INTRODUCTION

The Spanish Paediatric Nephrology Association (AENP) is the official scientific body that encompasses Spanish practitioners (paediatric nephrologists) dedicated to the practice of this specialty and one of its statutory objectives is to promote the development of paediatric nephrology.1 It was founded in 1973 under the name Sección de Nefrología de la Asociación Española de Pediatría (Nephrology Department of the Spanish Paediatric Association) and in 1995 went on to receive its current name.2

A year after its founding, it had its first scientific meeting in Madrid followed by annual meetings that in 1999 went on to be called Congresos Nacionales de Nefrología Pediátrica (National Meetings of Paediatric Nephrology).2

In its 37 years, the AENP has held 35 Meetings or National Congresses and, since 1992, four joint meetings with the Sociedad Portuguesa de Nefrología Pediátrica (Portuguese Society of Paediatric Nephrology). Each meeting includes round tables and conferences led by invited professors, but the research activity of paediatric nephrologists is demonstrated through scientific presentations, the fundamental basis of AENP meetings.

Coinciding with the 20th anniversary of the Paediatric Nephrology Unit (PNU) of the Hospital of León, we reviewed the presentations delivered at the meetings during that period of time in order to get to know the characteristics of the research activities of AENP members.

MATERIAL AND METHODS 

This is a retrospective, descriptive study of presentations delivered by Spanish paediatric nephrologists at national conferences of paediatric nephrology held between 1988 and 2007. The information was obtained by reviewing the programmes published in the books of the conferences and meeting abstracts published in Anales de Pediatría (Journal of Paediatrics).

Four meetings were held (1992, 1999, 2000, 2005) with Portuguese paediatric nephrologists and one (2002) within the European Congress of Paediatric Nephrology.

The following data was collected and assessed in the scientific programmes:

1. Number of presentations delivered each year and the change in number of presentations, in 5 year periods.

2. Hospitals from where the authors originate and the change in number of participating hospitals in each meeting, in 5-year periods.

3. Hospitals that have made the greatest number of scientific contributions.

4. Hospitals that have participated in all meetings by sending presentations.

5. Change in percentage of presentations from hospitals that perform transplantations, in 5-year periods.

6. Presentations from outside Spain.

7. Number of presentations delivered orally and in poster form.

8. Presentations on animal experimentation.

9. Topics chosen for presentations and their frequency.

10. Presentations on dialysis and kidney transplantation, molecular genetics and glomerular disease.

RESULTS

Number of presentations delivered

There were 1119 presentations delivered in the 20 years reviewed with a significant increase in presentations per meeting in recent years (Figure 1). If the data are analysed in 5-year periods, the average number of presentations increased from 45 presentations per year between 1988-1992 to 67 between 2003-2007.

Hospitals where authors come from

During the time period analysed, 91 hospitals made scientific contributions. Figure 2 shows the annual change in the number of hospitals. The average number of participating hospitals was 17 per year in the period 1988-1992, increasing to 34 per year between 2003-2007. The percentage of presentations from hospitals that perform transplantation went from 50.8% between 1988 and 1992 to 39.4% between 2003 and 2007.

The hospitals that delivered the most scientific presentations in the last 20 years were Hospital Materno-Infantil La Paz, Hospital de la Vall d´Hebron and Hospital Central de Asturias (HUCA). Only three centres delivered presentations in all the meetings held during these 20 years (La Paz, HUCA and Virgen del Rocío).

Foreign centres provided approximately 8% of the presentations, with Portugal contributing the most (37).

Number of presentations made orally and in poster form

In 1995, presentations began to be delivered in poster format. Since then, 369 of the 815 presentations delivered (45.3%) were in this format.

Number of presentations on animal experimentation.

In these 20 years, only 16 of the 1119 presentations (1.5%) reported on animal research, of which 15 came from HUCA-University of Oviedo.

Topics chosen for presentation

Every year presentations were delivered on glomerular pathology, tubulo-interstitial nephritis and kidney transplantation.

The most frequently chosen topic was glomerular disease, followed by urinary tract infection/vesicoureteral reflux and tubulo-interstitial pathology (Figure 3).

51 presentations were delivered on dialysis (32 peritoneal/19 haemodialysis). Kidney transplantation was the topic of 123 presentations and almost three quarters of these (90) were delivered between 1998 and 2007. There were 21 presentations on molecular genetics and/or molecular biology (1.8%) and only one of these was delivered before 1998.

Some 204 presentations were delivered on glomerular disease (18.2% of the total). Twenty-three of these came from Portuguese centres. A total of 33 Spanish hospitals delivered presentations on this topic. Hospital Sant Joan de Déu and Hospital La Fe delivered the most presentations.

Nephrotic syndrome was the most frequently presented glomerular disease (29 out of 69 were on its treatment). Systemic glomerular disease was the subject of 49 presentations (17 on Schönlein-Henoch nephropathy) and renal biopsy was the subject of 15.

DISCUSSION

Each year, paediatric nephrologists from selected Spanish hospitals take charge of the organisation of AENP meetings thus meeting the objectives of the association as stated in its statutes.1

These scientific meetings include keynote speeches given by Spanish and foreign specialists, round tables on current topics, debates, cases studies and expert Q&A.2 However, it is the scientific presentations from PNU of Spanish hospitals that give these meetings their meaning and allows for new specialists and hospitals to be incorporated into the activities of the AENP, helping the next generation of this paediatric subspecialty.3,4 From this point of view, our review provides information on the dynamic and scientific tone of the AENP and offers an idea of future expectations in this area of specific knowledge.

We chose to study this 20-year period because we felt it was a sufficiently long period of time and to make it easier to access the books on the presentations, keeping in mind that publication of abstracts in scientific journals was irregular over time.2

During these 20 years, we witnessed a progressive and striking increase in the number of presentations made in each meeting that paralleled the increase in participating hospitals. A total of 91 hospitals participated in the AENP meetings. The number of hospitals participating in each meeting doubled from the first five years (17 centres per year) to the last five years analysed (34 centres per year). This increase is probably related to the creation of new PNUs as recommended in the National Plan of Paediatric Nephrology.5,6 There are three types of units depending on the utilisation of health care and human resources, demographics and geopolitical criteria:5,6

1. Level I or basic units: Essentially preventive and care based.

2. Level II: Equipped to maintain a substitutive treatment for chronic kidney failure: haemofiltration, peritoneal dialysis and/or haemodialysis.

3. Level III: Basic infrastructure and equipment for maintaining a paediatric dialysis and kidney transplantation programme.

In these 20 years, the number of level II and III PNUs has not changed and only one new hospital has been authorised to perform kidney transplantation in children: Sant Joan de Déu of Barcelona. However, thanks to the efforts of former resident physicians of the major PNUs, many level I PNUs have been added to the healthcare network, as could be expected from the historical review carried out almost a decade ago by Dr. García-Nieto.2 The members of these new units are probably responsible for the increase in the number of presentations and participating hospitals in AENP meetings. This explains why half of all presentations came from transplant hospitals between 1988 and 1992, while only 39.4% of them came from transplant hospitals in the period 2003-2007.

Logically, the largest number of presentations delivered came from the two level III PNUs with a greater number of patients: University Hospital La Paz of Madrid and Hospital Vall d´Hebron of Barcelona. However, it is surprising that the level II PNU of HUCA ranks third among Spanish centres in the number of presentations, ahead of the other centres that perform transplants. It is one of the only three PNUs that delivered presentations at all the AENP meetings held in the 20 years reviewed, along with Hospital La Paz of Madrid and Hospital Virgen del Rocío of Seville.

Presentations delivered from outside Spain represented only 1.5% of the total and, in general, came from Portuguese hospitals in the context of Reuniones Ibéricas de Nefrología Pediátrica (Iberian Meetings of Paediatric Nephrology).2 The remaining international presentations came from nine other countries and their number is practically symbolic.

In 1995, presentations in poster form began to be accepted at AENP meetings.2 Since then, this type of presentation represents almost half of the total and its introduction has probably contributed to the increase in the number of presentations observed in recent years.

Basic research using animal testing is not common in Spanish hospitals and it is poorly represented in paediatric meetings and in particular in paediatric nephrology. Clinical research significantly is the dominant topic while animal experimentation almost always depends on universities and thus reaches only 1.5% of the total, almost all coming from the University of Oviedo-HUCA.

During childhood, glomerular disease is less frequent than that associated with infectious, hereditary, congenital and/or malformation symptoms, and causes little more than 20% of terminal kidney failure in childhood.7 Nonetheless, it was the most frequently chosen topic for presentation (almost 20% of the total), followed by urinary tract infection/vesicoureteral reflux and tubulo-interstitial pathology. Of all primary glomerular diseases, nephrotic syndrome is the most common topic of presentation, probably because it deals with the most frequent primary glomerular symptom in childhood.8 As expected, there are more presentations on Schönlein-Henoch nephropathy than those of systemic glomerular diseases.

However, only one third of PNUs delivered presentations on glomerular diseases, possibly because the small hospitals barely have any cases with these characteristics since these diseases are so infrequent. Hospital Sant Joan de Déu of Barcelona delivered the most presentations on this topic.

In addition to glomerular disease, every year there were presentations on tubulo-interstitial nephropathy and kidney transplantation. Kidney transplantation is a frequent topic at the meetings we reviewed despite the fact that Spain only has seven level III PNUs and until recently only had six.2 Presentations on dialysis are less common and those referring to peritoneal dialysis are the most common. This is not surprising since in recent years peritoneal dialysis has been chosen as the first substitute treatment for kidney function for twice as many children as haemodialysis.7

Virtually all the studies performed on genetics and molecular biology occurred in the last decade and it is likely that this will be an increasingly frequent topic for presentation. Mutations responsible for various tubular disorders and cystic kidney diseases have been reported recently and several Spanish PNUs have been involved in this process, a process followed by paediatric nephrology on a global level.9-11

We conclude by recalling that during the past 20 years the number of participating hospitals has increased as well as the number of presentations delivered at the AENP meetings. Glomerular disease was the most common topic. Presentations on kidney transplantation have increased in frequency in recent years and in the last decade presentations began to be given on molecular genetics. However, presentations on animal experimentation remain rare.

As noted by Dr. Rodríguez Soriano a few years ago, the phenomenon of subspecialisation in paediatrics is irreversible and is already setting new challenges in healthcare, teaching and research.12 Scientific meetings with the delivery of presentations are proof of this research activity and a basis on which to support training of specialists, providing crucial contributions to the development of specific areas within Paediatrics.

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Figure 1.

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Figure 2.

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Figure 3.