Interview with Prof Kai-Uwe Eckardt

Prof K.-U. Eckardt Universitätsklinikum Erlangen Medizinische Klinik IV Erlangen, Germany

Prof Zoccali: The Erlangen / Nuremberg department of Nephrology is one of the largest dedicated to renal diseases in Germany and in Europe. The structure of your activities and research interests are delineated in the updated version of your WEB site. Can you give us some complementary information on the organization of your department?

Prof Eckardt: A relevant issue for the organization is that the two clinical units in Nuremberg and Erlangen are both part of different large hospitals, but collaborate closely and are, therefore, both affiliated with the university. This provides unique opportunities for nephrology care in a large area, enabling the development of a different thematic focus on different wards, but also enabling care of a high standard to be provided close to where the patient lives. Access to large patient populations is a great advantage also for clinical research. On the other hand, the distance between the two units in Erlangen and Nuremberg is also a challenge for our daily work. Several mechanisms have been developed to facilitate the exchange. e.g. we have a video connection between both sites, so that conferences, seminars and meetings can be attended from both units.

Prof Zoccali: What are the strengths and weaknesses of your department?

Prof Eckardt: One strength is certainly the thematic spectrum, including outpatient care for CKD patients, clinical nephrology, hypertension, all aspects of renal replacement therapy, diabetology, general internal medicine and intensive care medicine. This allows us to provide very broad training to all fellows. A second major strength is the scientific tradition, that was formed and systematically build up many years ago by
my predecessor, the late Prof. Bernd Sterzel, and resulted in the fact that kidney research is today one of the main research topics at the medical faculty of our university and receives generous funding from the German Research Foundation. We can actually build on a very good research infrastructure and local collaboration network, which is very helpful. Unfortunately - and this is certainly a weakness - the buildings we are currently working in, in Erlangen, are pretty old and the nephrology labs are located in a small house, which has a special charm, but is a far cry from what modern lab facilities should actually look like. A new clinic is under construction and we hope that plans for a new research building will also soon be approved.

Prof Zoccali: You have a variety of research projects. Having a rich research program is fundamental for attracting and stimulating young trainees but poses tantalising problems in terms of funding, organization and integration. How do you manage these problems?

Prof Eckardt: As I have already mentioned, we are lucky to receive significant grant support. This includes a collaborative research centre on kidney disease (“Sonderforschungsbereich”) and a Clinical Research Group (“Klinische Forschergruppe”) on end-organ damage in hypertension, whose coordinator is Roland Schmieder. Additional projects are part of larger networks, e.g. EU projects within the 6 th framework.
In terms of organisation, it is essential for some scientists to work in the department, doing research alone, so that the research infrastructure is continuously maintained. In addition, we ensure that young scientists have time set apart without clinical duties, during which they can entirely concentrate on their research projects.

Prof Zoccali: Translational research is a much touted area. In reality this area is becoming an all-purpose log-in for funding. Could you tell us if and what transitional research programs you have in your department?

Prof Eckardt: Let me answer this in a more general way. As physician scientists, all of our work is - and should probably somehow be - related to mechanisms of disease and thus have potential relevance for innovations in diagnosis or treatment. We are trying to achieve this e.g. by using animal models of renal disease, by using human material (cells or tissue specimens), or by studying pathophysiological mechanisms directly in humans. At the same time hypothesis and scientific questions are formulated on the basis of our clinical experience and, in a way, this mutual interaction between clinical experience and clinical science can be considered “translational”. However, in a more strict sense “translational research” means, of course, that findings obtained in the lab are directly “translated” into clinical practice and it is quite clear that this is, overall, an extremely rare event, considering e.g. the development costs of a new drug or the safety requirements and hurdles for gene therapy etc. Therefore, I believe that the term, although fashionable, is frequently used in a somewhat dishonest way.

Prof Zoccali: Can you provide financial support to young investigators from abroad for well-focused research projects?

Prof Eckardt: Unfortunately we do not have our own resources that we can use to provide salaries for young investigators visiting our department. However, we are very happy to provide lab space and integrate them into our ongoing research projects, as well as support their application for fellowships and training grants. This has worked well in the past, and we continue to have fellows in Erlangen, who are supported e.g. by the International Society of Nephrology or the Humboldt Foundation. I believe also that it is important to facilitate the exchange of young investigators within Europe and I am very happy that ERA-EDTA has decided to take this up by initiating a new fellowship programme.

Prof Zoccali: Can you tell us frankly the pluses and the minuses emerging with international fellowship programs in your department?

Prof Eckardt: Of course, in individual cases there may be difficulties due to significant cultural differences between the fellow´s home country and our facility and not every project is as successful as one would hope. Nevertheless, I believe that the benefit of scientific and personal exchange usually clearly outweighs such difficulties.

Prof Zoccali: Do you accept fellows with limited educational goals, e.g. gaining skills in a clinical or laboratory methodology?

Prof Eckardt: In general yes, but this has to be discussed in detail with the project leaders and such focused visits are usually part of a broader collaboration with our groups.

Prof Zoccali: Which “in house” educational activities do you have? (Journal Club.…Invited speakers….Clinical meetings…)

Prof Eckardt: We have quite a number of educational activities, including a weekly seminar programme with invited speakers, who talk about clinical or basic research topics, a weekly conference, where usually the differential diagnosis and therapy of an interesting case is discussed, additional internal conferences on different renal topics, such as a renal biopsy conference or transplant conference and we organize several educational and scientific meetings each year.

Prof Zoccali: Do you provide well formalised “hands on” clinical training also in the outpatient clinics or just in the medical (nephrology) ward?

Prof Eckardt: Clinical training is mainly provided on the wards.

Prof Zoccali: What environmental and social appeal has Erlangen and Nuremberg beyond your department? What are the opportunities for making young doctors' stays enjoyable in Erlangen during week-ends and after the long hours spent in the hospital and in the laboratories?

Prof Eckardt: Erlangen and Nuremberg are located in Northern Bavaria and both have historic city centers and an active cultural life.. There are also a number of interesting and historical cities within about 120 km distance, including Bamberg, Würzburg and Munich, all places that guests usually enjoy visiting. In addition, the surroundings offer a lot of opportunities for sport activities, such as hiking, climbing, cycling or horse riding. Both Erlangen and Nuremberg have a great number of interesting local pubs and beer gardens. Erlangen is also famous for a festival around Pentecost, the “Bergkirchweih”, which attracts many visitors and may offer an opportunity to study “beer drinker hyponatremia” (but we have not yet pursued this).