A national course for renal fellows: the origins of renal physiology.

A national course endorsed by the American Society of Nephrology for renal fellows will be held annually at Mount Desert Island Biologic Laboratories (MDIBL) on the coast of Maine. The 1-wk course seeks to reconnect renal trainees with the origins of kidney physiology and a systems approach to mechanisms of homeostasis in electrolyte disorders. What is the rationale for such a course? As renal research focuses increasingly on specific regulatory processes, single molecules, or clinical outcomes, renal fellows and future junior nephrologists are losing touch with fundamental concepts of homeostasis and classical experiments forming the foundations of nephrology. A solid grounding in renal physiology and its history can only enhance the perspective of new renal investigators, and such knowledge will enrich the subsequent teaching moment with new medical students and trainees in medicine. Our 1-wk course in renal physiology and its history will be conducted at MDIBL in mid-September of each year, starting in 2008. There are openings for 30 renal fellows. The curriculum will consist of six different 11⁄2-d modules. Each trainee will be assigned to participate in three of the six modules. Topics for the modules include water homeostasis, salt homeostasis and secretion, collecting duct sodium balance, and proximal tubular function. In each module, classical experiments using well-established model systems will be combined with modern cellular and molecular techniques. For example, the collecting duct sodium balance module will monitor salt transport in toad urinary bladders mounted in Ussing chambers, by measuring the amiloride-sensitive short circuit current. Similar studies will be performed using cultured renal epithelial cells such as A6, in similar chambers. The response of the currents to exposure of the bladders to aldosterone, antidiuretic hormone, insulin, and other agents will be examined. These studies will be linked to functional studies of epithelial sodium channels expressed in Xenopus oocytes. Two electrode voltage-clamp experiments will examine channel function under a variety of conditions. Linking studies that regulate salt transport in whole epithelia to measurements of currents across the channels themselves will cement in participants an understanding of distal nephron salt homeostasis. The modules involve a long workday (Sunday, Tuesday, or Thursday) during which a topic is introduced and participants perform experiments and begin to analyze data. The next day (Monday, Wednesday, or Friday), participants work for half a day and, after lunch, present their experiments to the group. Each module progresses through the week. The initial presentations (Monday after lunch) focus on introduction and some data, as well as suggested experiments for the next group in the module. The second presentations (Wednesday after lunch) build on the introduction provided in the first presentations, summarize the data from the first two groups, and suggest experiments for the final group in the module. The final presentations (Friday after lunch) summarize the week’s work in the module and suggest future experiments. By participating in these three “group lab meetings,” the fellows will learn from each other and will follow the progress of all modules, including those in which they are only observers. Participants will be provided a syllabus that describes each module, including the rationale, overall approach, and scientific questions to be addressed. Methods to be used will be spelled out in detail, with appropriate diagrams, so that the trainees understand fully what they will be doing in the lab. Reprints of classic articles using the approaches in the module will also be included in the notebook, as well as an extensive bibliography. It is hoped these articles and references will help give participants access to the classic literature of nephrology. Senior, nationally prominent renal physiologists drawn from around the United States will lead each module. Aside from imparting effectively the perspective of their individual module, their close interaction with participants in the laboratory will help the fellows gain important perspectives on careers in nephrology. During the week, one or two eminent guest lecturers will also discuss the development of our understanding of areas such as glomerular filtration or tubular transport. Dr. Vivian Siegel, executive editor of JASN, editor-in-chief of Disease Models and Mechanisms, and Published online ahead of print. Publication date available at www.jasn.org.