic letters but clinics are enjoyable watching many patients develop from infancy into childhood and adolescence and then transition into adult care.

"I also feel that I belong not only to the department of nephrology but the paediatric hospital as when I walk through the hospital I recognise many faces. In nephrology, you interact with so many colleagues from different specialities, that learning never stops."

3. How and where to experience paediatric nephrology in your early medical career

There are 13 paediatric nephrology units in the UK (10 of which are also kidney transplant centres) and many other paediatric units will have a regular nephrology clinic which is run by a nephrology special interest (SPIN) paediatrician with a visiting paediatric nephrologist.

For medical students, most dedicated nephrology units will have opportunities for student-selected components (SSCs) and/or medical electives.

For foundation doctors and core trainees, there is the opportunity to undertake taster weeks in paediatric nephrology or to attend clinics if your hospital does not have a dedicated nephrology unit. Core trainees are welcome to attend biannual paediatric nephrology training days if space is available. To enquire about these, please contact the trainee representative on the paediatric nephrology CSAC. Placements in paediatric intensive care units (PICU) may also offer the opportunity to work closely with the nephrology team, particularly in relation to seeing kidney transplant recipients in their immediate post-operative recovery and managing patients requiring continuous kidney replacement therapy (CKRT).

4. Applying to a paediatric nephrology programme

Paediatric nephrologists provide holistic care to children with complex needs from birth till they transition to adult services. Competencies which demonstrate transferable skills required to provide holistic care are very important for assessors of a written application and during interviews.

Showing interest in attending clinics with a focus on nephrology and seeking out opportunities to expose oneself to nephrology demonstrate an interest in the speciality. Examples of clinical situations (as case-based discussions) of providing holistic care with good communication skills would demonstrate the transferable skills required to be a trainee nephrologist. Courses and conferences which help improve communication, and knowledge of kidney pathology which are then relatable to your own practice are useful. Audits or quality improvement projects (which improve patient care or experience of care) including writing up of patient information leaflets can demonstrate skills and genuine interest in paediatric nephrology. Exposure to and leading on research projects and presenting them locally or at national/international conferences also demonstrates a desire to practice evidence-based medicine.

Members of the paediatric nephrology CSAC can be approached for information about gaining more experience and applying to train in paediatric nephrology. If you wish to seek specific advice on research experience, please contact the Research Advisor in the CSAC. For advice from a trainee’s perspective, please contact the Trainee Representative, who can link you up with a paediatric nephrology trainee in your area.

For more information on paediatric nephrology as a sub-speciality, you can Join the British Association of Paediatric Nephrology (BAPN) or follow them on X (@BAPNnephrology).

5. Information for paediatric nephrology trainees

Towards the end of your paediatric nephrology training, you may be interested in enquiring about job opportunities. You can approach consultant colleagues within your paediatric nephrology department, the paediatric nephrology CSAC Chair and the British Association for Paediatric Nephrology (BAPN) for more information about upcoming consultant jobs within the UK.

To find out more about paediatric nephrology, the CSAC recommend the following websites as useful resources: