Interview with Prof Rosanna Coppo

Prof R. Coppo Director of the Nephrology, Dialysis and Transplantation Department Regina Margherita Hospital Turin, Italy

Prof Zoccali: The Pediatric Nephrology and Transplantation Unit of the Regina Margherita Hospital is the leading Unit of Pediatric Nephrology in Italy at least as far as scientific productivity is concerned. Here you will find a small, but very effective staff; a well organised lab and national and international collaborations going on. May you give us more detailed information on the organization of your Unit?

Prof Coppo: I was asked to become the Chief of this Unit, moving from adult Nephrology where I was trained and then worked for 15 years, since it was decided, at a regional level, that there was a need to develop this particular aspect of Nephrology, which had just begun a small program of pediatric dialysis but still had no renal transplantation. The young Medical doctors working at the Regina Margherita University Hospital were doing an honest medium-level work, but no computer was there, no scientific journal was regularly read and the participation to the National Congress of Pediatric Nephrology consisted of just one poster a year regarding an interesting case that had been observed. I instead was coming from a University Unit which had trained me to high levels of scientific interest and clinical work. The greatest problem, when you become a Chief of a Unit different from the one where you are used to working in, is to combine the new changes you are willing to introduce with the old style medical thinking. First of all I looked for the support of a “right hand” enthusiastic and expert Nephrologist, and I was so fortunate to have Alessandro Amore work in my group: he is a very dedicated co-worker of mine since we were 20 and 30 years old respectively. He gave me the constant support of his friendly and intelligent help of a tireless worker. I tried not to impose a re-organization of the structure of the people already working there, but instead to reinforce their natural attitudes, while new entries were launched in new initiatives.
Hence, the work is distributed in 3 categories of doctors:

• pure clinical staff, mostly Pediatrics, with consolidated clinical experience, working at establishing the first diagnosis and treatment of non complicated cases;
• clinicians with great experience in dialysis of small children, and technically expert in dialysis equipments and instrumental procedures;
• clinical & research-oriented doctors, who are more keen on following and developing new ideas. They perform renal biopsy and are interested in immunopathology, they also follow children with renal transplantation. These doctors are actively involved in Clinical and Laboratory Research, in a team in which 3-4 Biologists and 2-3 Residents / University Students are involved as well.

This organization has the advantage of leaving each doctor free to choose his/her work to reach full satisfaction, which increases as the amount of clinical/research work increases. Finally all the Nephrologists and Pediatrics working in my Unit also have an important training and tutoring activity for young doctors Fellows in the Specialization Schools of Pediatrics and Nephrology

Prof Zoccali: You have a past experience in adult nephrology. What do you miss with reference to your adult nephrology work and what do you enjoy most in pediatric nephrology?

Prof Coppo: The variety of complicated cases you see in adult nephrology, particularly for hematologic, systemic or diabetic patients was of interest for me, but I was really relieved when, after 15 years of seeing patients dying after years of dialysis, with such a rapid decline in general conditions, legs amputation and loss of the capability to take care of themselves, I had to take care of beautiful babies, with a disease that is generally curable, who instead of the decline experienced in most of the cases, showed a clear improvement and even a complete recovery. It felt like breathing fresh air: even in those cases of disease progression to dialysis, this lasted a very short time (a few months) before transplantation, therefore it was not a true limitation for life.
If on one hand I do miss the direct front-to front discussion with the patient, dividing with him/her the joy of successfully fighting the disease, I also enjoy the tender pleasure to see that the child understands that you are his friend and feels in a more sensitive way the interest you are putting in is health.
Children are nice even when they are diseased and you feel fascinated by them.
Moreover, my greatest interest in Nephrology has been always focused on pathogenetical factors and children represent a unique set of patients with “pure” disease, observed since the true beginning, in which you can investigate the risk factors for development and progression without confounding factors.

Prof Zoccali: You have a very active life as a clinician, investigator and, being Chairman of the Administrative Offices of the ERA-EDTA, also as a manager. How do you manage to deal with all these demanding activities?

Prof Coppo: I do not know if I am such a good example, since I always feel the pressure of what I have to do and I what I’m instead leaving do to for tomorrow. I often have the feeling that much of what I did could have been done better than it was. I try to do all my duties as best as I can, but the time is short and often I feel inadequate. This feeling is particularly strong if you consider the remaining of my life, which is so important as well: the sense of inadequateness as far as my duties at home and with my friends and my family members are concerned is enormous. Finally I feel that the work I am doing did not leave enough time to my life itself. I cannot say how many novels I have not read, how many movies I have not seen, how many tennis matches I have not played. But, at the end of this list, I must say that I did and I am still making a choice, and in life you must face the need to select what you have time to do and what you disregard: well I am more than happy to say that I like the foolish life I am living, I like perhaps the rush itself, I like having several commitments, I like the recognition of my work and I like to have a very nice little family. I do not know if I compound sufficiently well these activities, but I would like to suggest to other younger ladies, who are trying to compound their life activities as I am doing, to keep on going, that it is worthwhile.

Prof Zoccali: Your scientific interests are mainly concentrated on basic science and translational research themes. Could you please tell us which is the most intriguing study you are presently pursuing?

Prof Coppo: I am an enthusiastic researcher. I love new ideas and new research paths. Our Group has dealt with the pathogenesis and treatment of IgA nephropathy for many years, and I keep considering this field of research the most relevant of the researches pursued. We are presently investigating the activation of transcription factors, mainly NF-kB in peripheral lymphomonocytes of patients with IgAN which we suppose reflect what is activating into the kidney and, what it of most interest, we are trying to limit this NF-kB activation via old and new drugs which can blunt this transcription factor by means of several mechanisms, and, among the others, we are focusing on proteasome inhibitors.

Prof Zoccali: Which are the strengths and the weaknesses of your Unit?

Prof Coppo: Weaknesses first: the doctors working in a very specialized Unit like mine must be very selected, being able to accomplish the need of knowing Pediatrics, Nephrology and extreme applications of dialysis and transplantation techniques. A weakness is that it is impossible for everybody to know everything, so we have in our unit super-super experts, but with some loss of a uniform performance and skill.
Strengths: we are working together in a very syntactic way. Each week we have 2 meetings and 2 grand rounds: everybody knows the clinical problems of the patients in the ward and it is exceptional that we have not a unanimous way of seeing the problems and thus finding a solution. We do have problems for holidays or call turns, but we are a very unite unit as far as the interest of the baby with nephrological problems is concerned. And I must say that the results make us proud of our common work.

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

Prof Coppo: We have several financial supports for selected studies, for instance from the Italian Ministry of Health, from our Region as well as from private donations. When we begin a study we look for young doctors investigators working for 1-2 years on the project. In case of visitor investigators we can offer some support while they are working at a project already on the way. If a young investigator comes for a well focused project we can negotiate the extent of support we can offer.

Prof Zoccali: Can you frankly tell us the pluses and the minuses of the educational programs in your Unit?

Prof Coppo: We chair the University Course in Pediatric Nephrology of our Region, which comes after 3 years of General Pediatrics and lasts for an additional 2 years. My Units participate in the program of education of these young doctors and this offers them the first possibility to up-date their own knowledge.
Half of the Unit is actively involved in Laboratory and Clinical Research: their CME is mostly focused on the topics of their research. This can lead to an extra-education, with the drawback of leaving in the shadows the section of CME not touched by the research. Those who do Clinical work only tend to avoid the contact with news too far from the clinical practice. We perform internal CME courses, accredited by the National System, which, in the last years, has focused on Transplantation.

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

Prof Coppo: We have accepted several of these young fellows, a couple from China, one from the US and several from other Italian Regions. I do like having young fellows to teach and train. Our Unit is made by kind persons who always leave a very positive souvenir to the visiting fellow.

Prof Zoccali: What environmental and social attractiveness does Turin have beyond your Unit? What are the opportunities for making the stay of young doctors in Turin enjoyable?

Prof Coppo: Turin is an industrial city, but it is beautiful, particularly after the “refresh” made for the recent Winter Olympic games: the squared plan of the city, with its large boulevards and ample squares with some outstanding baroque monuments in a context of a natural amphitheatre made by the Alps, the Po river and its backward morenic hill, offer a view of a city which should be visited.
Apart from museums (from the Egyptian to the modern art museums), theatres and cafés, Turin offers a unique possibility to ski in exceptional nearby mountains, which hosted the Winter Olympic games.

Prof Zoccali: Could you tell us which is your favourite hobby?