Prof
W. Hörl
Division of Nephrology
Department of Medicine
University of Vienna
Vienna, Austria
Division of Nephrology
Department of Medicine
University of Vienna
Vienna, Austria
|
|
|
Prof
W. Hörl
Division of Nephrology Department of Medicine University of Vienna Vienna, Austria |
Prof Zoccali: In a way you are a sort of exception in academic medicine in Europe because you initiated your career in your country, in Germany, and then moved to Vienna. Even though the links between German and Austrian medicine are strong, this move is probably unusual. Could you tell us something about this? Do you think that the (cultural) barriers for free movement of academic clinicians in Europe will be eventually abated?
Prof Hörl: Movement between German speaking countries is not unusual. If a free position is offered in one of the universities in Austria, Germany or Switzerland, usually the deans of all universities of these countries are informed. The deans inform the chiefs of the respective division or department that candidates should be encouraged to apply for the position offered. Main obstacle is the language barrier. Nevertheless, there is some exchange between the Netherlands and Germany (e.g. Prof Fokko van der Woude moved from Holland to the Department of Nephrology at the University Hospital in Mannheim/Germany) or between Germany and Denmark (Prof Jens Leipziger moved from the Department of Physiology in Freiburg/Germany to Denmark). Some German colleagues moved also to England.
Prof Zoccali: You are Director of one of the largest department
of nephrology in Europe. Which were the leading ideas on which you based the
design of the scientific and managerial structure of your department?
Prof Hörl:
All together I have approx. 180 coworkers, and we take care of more than 2000
patients with acute and chronic kidney diseases, approx. 50% of these patients
are renal transplant patients. Therefore, several of my medical coworkers (n=33)
are involved in renal transplant programs (C4d as a marker for humeral rejection;
immunological and non-immunological chronic graft failure; new immunosuppressive
protocols; tolerance; renal transplantation in the elderly). We have our own
ICU unit, therefore acute renal failure, sepsis, catheter problems, continuous
renal replacement therapy are also topics for clinical and experimental research
programs where several coworkers are involved.
We have a huge dialysis program and more than 30,000 hemodialysis treatments
are performed per year in our unit, approx. 30% of our dialysis patients are
PD patients (CAPD or APD patients). Thus, research programs include isolation
and characterization of uremic toxins, therapy of renal anemia plus adjuvant
therapeutic options, new aspects of therapy or prevention of secondary hyperparathyroidism
with new phosphate binders, vitamin D analogues and calcimimetics or the impaired
cellular host defense in this patient population.
We have a huge plasmapheresis unit with more than 60 patients with all kinds
of severe systemic diseases, severe lipid disorders, neurological or hematological
or endocrine diseases or severe cardiomyopathy. Thus, interdisciplinary research
programs with these topics are ongoing.
Since there is no separate department of hypertension at the university hospital
in Vienna with 2200 beds, we take care not only for patients with all kinds
of renal hypertension but also for patients with severe essential hypertension.
We have excellent co-operations with other departments of internal medicine,
the transplant unit (which performs approx. 200 kidney transplantations a year
and transfer all patients after few days to us), the department of pathology
(Prof D. Kerjaschki) and many national and international centers. Due to the
huge size of our department, we are involved in many multicentre studies. In
my opinion it is very important that each medical coworker has his or her own
clinical and scientific project(s). This separation avoids conflicts or reduces
possible conflicts markedly.
Prof Zoccali: Which difficulty, if any, have you had in re-organizing your activity in Vienna?
Prof Hörl: There were 12 years in which there was no Chair of Nephrology at the University in Vienna before I moved to Vienna. Nephrologists worked in two different departments under control of “generalists”. I was Chief of the Department of Nephrology at the University in Homburg/Saar (Germany) when I was asked to take the position in Vienna. A certain difficulty was to bring the coworkers after many years of competition together in order to create one single unit without different (or even opposite) diagnostic and therapeutic guidelines and procedures. Meanwhile we are a multinational team, which is very productive clinically, scientifically and in teaching the huge number of medical students.
Prof Zoccali: I would like to pose you a question that I submitted
to other leading clinicians before. Do you think that in Europe nephrology as
a specialization is considered less attractive than it used to be 10 years ago
or so?
Prof Hörl: Not in Vienna, the capital of a country with
a very high kidney transplant activity for many years. We are also very active
in diagnosing kidney diseases as early as possible and in retarding progression
of the disease. Therefore, many patients contact us (with or without a transfer
from the family doctor), the cooperation with the departments of radiology and
pathology are excellent in allowing us to manage such a huge patient program.
I think it is unique that we have our own ICU unit.
Prof Zoccali: You have strong links with Eastern Countries
where nephrology is growing at a fast rate. What would you do to strengthen
the collaboration with eastern countries?
Prof Hörl: We have had fellows from East Europe, scientific programs and meetings with some of the countries. We try to help to improve or to overcome some of their local difficulties.
Prof Zoccali: You have been the European Editor of the American
Journal of Kidney Diseases and are now Editor of the European Journal of Clinical
Investigation. Scientific communication is undergoing profound changes. Which
is the main challenge you are facing now in your position of Editor of a journal
that covers a wide area of clinical science?
Prof Hörl: First, I have established a very international board for EJCI with experts from Europe, USA, Canada, Japan and Australia in a wide area of clinical science. We have approx. 450 submissions per year, organize as quickly as possible, with a fair and competent review process. I am reading also nearly each submitted article. Meanwhile we have submissions from a broad spectrum of countries also outside Europe. The board members are encouraged to look for hot topics in their field of expertise and their countries, and to invite these scientists for editorial comments. We are stimulating the publication of letters to promote scientific exchange and discussion.
Prof Zoccali: As a head of a large department with several research programs, you have a wide range of scientific interests. Among these which is presently at the top of the list?
Prof Hörl: During the last months, my co-worker, Dr Marcus Säemann, provided exciting new insights in the role of Tamm Horsfall Protein as an important regulator of host defence in the urinary tract. I hope several of his manuscripts will appear at the beginning of next year, and the readers will find his data as exciting as I.
Prof Zoccali: Do you think that scientific societies in Europe
should actively promote clinical research in areas scarcely covered by research
funded by drug companies?
Prof Hörl: Yes, I see also an important role of the ERA-EDTA in this field.
Prof Zoccali: Which is the scientific article that most impacted
on your scientific interests?
Prof Hörl: Many years ago I read with great interest the article of Montgomerie et al. “Renal failure and infection” published in Medicine 47:1-32, 1968. Thereafter, I decided to investigate the reasons for impaired cellular host defence in this patient population. Meanwhile we have isolated and characterized many proteins that interfere with the impairment of neutrophils in uremic patients. This data brought new insight in our understanding of why renal failure patients suffer so often from infectious complications, which are the main cause for hospitalization and the second main cause of death. We also found that accumulation of intracellular calcium (due to secondary hyperparathyroidism) and overtreatment with IV iron contribute to impaired neutrophil function in these patients.
Prof Zoccali: Which are your favorite hobbies?
Prof Hörl: Classical music and stamps.
