EXPERIMENTAL AND CLINICAL TRANSPLANTATION

This article analyzes the foundation, institutiona-lization, and development of pediatric nephrology in Türkiye. Erich Frank is the pioneer and inspiration for Turkish nephrologists. He pioneered the training of a new generation of modern physicians, the first generation of Turkish nephrologists, and the establishment of the discipline of nephrology. Turkish pediatricians closely followed these developments and tried to improve their knowledge, making an effort to study abroad. These physicians established pediatric nephrology departments in their universities, trained young pediatric nephrologists, initiated pediatric hemodialysis-peritoneal dialysis units, and realized renal transplantation in children. Another pioneer of pediatric nephrology is Prof. İhsan Doğramacı, who established the first pediatric nephrology department at the Ankara-Hacettepe Medical Center in the 1960s. He directed many physicians to pediatric nephrology and provided them education and research opportunities abroad. Pediatric nephrology became a subspecialty in pediatrics in 1983 in Türkiye. Over the years, the number of Turkish pediatric nephrologists has increased; in 1990, they established the Pediatric Nephrology Association. This gave momentum to the standardization of education, better patient care, and scientific studies. Renal biopsies were initiated in 1964, the first pediatric hemodialysis application was conducted in 1974, the first renal transplantation from the living donor was in 1975, and the first continuous peritoneal dialysis was in 1989. With regard to international collaborations, since 2000, a council member from Türkiye has continuously been elected to the executive board of the European Society for Pediatric Nephrology; currently, the European Society for Pediatric Nephrology is led by President Rezan Topaloğlu. Several Turkish pediatric nephrologists have worked in international associations. Today, Türkiye has 107 pediatric nephrology centers, 265 well-trained specialists, 28 hemodialysis units, 39 peritoneal dialysis units, and 26 pediatric transplant centers.

Key words : Institutionalization, Pioneers, Progression

Publications that review institutional studies, developments, and achievements at the international level in Türkiye are very limited. In the field of pediatric nephrology, physicians and scientists who have strived with devotion in the past are not sufficiently recognized. The pioneers of pediatric nephrology, stages of development of pediatric nephrology, scientific studies, and the services provided to pediatric kidney patients are worthy of being a success story and are at a level that will set an example for both neighboring countries and European countries. This article has recorded the stages of pediatric nephrology development in Türkiye over 60 years to the level it has reached today by someone who has personally experienced and witnessed it.¹

In the 1960s, physicians, especially Gavin Arneil from Scotland and Henry Barnett from the United States, who understood the need for better treatment and had understanding of kidney diseases in children and the need to share this information internationally, took action. Contacting Pierre Royer and Rene Habib from France and other scientists, they first initiated multicenter studies in 1965. In 1967, with the participation of 23 countries, they founded the European Society for Pediatric Nephrology and, in 1974, the International Society of Pediatric Nephrology.^2,3 These associations put efforts in developing countries to support education in nephrology, dialysis, and transplantation.

Mustafa Kemal Atatürk, the founder of the Republic of Türkiye, who planned the university revolution in 1933, and his colleagues invited scientists who fled Nazism in Germany to Türkiye and started university education in many branches in the modern sense.

The pioneer and inspiration of Turkish nephrologists is Erich Frank. For 23 years, this scientist pioneered the training of a new generation of modern physicians, the first generation of Turkish nephrologists, and the establishment of the discipline of nephrology.⁴

As in the rest of the world, general pediatrics started as a following to adult physicians and pediatric nephrology as a following to adult nephrologists, taking them as examples. When the Turkish Society of Nephrology was founded in March 1970, the pediatricians became members and have worked with adult nephrologists to this day. Before this date, Turkish pediatricians were closely following the studies in the field of pediatric nephrology and the global pioneers of the 1960s. During these years, Turkish pioneers were trying to improve their nephrology knowledge even before the International Society of Pediatric Nephrology and the European Society of Pediatric Nephrology were established. For this, they made an effort to study abroad and trained in Europe and the United States from 1960 to 1979 (Table 1).

When these physicians returned home, they pioneered the establishment and development of pediatric nephrology, the training of young pediatric nephrologists, and the initiation of hemodialysis-peritoneal dialysis and pediatric renal transplantation in many centers, such as Istanbul, Ankara, Izmir, Adana, Antalya, and Kayseri.

It should be noted that, thanks to İhsan Doğramacı, many of these scientists were directed to pediatric nephrology, that abroad education and research opportunities were provided, and that many disciplines such as pediatric nephrology and nephropathology were developed. Ihsan Dogramaci, the great mentor with a cosmopolitan vision, paid much attention to pediatric nephrology, thus initiating the process of implementing pediatric nephrology in Türkiye and in Europe. İhsan Doğramacı established the pediatric nephrology department in Ankara-Hacettepe in the early 1960s. He closely followed the developments in the field of nephrology in Europe and the United Stares; in addition to being one of the founders of the European Society for Pediatric Nephrology, he also ensured that Türkiye was granted founding member status among 23 countries.²

In November 1983, pediatric nephrology achieved the status of a subspecialty in pediatrics in Türkiye. Turkish pediatric nephrologists whose accumulation increased over the years established the Pediatric Nephrology Association on July 20, 1990. The founding members of this society were Faik Tanman, ümit Saatçi, Keriman Tınaztepe, Alphan Cura, Ayfer Gür Güven, Necmiye Tümer, Ayşin Bakkaloğlu, Hulusi Koçak, Aydan Şirin, Nurdan Kural, Galip Köse, Sevinç Emre, Enver Hasanoğlu, Sevgi Mir, and Nesrin Beşbaş.

The development of pediatric nephrology in Türkiye has gained momentum with the standardization of pediatric nephrology education, systematic and crucial educational studies that set an example for European countries such as the programming, and standardization of core education (curriculum) for training in pediatric nephrology. Proficiency examinations (certification) have been accomplished. Accreditation of training centers was done on a voluntary basis. While previously together with Turkish Society of Nephrology, for the past 11 years, the Turkish Pediatric Nephrology Association has been participating in European patient registration systems with independent data.

Multicenter studies covering important diseases of pediatric nephrology have been initiated and are continuing. These studies have also been published in international journals, especially in prestigious journals such as Pediatric Nephrology and Pediatric Transplantation. The publications of the Turkish pediatric nephrology community were successful enough to be in the top 3 in Europe and in the top 5 in the world.⁵ Multicenter study subjects can be grouped under the headings of hereditary-familial renal diseases, familial Mediterranean fever, nephrotic syndrome, chronic renal failure, hemolytic uremic syndrome, vasculitis, tubular disorders, congenital urinary system abnormalities, urolithiasis, peritoneal dialysis, and renal transplantation. Progress has recently been made in the field of nephrogenetics and molecular nephrology. We have contributed internationally to subjects such as familial Mediterranean fever, hereditary renal diseases, hereditary nephrotic syndromes, lupus nephritis, cystinosis, distal renal tubular acidosis, and atypic hemolytic uremic syndrome.

Another historical beginning is the arrival of the pediatrician and adolescent specialist Sidney W. Maurer from the United States to Ankara-Hacettepe in 1964 among the peace volunteers. He taught biopsy techniques to Nimet ünay Gündoğan, assistant of pediatrics under the patronage of Mithat Çoruh, the head of the Pediatric Nephrology unit (personal communication with Nimet ünay Gündoğan and Mithat Çoruh in 2011).⁶ Thus, the practice of closed needle biopsy was started. Renal biopsy evaluations in pediatric patients were initiated by Keriman Tınaztepe (personal communication), one of the founders of Pediatric Pathology in Türkiye and by Behçet Tınaztepe, who was educated at the University of Pennsylvania in the field of pathology.^7,8

Historically, the first pediatric hemodialysis application in Türkiye was carried out in Hacettepe in 1974, the first pediatric renal transplantation from a living donor was carried out in Hacettepe in 1975, and the first pediatric continuous peritoneal dialysis was carried out at the Ankara Medical School in 1989.

With regard to international collaborations, since 2000, a council member from Türkiye has continuously been elected to the executive board of the European Society of Pediatric Nephrology; presently, it is led by President Rezan Topaloğlu. Hilal Mocan was elected as the first Turkish member in 2000, followed by Necla Buyan (2003-2006), Ayfer Gür Güven (2006-2009), Rezan Topaloğlu (2009-2012), Fatoş Yalçınkaya (2012-2015), Ali Düzova (2014-2017), Sevcan Bakkaloğlu (2017-2020), and Aysun Karabay Beyazıt (2020-2023), who joined the management of the European Society for Pediatric Nephrology. In addition, Ayfer Gür Güven served as the European Society for Pediatric Nephrology Education Commission Chair between 2009 and 2012. Rezan Topaloğlu served as Assistant President between 2015 and 2019 and has been the European Society for Pediatric Nephrology President since 2019. Ayşin Bakkaloğlu in 2001, Oğuz Söylemezoğlu in 2010, and later Rezan Topaloğlu became members of the International Society of Pediatric Nephrology board of directors. Rezan Topaloğlu became the International Society of Pediatric Nephrology Junior Master Class Chair. Oğuz Söylemezoğlu served as a board member of the International Pediatric Transplantation Association between 2009 and 2011. Sevcan Bakkaloğlu served as Scientific Advisory Board Member and has important duties in other associations, including European Renal Association-European Renal Best Practice (2017 to present), European Society for Pediatric Nephrology Registry Türkiye Representative (2017 to present), European Society for Pediatric Nephrology Registry Vice Chair (2021 to present), European Society for Pediatric Nephrology Dialysis Working Group Board Member (2013-2018), European Society for Pediatric Nephrology Chronic Kidney Disease Mineral Bone Disorders Working Group Board Member (2013-2019), and European Pediatric Dialysis Working Group Council Member (2009 to present).

The 39th European Society for Pediatric Nephrology congress was held in Istanbul from September 10 through September 13, 2005, and the 51st European Society for Pediatric Nephrology congress was held in Antalya from October 3 through October 6, 2018. In 2009, the fifth International Pediatric Transplantation Congress was held in İstanbul. In addition to these, in 1998, the South Eastern European Pediatric Nephrology Working Group was formed with the support of Ihsan Dogramaci, which created collaborations among Balkan countries.

With the organization of the Turkish Pediatric Nephrology Association, since 1996, national congresses with international participation every 2 years, training seminars in different cities every year, and monthly case discussions have been held.

Today, Türkiye has 107 pediatric nephrology centers and 265 well-trained specialists, 28 pediatric hemodialysis units, 39 pediatric peritoneal dialysis units, and 26 pediatric transplant centers. The Turkish Pediatric Nephrology Association continues its institutional, scientific, educational, and social duties with increasing momentum and devotion.

Volume: 21 Issue: 6 June 2023 - Supplement - 2

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