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Yale Medicine Thesis Digital Library

Starting with the Yale School of Medicine (YSM) graduating class of 2002, the Cushing/Whitney Medical Library and YSM Office of Student Research have collaborated on the Yale Medicine Thesis Digital Library (YMTDL) project, publishing the digitized full text of medical student theses on the web as a valuable byproduct of Yale student research efforts. The digital thesis deposit has been a graduation requirement since 2006. Starting in 2012, alumni of the Yale School of Medicine were invited to participate in the YMTDL project by granting scanning and hosting permission to the Cushing/Whitney Medical Library, which digitized the Library’s print copy of their thesis or dissertation. A grant from the Arcadia Fund in 2017 provided the means for digitizing over 1,000 additional theses. IF YOU ARE A MEMBER OF THE YALE COMMUNITY AND NEED ACCESS TO A THESIS RESTRICTED TO THE YALE NETWORK, PLEASE MAKE SURE YOUR VPN (VIRTUAL PRIVATE NETWORK) IS ON.

Theses/Dissertations from 2023 2023

Radiomics: A Methodological Guide And Its Applications To Acute Ischemic Stroke , Emily Avery

Characterization Of Cutaneous Immune-Related Adverse Events Due To Immune Checkpoint Inhibitors , Annika Belzer

An Investigation Of Novel Point Of Care 1-Tesla Mri Of Infants’ Brains In The Neonatal Icu , Elisa Rachel Berson

Understanding Perceptions Of New-Onset Type 1 Diabetes Education In A Pediatric Tertiary Care Center , Gabriel BetancurVelez

Effectiveness Of Acitretin For Skin Cancer Prevention In Immunosuppressed And Non-Immunosuppressed Patients , Shaman Bhullar

Adherence To Tumor Board Recommendations In Patients With Hepatocellular Carcinoma , Yueming Cao

Clinical Trials Related To The Spine & Shoulder/elbow: Rates, Predictors, & Reasons For Termination , Dennis Louis Caruana

Improving Delivery Of Immunomodulator Mpla With Biodegradable Nanoparticles , Jungsoo Chang

Sex Differences In Patients With Deep Vein Thrombosis , Shin Mei Chan

Incorporating Genomic Analysis In The Clinical Practice Of Hepatology , David Hun Chung

Emergency Medicine Resident Perceptions Of A Medical Wilderness Adventure Race (medwar) , Lake Crawford

Surgical Outcomes Following Posterior Spinal Fusion For Adolescent Idiopathic Scoliosis , Wyatt Benajmin David

Representing Cells As Sentences Enables Natural Language Processing For Single Cell Transcriptomics , Rahul M. Dhodapkar

Life Vs. Liberty And The Pursuit Of Happiness: Short-Term Involuntary Commitment Laws In All 50 US States , Sofia Dibich

Healthcare Disparities In Preoperative Risk Management For Total Joint Arthroplasty , Chloe Connolly Dlott

Toll-Like Receptors 2/4 Directly Co-Stimulate Arginase-1 Induction Critical For Macrophage-Mediated Renal Tubule Regeneration , Natnael Beyene Doilicho

Associations Of Atopic Dermatitis With Neuropsychiatric Comorbidities , Ryan Fan

International Academic Partnerships In Orthopaedic Surgery , Michael Jesse Flores

Young Adults With Adhd And Their Involvement In Online Communities: A Qualitative Study , Callie Marie Ginapp

Becoming A Doctor, Becoming A Monster: Medical Socialization And Desensitization In Nazi Germany And 21st Century USA , SimoneElise Stern Hasselmo

Comparative Efficacy Of Pharmacological Interventions For Borderline Personality Disorder: A Network Meta-Analysis , Olivia Dixon Herrington

An Examination Of Honor Society Membership, Mistreatment, And Discrimination By Medical Student Demographics , Katherine Ann Hill

Factors Influencing Decision For Contralateral Prophylactic Mastectomy Versus Unilateral Mastectomy , Julian Huang

Beta-Catenin Nuclear Transport In Wnt Signaling: Kap-Beta2/transportin Mediates Nuclear Import Of Beta-Catenin Via A Py-Nls Motif In A Ran Gtpase Dependent Manner , Woong Y. Hwang

Perspectives On Emergency Department-Initiated Buprenorphine Among Clinical Pharmacists , Marissa Justen

Examination For Independent Predictors Of Seasonality Of Birth Across Forty-Nine Low- And Middle-Income Countries: Analyses Of The United States Agency For International Development Demographic And Health Survey Data , Jehanzeb Kayani

Pediatricians, Social Identity, And The Law In The Early-Twentieth-Century United States , Christopher R. Keys

Single Neuronal Firing Dynamics In A Mouse Model For Absence Seizures , Waleed Khan

The Impact Of Cannabidiol In Patients With Early Psychosis: A Randomized Controlled Trial , Sreeja Kodali

Renalase Agonist Therapy And The Cardiac Response To Pressure Overload In Chronic Kidney Disease , Govind Krishna Kumar Nair

Sociodemographic And Insurance Disparities In Urologic Oncology Care Access And Surgical Outcomes , Folawiyo Laditi

How Ethics Committees Deliberate Resource Allocation For Undocumented Children, A Qualitative Analysis , YuKyung Lee

Mental Health Service Use Among Immigrant And U.S. Born Asian American Pacific Islanders , Hieronimus Loho

Severity And Operative Age In Metopic Synostosis: The Association With Neurocognitive Outcomes , Aaron Samuel Long

Comparison Of The Bone Bruise Patterns In Contact And Non-Contact Acute Anterior Cruciate Ligament Injuries , Jay Thomas Moran

Multi-Omic Differences Between Right And Left Sided Colorectal Cancer Liver Metastases , Montana Tremaine Morris

Almajiri Health; A Scoping Review On Disease, Health Literacy And Space For Participatory Research , Muzzammil Imran Muhammad

Investigating Effects Of Glycolysis Inhibition On Metabolism And Extracellular Ph In A Mouse Model Of Hepatocellular Carcinoma , David Nam

Applying Deep Learning To Identify Imaging Biomarkers To Predict Cardiac Outcomes In Cancer Patients , Aishwarya Kishore Nene

Incarcerated Patients Have Higher Mortality After Trauma: An Unreported Healthcare Disparity , Harry NewmanPlotnick

The Association Between Social Needs Care Coordination And Social Needs Status Amongst Patients In A Federally Qualified Health Center , Autumn Nobles

Diagnosis Of Polycystic Ovary Syndrome And Non-Hispanic Black Race Are Predictive Of Hypertension In Reproductive Age Women -Analysis Of Real World Electronic Medical Record Data , Nyerovwo Okifo

Utility Of Shear Wave Elastography In Breast Cancer Diagnosis: A Systematic Review And Meta-Analysis , Aishwarya Pillai

“I Was Reaching Out For Help And They Did Not Help Me”: Mental Healthcare In The Carceral State , Anna Grace Preston

Associations Of Frailty With Tumor Characteristics & Longitudinal Outcomes In Patients With Meningiomas , Hanya M. Qureshi

A Single Nucleotide Polymorphism In An Rgs6 Enhancer Regulates Heart Rate Variability And Parasympathetic Modulation , Namita Ravi

Firearm Injury Prevention Strategies In Children And Young Adults , Christopher Schenck

Assessing Quality Of Oral Cancer Care Across A Health System And Region: Opportunities To Improve Care , Hemali Parimal Shah

Single-Cell Transcriptomic Atlas Reveals Molecular Drivers Of Human Inner Ear Development , Amar H. Sheth

More Than Meets The Eye: Improving Recognition Of Child Abuse In Emergency Departments , May Shum

A Novel Smarcc1-Mutant Bafopathy Implicates Epigenetic Dysregulation Of Fetal Neural Progenitors In The Pathogenesis Of Congenital Hydrocephalus , Amrita K. Singh

Baseline Skin Cytokine Profiles Determined By Rna In Situ Hybridization Correlate With Response To Dupilumab In Patients With Eczematous Dermatitis , Katelyn Singh

Barriers To Identifying Learning Disabilities: A Qualitative Study Of Clinicians And Educators , Lauren Stone

"Come On. I Need An Answer." A Mixed-Methods Study Of Barriers And Disparities In Diagnostic Odysseys , Zeyu Tang

Cognitive Impairment And Long-Term Health Outcomes In Patients With Coronary Microvascular Dysfunction , Abriana Tasillo

Family Dyads, Emotional Labor, And The Theater Of The Clinical Encounter: Co-Constructive Patient Simulation As A Reflective Tool In Child And Adolescent Psychiatry Training , Isaiah Thomas

Comparative Effectiveness Of Digital Breast Tomosynthesis For Breast Cancer Screening In Older Women , Akhil Upneja

Analysis Of Prices And Outcomes For Common Hospitalized Conditions In 2021 , Lina Vadlamani

Recording Multiunit Activity Of The Locus Coeruleus In An Awake Mouse Model Of Focal Limbic Seizures , Marcus Valcarce-Aspegren

Improving Cancer Classification With Domain Adaptation Techniques , Juliana Veira

Soil-Transmitted Helminthiases And Deworming Response In School-Aged Children In Retalhuleu, Guatemala , Rebeca Esther Vergara Greeno

The Synergy Between Physiologic Dendritic Cells And Mrna-Loaded Lipid Nanoparticles And Its Potential As A Cellular Immunotherapy , Brian Myles Wei

Lipid Profiles Help Explain Protection From Atherosclerosis In Ascending Aortic Aneurysm Patients , Gabe Weininger

The Impact Of Peer Interventions On Physical Activity For Individuals Living With Mental Illness , Julia Wolfe

Perioperative Outcomes In Patients With Systemic Sclerosis: An Analysis Of A Large Case Series , Luying Yan

Engineering And Evaluating Biodegradable Bioadhesive Nanoparticle-Encapsulated Sunscreens , Beverly Xi Yu

Theses/Dissertations from 2022 2022

Contested Spaces, Stigmatized Treatment: Methadone In 1970s New York, Boston, And New Orleans , Zoe Miranda Adams

Comorbid Pad And Mvd: A Retrospective Nrd Analysis Of Trends, Outcomes, And Readmissions , Miguel Algara

Epidemiology Of Domestic Violence-Related Ocular Injuries Among Adult Patients , Joana E. Andoh

Longitudinal Modeling Of Early Hiv Burden In The Central Nervous System , Victor Diego Armengol

Generating Clinical Evidence Using Real World Data And Personal Digital Devices , Victoria L. Bartlett

Incidence And Prognosis Of Cranial Neuropathies In Children With Covid-19: A Systematic Review And Meta-Analysis , Priyanka Bisarya

A Deep Dive In Head & Neck Cancer: Machine Learning Applications In Diagnostic And Prognostic Evaluations , Alexandra Tan Bourdillon

A Serological Survey Of Sars-Cov-2 Infection In Casino Employees , Julian Campillo Luna

The Real Cause Of The Broken Rib: Developments In Pediatricians' Approach To Child Abuse; 1960 - 2020 , Sofia Charania

Identification Of A Novel Link Between Adiposity And Visuospatial Ability , Herbert Alexander Chen

Predictors Of Very Late Onset Infection In Kidney Transplant Recipients At Least Ten Years Post Transplant , Harry Cheung

Deep Learning Algorithms For Predicting Response To Neoadjuvant Chemotherapy For Breast Cancer , Rachel Choi

Testing Ictal Conscious Awareness: Responsiveness Versus Recall Of Experiences During Seizures , Violeta Contreras Ramirez

Mechanisms Of Progestin Resistance In Reproductive-Age Women With Atypical Endometrial Hyperplasia , Katherine Mcmaster Cooke

Biomarkers Of Egfr Decline After Pediatric Cardiac Surgery In The Assess-Aki Cohort , Christina Anne-Josiane De Fontnouvelle

Amd3100 Administration For The Treatment Of Asherman’s Syndrome In A Murine Model , Pablo Antonio Delis

Fracture Callus Evaluation In The Setting Of Breast Cancer Metastasis And Rescue Of Healing Via Inhibition Of Erk1/2 , Christopher Dussik

Primary Care Characteristics And Medication Management Among Patients Receiving Office Based Opioid Treatment With Buprenorphine , Xinxin Du

Factors Impacting Trauma-Specific Quality Of Life Following Injury: A Multi-Center Assessment In Lebanon , Ali Elreichouni

Consciousness: Mechanisms And Neuropsychiatric Outcomes , Isaac Gilbert Freedman

Investigation Of Outcomes Following Cervical Spine Surgery In Patients With Pre-Existing Non-Spinal Neurological Conditions , Anoop Raj Galivanche

Medical Students’ Experiences, Knowledge, And Perceptions Of Patients With Substance Use Disorder , Sophia Francesca Gamez

“people Fall Through The Cracks”: Prolonged Lengths Of Stay Beyond Medical Necessity , Lucy Gao

Housing As Healthcare: The Role Of Homelessness In Patient Characteristics And Retention In Outpatient Medication For Opioid Use Disorder Treatment , Marina Gaeta Gazzola

Sleep Apnea In Veterans With Schizophrenia: Estimating Prevalence And Impact On Cognition , Stephen Edward Ghazikhanian

Self-Injurious Behavior And Problematic Video Gaming In Adolescents With Problematic Shopping , Norman Robert Greenberg

Importance Of Social Support In Older Adults After Hospitalization For Acute Myocardial Infarction , Yaakov Green

In-Vivo Nanoparticle Delivery To Fetal Mouse Pancreas And Liver , Mary Elizabeth Guerra

Characteristics Of Inpatient Behavioral Health Services And Hormonal Treatment Decision-Making In Transgender/gender-Expansive Youth , Justin William Halloran

Preferential Utilization Of Resident Physicians To Care For Patients With Medicaid And Persons Of Color At Us Academic Health Centers , Samer Hassan

Atypical Presentation Of Hereditary Hypophosphatemic Rickets With Hypercalciuria Due To Digenic Mutations , Bryan Bo-Ran Ho

Gender Differences In Outcomes Of Coordinated Specialty Care For Early Psychosis , Seong Im Hong

Resident Physician Thriving And The Residency Experience During The Covid-19 Pandemic: A Qualitative Study , Joshua Hyman

Early Experience With The Fda’s Breakthrough Devices Program And Potential Payment Mechanisms , James Johnston

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Search for theses.

• Orbis , Yale Online Catalog Search for all Yale theses using Orbis by including the words "Yale" and  "thesis" as keywords in your search.  Items cataloged in Orbis will have both a call number and a "handle" URL for the catalog record. Please include both if if you make an email inquiry about access.  
• Dissertations & Theses - Full Text  Digital Dissertations contains more than 1.6 million entries with information about doctoral dissertations, including Yale MD/PhD dissertations. It is the same database as Dissertation Abstracts, but with the significant advantage that titles published since 1997 are available in PDF digital format.  
• Yale Medicine Thesis Digital Library Project Starting in 2006, each YSM graduating class is required to deposit an electronic thesis. Theses from 2011-onward are also accessible through Dissertations & Theses - Full Text . Note: If a medical student selects a temporary or permanent embargo for campus-only access, the full-text will not be available in the Proquest system during the embargo. Thesis abstracts should be available in either EliScholar or Proquest.  
• EliScholar Alumni theses can be found in Yale University’s institutional repository. If you would like to have your thesis added to EliScholar, please complete this form .

Theses in the Library

The Medical Library receives one copy of each Yale School of Medicine thesis and two copies of each School of Nursing thesis. School of Public Health theses are in the Medical Library through 2008. In 2009, SPH theses are electronic only and available in the Proquest Dissertations & Theses - Full Text  product. Each thesis is cataloged with author and subject entries for Orbis, the Yale online catalog. In addition, a historical list of theses arranged by year , indicating the call numbers for requesting the thesis, is shelved in the Medical Library Information Room. To view a print thesis, thesis request forms are available at the Circulation Desk. Theses from 1974 to the present are shelved within the Medical Library and are retrieved twice a day, at 11:00 a.m. and 4:30 p.m. Monday through Friday. Earlier theses are stored in the Library Shelving Facility (LSF). Theses at LSF may be delivered to the Medical Library via the campus library delivery service. The second copy of the School of Nursing theses may be checked out for home use, but all other theses must be used in the Library. For more information, please call the Circulation Desk 203-785-5354.

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PhD Thesis Guide

This phd thesis guide will guide you step-by-step through the thesis process, from your initial letter of intent to submission of the final document..

All associated forms are conveniently consolidated in the section at the end.

Deadlines & Requirements

Students should register for HST.ThG during any term in which they are conducting research towards their thesis. Regardless of year in program students registered for HST.ThG in a regular term (fall or spring) must meet with their research advisor and complete the  Semi-Annual PhD Student Progress Review Form to receive credit.

Years 1 - 2

• Students participating in lab rotations during year 1, may use the optional MEMP Rotation Registration Form , to formalize the arrangement and can earn academic credit by enrolling in HST.599. 
• A first letter of intent ( LOI-1 ) proposing a general area of thesis research and research advisor is required by April 30th of the second year of registration.
• A second letter of intent ( LOI-2 ) proposing a thesis committee membership and providing a more detailed description of the thesis research is required by April 30th of the third year of registration for approval by the HST-IMES Committee on Academic Programs (HICAP).

Year 4 

• Beginning in year 4, (or after the LOI-2 is approved) the student must meet with their thesis committee at least once per semester.
• Students must formally defend their proposal before the approved thesis committee, and submit their committee approved proposal to HICAP  by April 30 of the forth year of registration.
• Meetings with the thesis committee must be held at least once per semester. 

HST has developed these policies to help keep students on track as they progress through their PhD program. Experience shows that students make more rapid progress towards graduation when they interact regularly with a faculty committee and complete their thesis proposal by the deadline.

Getting Started

Check out these resources  for finding a research lab.

The Thesis Committee: Roles and Responsibilities

Students perform doctoral thesis work under the guidance of a thesis committee consisting of at least three faculty members from Harvard and MIT (including a chair and a research advisor) who will help guide the research. Students are encouraged to form their thesis committee early in the course of the research and in any case by the end of the third year of registration. The HST IMES Committee on Academic Programs (HICAP) approves the composition of the thesis committee via the letter of intent and the thesis proposal (described below). 

Research Advisor

The research advisor is responsible for overseeing the student's thesis project. The research advisor is expected to:

• oversee the research and mentor the student;
• provide a supportive research environment, facilities, and financial support;
• discuss expectations, progress, and milestones with the student and complete the  Semi-Annual PhD Student Progress Review Form each semester;
• assist the student to prepare for the oral qualifying exam;
• guide the student in selecting the other members of the thesis committee;
• help the student prepare for, and attend, meetings of the full thesis committee, to be held at least once per semester;
• help the student prepare for, and attend, the thesis defense;
• evaluate the final thesis document.

The research advisor is chosen by the student and must be a faculty member of MIT* or Harvard University and needs no further approval.  HICAP may approve other individuals as research advisor on a student-by-student basis. Students are advised to request approval of non-faculty research advisors as soon as possible.  In order to avoid conflicts of interest, the research advisor may not also be the student's academic advisor. In the event that an academic advisor becomes the research advisor, a new academic advisor will be assigned.

The student and their research advisor must complete the Semi-Annual PhD Student Progress Review during each regular term in order to receive academic credit for research.  Download Semi Annual Review Form

*MIT Senior Research Staff are considered equivalent to faculty members for the purposes of research advising. No additional approval is required.

Thesis Committee Chair

Each HST PhD thesis committee is headed administratively by a chair, chosen by the student in consultation with the research advisor. The thesis committee chair is expected to:

• provide advice and guidance concerning the thesis research; 
• oversee meetings of the full thesis committee, to be held at least once per semester;
• preside at the thesis defense; 
• review and evaluate the final thesis document.

The thesis committee chair must be well acquainted with the academic policies and procedures of the institution granting the student's degree and be familiar with the student's area of research. The research advisor may not simultaneously serve as thesis committee chair.

For HST PhD students earning degrees through MIT, the thesis committee chair must be an MIT faculty member. A select group of HST program faculty without primary appointments at MIT have been pre-approved by HICAP to chair PhD theses awarded by HST at MIT in cases where the MIT research advisor is an MIT faculty member.**

HST PhD students earning their degree through Harvard follow thesis committee requirements set by the unit granting their degree - either the Biophysics Program or the School of Engineering and Applied Sciences (SEAS).

** List of non-MIT HST faculty approved to chair MIT thesis proposals when the research advisor is an MIT faculty member.

In addition to the research advisor and the thesis committee chair, the thesis committee must include one or more readers. Readers are expected to:

• attend meetings of the full thesis committee, to be held at least once per semester;
• attend the thesis defense; 

Faculty members with relevant expertise from outside of Harvard/MIT may serve as readers, but they may only be counted toward the required three if approved by HICAP.

The members of the thesis committee should have complementary expertise that collectively covers the areas needed to advise a student's thesis research. The committee should also be diverse, so that members are able to offer different perspectives on the student's research. When forming a thesis committee, it is helpful to consider the following questions: 

• Do the individuals on the committee collectively have the appropriate expertise for the project?
• Does the committee include at least one individual who can offer different perspectives on the student's research?  The committee should include at least one person who is not closely affiliated with the student's primary lab. Frequent collaborators are acceptable in this capacity if their work exhibits intellectual independence from the research advisor.
• If the research has a near-term clinical application, does the committee include someone who can add a translational or clinical perspective?  
• Does the committee conform to HST policies in terms of number, academic appointments, and affiliations of the committee members, research advisor, and thesis committee chair as described elsewhere on this page?

[Friendly advice: Although there is no maximum committee size, three or four is considered optimal. Committees of five members are possible, but more than five is unwieldy.]

Thesis Committee Meetings

Students must meet with their thesis committee at least once each semester beginning in the fourth year of registration. It is the student's responsibility to schedule these meetings; students who encounter difficulties in arranging regular committee meetings can contact Julie Greenberg at jgreenbe [at] mit.edu (jgreenbe[at]mit[dot]edu) .

The format of the thesis committee meeting is at the discretion of the thesis committee chair. In some cases, the following sequence may be helpful:

• The thesis committee chair, research advisor, and readers meet briefly without the student in the room;
• The thesis committee chair and readers meet briefly with the student, without the advisor in the room;
• The student presents their research progress, answers questions, and seeks guidance from the members of the thesis committee;

Please note that thesis committee meetings provide an important opportunity for students to present their research and respond to questions. Therefore, it is in the student's best interest for the research advisor to refrain from defending the research in this setting.

Letters of Intent

Students must submit two letters of intent ( LOI-1 and LOI-2 ) with applicable signatures. 

In LOI-1, students identify a research advisor and a general area of thesis research, described in 100 words or less. It should include the area of expertise of the research advisor and indicate whether IRB approval (Institutional Review Board; for research involving human subjects) and/or IACUC approval (Institutional Animal Care and Use Committee; for research involving vertebrate animals) will be required and, if so, from which institutions. LOI-1 is due by April 30 of the second year of registration and and should be submitted to HICAP, c/o Traci Anderson in E25-518. 

In LOI-2, students provide a description of the thesis research, describing the Background and Significance of the research and making a preliminary statement of Specific Aims (up to 400 words total). In LOI-2, a student also proposes the membership of their thesis committee. In addition to the research advisor, the proposed thesis committee must include a chair and one or more readers, all selected to meet the specified criteria . LOI-2 is due by April 30th of the third year of registration and should be submitted to HICAP, c/o Traci Anderson in E25-518.

LOI-2 is reviewed by the HST-IMES Committee on Academic Programs (HICAP) to determine if the proposed committee meets the specified criteria and if the committee members collectively have the complementary expertise needed to advise the student in executing the proposed research. If HICAP requests any changes to the proposed committee, the student must submit a revised LOI-2 for HICAP review by September 30th of the fourth year of registration. HICAP must approve LOI-2 before the student can proceed to presenting and submitting their thesis proposal. Any changes to the thesis committee membership following HICAP approval of LOI-2 and prior to defense of the thesis proposal must be reported by submitting a revised LOI-2 form to HICAP, c/o tanderso [at] mit.edu (Traci Anderson) . After final HICAP approval of LOI-2, which confirms the thesis committee membership, the student may proceed to present their thesis proposal to the approved thesis committee, as described in the next section.

Students are strongly encouraged to identify tentative thesis committee members and begin meeting with them as early as possible to inform the direction of their research. Following submission of LOI-2, students are required to hold at least one thesis committee meeting per semester. Students must document these meetings via the Semi- Annual PhD Student Progress Review form in order to receive a grade reflecting satisfactory progress in HST.ThG.

Thesis Proposal and Proposal Presentation

For MEMP students receiving their degrees through MIT, successful completion of the Oral Qualifying Exam is a prerequisite for the thesis proposal presentation. For MEMP students receiving their degrees through Harvard, the oral qualifying exam satisfies the proposal presentation requirement.

Proposal Document

Each student must present a thesis proposal to a thesis committee that has been approved by HICAP via the LOI-2 and then submit a full proposal package to HICAP by April 30th of the fourth year of registration. The only exception is for students who substantially change their research focus after the fall term of their third year; in those cases the thesis proposal must be submitted within three semesters of joining a new lab. Students registering for thesis research (HST.THG) who have not met this deadline may be administratively assigned a grade of "U" (unsatisfactory) and receive an academic warning.

The written proposal should be no longer than 4500 words, excluding references. This is intended to help students develop their proposal-writing skills by gaining experience composing a practical proposal; the length is comparable to that required for proposals to the NIH R03 Small Research Grant Program. The proposal should clearly define the research problem, describe the proposed research plan, and defend the significance of the work. Preliminary results are not required. If the proposal consists of multiple aims, with the accomplishment of later aims based on the success of earlier ones, then the proposal should describe a contingency plan in case the early results are not as expected.

Proposal Presentation

The student must formally defend the thesis proposal before the full thesis committee that has been approved by HICAP.

Students should schedule the meeting and reserve a conference room and any audio visual equipment they may require for their presentation. To book a conference room in E25, please contact Joseph Stein ( jrstein [at] mit.edu (jrstein[at]mit[dot]edu) ).

Following the proposal presentation, students should make any requested modifications to the proposal for the committee members to review. Once the committee approves the proposal, the student should obtain the signatures of the committee members on the forms described below as part of the proposal submission package.

[Friendly advice: As a professional courtesy, be sure your committee members have a complete version of your thesis proposal at least one week in advance of the proposal presentation.]

Submission of Proposal Package

When the thesis committee has approved the proposal, the student submits the proposal package to HICAP, c/o Traci Anderson in E25-518, for final approval. HICAP may reject a thesis proposal if it has been defended before a committee that was not previously approved via the LOI-2.

The proposal package includes the following: 

• the proposal document
• a brief description of the project background and significance that explains why the work is important;
• the specific aims of the proposal, including a contingency plan if needed; and
• an indication of the methods to be used to accomplish the specific aims.
• signed research advisor agreement form(s);
• signed chair agreement form (which confirms a successful proposal defense);
• signed reader agreement form(s).

Thesis Proposal Forms

• SAMPLE Title Page (doc)
• Research Advisor Agreement Form (pdf)
• Chair Agreement Form (pdf)
• Reader Agreement Form (pdf)

Thesis Defense and Final Thesis Document

When the thesis is substantially complete and fully acceptable to the thesis committee, a public thesis defense is scheduled for the student to present his/her work to the thesis committee and other members of the community. The thesis defense is the last formal examination required for receipt of a doctoral degree. To be considered "public", a defense must be announced to the community at least five working days in advance. At the defense, the thesis committee determines if the research presented is sufficient for granting a doctoral degree. Following a satisfactory thesis defense, the student submits the final thesis document, approved by the research advisor, to Traci Anderson via email (see instructions below).

[Friendly advice: Contact jrstein [at] mit.edu (Joseph Stein) at least two weeks before your scheduled date to arrange for advertising via email and posters. A defense can be canceled for insufficient public notice.]

Before the Thesis Defense 

Committee Approves Student to Defend: The thesis committee, working with the student and reviewing thesis drafts, concludes that the doctoral work is complete. The student should discuss the structure of the defense (general guidelines below) with the thesis committee chair and the research advisor. 

Schedule the Defense: The student schedules a defense at a time when all members of the thesis committee will be physical present. Any exceptions must be approved in advance by the IMES/HST Academic Office.

Reserve Room: It is the student's responsibility to reserve a room and any necessary equipment. Please contact imes-reservation [at] mit.edu (subject: E25%20Room%20Reservation) (IMES Reservation) to  reserve rooms E25-140, E25-141, E25-119/121, E25-521. 

Final Draft: A complete draft of the thesis document is due to the thesis committee two weeks prior to the thesis defense to allow time for review.  The thesis should be written as a single cohesive document; it may include content from published papers (see libraries website on " Use of Previously Published Material in a Thesis ") but it may not be a simple compilation of previously published materials.

Publicize the Defense:   The IMES/HST Academic Office invites the community to attend the defense via email and a notice on the HST website. This requires that the student email a thesis abstract and supplemental information to  jrstein [at] mit.edu (Joseph Stein)  two weeks prior to the thesis defense. The following information should be included: Date and time, Location, (Zoom invitation with password, if offering a hybrid option), Thesis Title, Names of committee members, with academic and professional titles and institutional affiliations. The abstract is limited to 250 words for the poster, but students may optionally submit a second, longer abstract for the email announcement.

Thesis Defense Guidelines

Public Defense: The student should prepare a presentation of 45-60 minutes in length, to be followed by a public question and answer period of 15–30 minutes at discretion of the chair.

Committee Discussion:  Immediately following the public thesis presentation, the student meets privately with the thesis committee and any other faculty members present to explore additional questions at the discretion of the faculty. Then the thesis committee meets in executive session and determines whether the thesis defense was satisfactory. The committee may suggest additions or editorial changes to the thesis document at this point.

Chair Confirms Pass: After the defense, the thesis committee chair should inform Traci Anderson of the outcome via email to tanderso [at] mit.edu (tanderso[at]mit[dot]edu) .

Submitting the Final Thesis Document

Please refer to the MIT libraries  thesis formatting guidelines .

Title page notes. Sample title page  from the MIT Libraries.

Program line : should read, "Submitted to the Harvard-MIT Program in Health Sciences and Technology, in partial fulfillment of the the requirements for the degree of ... "

Copyright : Starting with the June 2023 degree period and as reflected in the  MIT Thesis Specifications , all students retain the copyright of their thesis.  Please review this section for how to list on your title page Signature Page: On the "signed" version, only the student and research advisor should sign. Thesis committee members are not required to sign. On the " Accepted by " line, please list: Collin M. Stultz, MD, PhD/Director, Harvard-MIT Program in Health Sciences and Technology/ Nina T. and Robert H. Rubin Professor in Medical Engineering and Science/Professor of Electrical Engineering and Computer Science.

The Academic Office will obtain Professor Stultz's signature.

Thesis Submission Components.  As of 4/2021, the MIT libraries have changed their thesis submissions guidelines and are no longer accepting hard copy theses submissions. For most recent guidance from the libraries:  https://libguides.mit.edu/mit-thesis-faq/instructions  

Submit to the Academic Office, via email ( tanderso [at] mit.edu (tanderso[at]mit[dot]edu) )

pdf/A-1 of the final thesis should include an UNSIGNED title page

A separate file with a SIGNED title page by the student and advisor, the Academic Office will get Dr. Collin Stultz's signature.

For the MIT Library thesis processing, fill out the "Thesis Information" here:  https://thesis-submit.mit.edu/

File Naming Information:  https://libguides.mit.edu/

Survey of Earned Doctorates.  The University Provost’s Office will contact all doctoral candidates via email with instructions for completing this survey.

Links to All Forms in This Guide

• MEMP Rotation Form (optional)
• Semi-Annual Progress Review Form
• Letter of Intent One
• Letter of Intent Two

Final Thesis

• HST Sample thesis title page  (signed and unsigned)
• Sample thesis title page  (MIT Libraries)

Edinburgh Research Archive

•   ERA Home
• Edinburgh Medical School

Edinburgh Medical School thesis and dissertation collection

By Issue Date Authors Titles Subjects Publication Type Sponsor Supervisors

Search within this Collection:

Edinburgh Medical School is one of two schools at the College of Medicine and Veterinary Medicine at the University of Edinburgh. The Edinburgh Medical School integrates research and teaching across our three Deaneries: Biomedical Sciences, Clinical Sciences and Molecular,Genetic and Population Health Sciences.

Recent Submissions

Phenotype of newly generated neurons following spinal cord injury in zebrafish , exploration of relationships between life course measures of socioeconomic status and structural brain changes linked with older life cognitive decline , high resolution analysis of the tumour microenvironment of high grade serous ovarian cancer (hgsoc) using single cell transcriptomics and quantitative histopathological examination , complications of portal hypertension: clinical studies , imaging of abdominal aortic aneurysm disease activity and implications for endovascular aneurysm repair , hallmarks of cotranslational protein complex assembly and its relationship with the dominant-negative effect , optimising islet transplantation therapy for the treatment of type 1 diabetes by targeting the liver niche with etanercept-loaded microparticles to promote the long term function of islets , developing a systematic, data-driven framework to identify, evaluate, and prioritise candidate drugs for clinical trials in motor neuron disease , investigating an arginase 1⁺ monocyte- macrophage population in driving fibrosis in chronic kidney disease. , in vivo investigation of component-specific functions of the hippo pathway , prevalence of female infertility in the uk armed forces , understanding colorectal cancer risk loci that alter transcriptional dynamics , behaviour change intervention for smokeless tobacco (st) cessation delivered by dentists in a dental setting: a feasibility study , dna methylation & its regulation in colorectal tumours , lesion reversibility in small vessel disease: understanding changes contributing to vascular dementia , effect of autologous macrophage therapy in cirrhosis in response to individual immune reparative pathways: developing a novel therapy , computational techniques to interpret the neural code underlying complex cognitive processes , identifying genomic and phenotypic risks factors for the clinical progression of depressive symptoms , investigating the essential extracellular invadolysin metalloprotease , defining novel regulators of inflammatory signalling in pancreatic cancer .

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Writing a medical thesis: tips for post-graduate students.

What is a medical thesis?

A medical thesis is the written work resulting from an original research in the field of Medicine, Nursing, Pharmacy, and other health and life sciences. It is submitted by the students in order to obtain a higher degree from the University.

However, keep this in mind! The purpose of submitting a medical thesis is not limited to the achievement of a doctoral or post-graduate degree. It is a medium to organize the scientific knowledge in a way to make further progress in the field.

That’s the reason why the experts in  medical thesis writing  stress on the importance of choosing the right topic for your thesis. You must be able to address a genuine problem or series of problems through your medical thesis. Choose a topic that aligns with your interest and where you can offer a fresh perspective through your research study.

Writing your medical thesis

After choosing the topic for your research study, collaborate with your supervisor to design your research study and its goal. Collect all the information and data pertaining to your research before proceeding with your clinical trials.

Now, you are ready with your research data and clinical findings. You just need to pen down your findings in your medical thesis.

That sounds easy, isn’t it?

In reality, it’s not so. But, you need not worry!  Writing a medical thesis  becomes easy and fun if you follow the given steps with competence:

1.Outline the structure of medical thesis

Prepare an outline of the thesis in accordance with the following sections:

• Introduction: Why did you start your study?
• Methods Used
• Results of the study
• Discussion of results

List the major sections and chapters in each. Do a section at a time. Assemble all the figures and tables and organise them into a logical sequence.

2.Writing a title of the thesis

The title reflects the content of your thesis. For writing a perfect thesis title:

• Be concise and accurate. The title must neither be too long nor too short
• Avoid unnecessary words and phrases like “Observation of” or “A study of”
• Do not use abbreviations
• Avoid grammatical mistakes

3.Writing an Introduction

The purpose of writing an Introduction is to provide the reader with sufficient background information on the topic and help him understand and evaluate the results of the present study, without needing to refer to the previous publications on the topic.

• Give this background information in brief in the first paragraph
• Include the importance of the problem and what is unknown about it in the second paragraph
• State the purpose, hypothesis, and objective of your study in the last paragraph

Cite the research papers written on your research topic

• Include unnecessary information other than the problem being examined
• Include the research design, data or conclusion of your study
• Cite well-known facts
• Include information found in any textbook in the field

4.Writing the section of “Methods Used”

This section must be so written that the reader is able to repeat the study and validate its findings.

Write a detailed exposition about the participants in the study, what materials you used and how you analyzed the results

• Give references but no description for established methods
• Give a brief description and references for published but lesser known methods
• Give detailed description of new methods citing the reasons for using them and any limitations if present
• Include background information and results of the study
• Refer to animals and patients as material
• Use trade name of the drugs; instead, use their generic names
• Use non-technical language for technical statistical terms

5.Writing your Results

Keep in mind the objective of your research while writing the “Results” section. The findings of the research can be documented in the form of:

• Illustrative graphs

Use text to summarize small amounts of data. Do not over-use tables, figures, and graphs in your paper. Moreover, do not repeat information presented in the table or figure in the text format. Text must be a summary or highlight of the information presented in tables or figures.

6.Discussing your Results

Good medical theses have a targeted discussion keeping it focused on the topic of the research. Include:

• Statement of the principal findings. Make it clear to show that your thesis includes new information
• Strengths and weaknesses of your study
• Strengths and weaknesses in relation to the other studies
• A take-home message from your study for clinicians and policymakers
• Any questions that are left unanswered in your study to propose new research

How to conclude your medical thesis?

The conclusion of your research study must comprise of:

• The most important statement or remark from the observations
• Summary of new observations, interpretations, and insights from the present study
• How your study fills the knowledge gap in its respected field?
• The broader implications of your work
• How can your work be improved by future research?

However, avoid any statement that does not support your data.

With these tips, write your thesis like a pro and don’t let it delay your doctoral award!

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Thesis/Dissertation Topics For MD/MS/DNB.

Overall More than 70 thousand Thesis Topics covering all subjects of broad specialty  

Remember Subscribing to the premium thesis topics not only will enable you to browse through premium thesis topics but also you will get access to online guidance about synopsis writing, sample size calculation, inclusion and exclusion criteria and guidance throughout thesis writing. In case you dont subscribe still do not hesitate to contact me for guidance.

Thesis Topics for MD/MS and DNB

It’s a junior resident’s nightmare to search for appropriate thesis topics for MD/MS and DNB. While we all know the first year of residency in any medical college is a period when the junior residents are all overburdened with work. It’s not uncommon to see Junior Residents not getting time to eat, shave or even take bath. In this demanding period looking for an appropriate thesis topics for MD/MS and DNB is another task that needs to be performed by Junior Residents. Many times Junior Residents end up selecting topics that they later regret selecting. 

In this regard i vividly remember my co-resident. When i joined MD radiology one of co-resident took a topic on cardiac MRI in thalassemia. Cardiac MRI facility was not available in our institute and then for this she had an agreement with a private diagnostic center for cardiac MRI at concessional rates. After some days the management of that private diagnostic center changed and new management refused to do cardiac MRI at concessional rates and all hell broke. She suffered a lot because she didn’t think at the time of choosing thesis topic that cardiac MRI was not available in our department. So carefully choosing a thesis topic is a must. 

The topics for MD/MS and DNB should be important but not difficult. And for this you have to go through at least 400-500 thesis topics for MD/MS/DNB before selecting one.  Its not possible to search for thesis topics in libraries, over the internet, and everywhere else because of  shortage of time.

Taking into consideration all these difficulties faced by junior residents we have painstakingly collected more than 50,000+ thesis topics for MD/MS/DNB of all broad specialty subjects. That comes to an average of 3000 thesis topics per subject. And it’s not over here we are continuously updating the list so that as and when new topics emerge on the horizon we will go on adding them.

This website will give you a list of all the relevant thesis topics in one place and it will be very hard for you to find any thesis topic outside this list. If there is a good thesis topic for MD/MS and DNB then it will be on this list. Do check the list of conventional as well as emerging Thesis Topics.

We wish you all the best in choosing appropriate thesis topics for MD/MS and DNB.

You can directly discuss with me on whatsapp regarding a thesis topic. Ill help you not only for selection of a thesis topic but also ill guide you throughout your Journey of writing thesis. I have more than 60 research papers published in my name in various national and international journals and i can guide you if you face any difficulty during writing of thesis. I can help you write synopsis, Review of literature, Statistics and discussion etc.

Please Remember you will not only get a good thesis topic from here but also you will get a mentor throughout your PG residency. Ill always be there to help you.

I have another website where i’ve helped many doctors get their paper published in national and international medical journals. Do check it click here

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Subject-wise thesis topics for md/ms and dnb.

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Thesis Topics For MDS

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Disclaimer!

There are many methods of sample size determination. It is one of the first hurdle when someone starts writing a thesis. I have tried to give simplest way of determination of sample size. You need to show the method to your PG teacher before you include this method in your thesis. First confirm from your PG teacher and then only proceed.

Publication types

• Case Reports

Home > MAHE Student Work > KMCMLR

Kasturba Medical College, Mangalore Theses and Dissertations

Theses/dissertations from 2021 2021.

“The Impact of Self-Stigma of Seeking Help and Perceived Social Support on Burnout among Clinical Psychologists” , Aavrita A

The impact of self-stigma of seeking help &percieved social support on burnout among clinical psychologists. , Aavrita .

Immediate Effects of Novel Hand Rehabilitation Board on Fine Motor Skills in Children with Cerebral Palsy. , Romita Fernandes. Abraham

"COMPARISON OF THREE SCORING CRITERIA TO ASSESS RECOVERY FROM GENERAL ANAESTHESIA IN THE POST-ANAESTHESIA CARE UNIT- A LONGITUDINAL OBSERVATIONAL STUDY " , Shagun Aggarwal

Comparative predictive validity of Alberta Infant Motor Scale and Infant Neurological International Battery in Low Birth Weight Infants- A Prospective Longitudinal Study. , Polisetti Siva Sai Anand

Antagonistic Asynchrony in Muscle Recruitment Pattern of Forward Reach Movement In Children With Cerebral Palsy. , Sanya Anklesaria

Muscle fatigue response of rotator cuff muscles in sitting and standing postures , Lisanne Aranha

Effectiveness of static weight bearing versus modified constraint induced movement therapy on improving hand function in hemiplegic cerebral palsy- A Randomized Clinical Trial. , Ruth Bavighar

How informed are our patients about generic medicines? – A study from coastal South India , Darshan BB

Morphological variants of the human spleen, a cadaveric study , Murlimanju BV

Association between cervical breast cancer and Diabtetes mellitus among women seeking health care in tertiary hospitals od south India: A cross sectional study , Pratik Kumar Chatterjee

Carcinoma Breast in among Women with Diabetes Mellitus: A Case Control Study , Pratik Kumar Chatterjee

Perception of Empathy among medical students: A cross sectional study , Pratik Kumar Chatterjee

CLINICOMYCOLOGICAL PROFILE OF DERMATOPHYTOSIS IN A TERTIARY CARE HOSPITAL IN SOUTH INDIA , Adyashree Dalai

Study of outcome of Ponseti technique of management for idiopathic clubfoot in a tertiary center in south India , Lulu Damsas

Comparative study of emotional labour &burnout on life satisfaction among school teachers across different educational settings , Meghana Dharampalan

“Comparative Study of Emotional Labor and Burnout on Life Satisfaction Among School Teachers Across Different Educational Settings” , Meghana V. Dharmapalan

“Relationship Between Sexual Fantasy, Sexual Communication, Personality Traits and Sexual Satisfaction in Married Individuals” , Rhea Dhir

Comparing the efficacy of USG guided supraclavicular brachial plexus block with or without intercostobrachial nerve block for forearm surgeries – an observational study , DIKSHA D’MELLO

Does Quality of Sitting influence Functional Mobility in Cerebral Palsy? A cross-sectional study , Kaiorisa N. Doctor

Factors effecting gait velocity in osteoarthritis knee-An observational study. , Lisha Gretal D’silva

Effect of Inspiratory Muscle Training on Pulmonary Function, Functional Capacity, Quality Of Life And Length Of Stay in individuals undergoing Cardiac Surgery , Fiona Verdine Dsouza

Relationship of Academic Resilience with Self-Efficacy, and Perceived Social Support; Among Civil Service Aspirants , Neha Eldho

EFFICACY, FEASIBILITY, AND SAFETY OF PERCUTANEOUS IMAGE-GUIDED CATHETER DRAINAGE OF THORACIC, ABDOMINAL, AND PELVIC FLUID COLLECTION , Aishwarya Gadwal

Comparison of efficacy of two different bolus doses of norepinephrine as prophylac-tic to prevent post-spinal hypotension during elective caesarean section , PRANATHI GARAPATI

Trends in Frailty and its Associated factors in Community Dwelling Elderly Indian Population during COVID-19 Pandemic- A Prospective Analytical Study , Karan Gautam

Speech Sound acquisition in some south Indian Dravidian languages: A systematic review , Jesica George

Comparison of Femoral nerve block with Dexmedetomidine and Adductor canal block with Dexmedetomidine for postoperative analgesia for Total Knee Arthroplasty . , NEHA GEORGE

Assessment Of Cardiovascular Risk Factors In Patients With Osteoarthritis Knee , Sagar Goel

Effectiveness of Intermittent Cervical Traction with and without Neural Mobilization in Discogenic Cervical Radiculopathy , Aditi Goyal

Study of maternal and cord blood vitamin B12 levels with anthropometry in term neonates born to normal and malnourished mothers: a hospital based cross sectional study , Sugapradha a. GR

Development of a Questionnaire to Determine the Intervention and Service Delivery Practices of Speech-Language Pathologists for Children with Speech Sound Disorders in India , Shaily Gupta

Relationship between Physical Activity, Objective Sleep Parameters and Circadian Rhythm in Patients with Head and Neck Cancer receiving Chemoradiotherapy- A Longitudinal Study , Rachita Gururaj

“Emotional Contagion, Perceived Stress and Coping Strategies Among Nurses” , Saumya Hariharan

Assessment of knowledge and belief about stuttering among undergraduate medical students , Anushree Harihar

Association of serum lipid levels and other systemic risk factors with retinal hard exudates in diabetic retinopathy patients. , Harshita Mukesh Hiran

Assessment of risk of Diabetes Mellitus by using Indian Diabetes Risk Score among Housekeeping staff , Ramesh Holla

“Emotional Intelligence, Self-compassion, and Life-Satisfaction In Clinical Psychologists” , Vania Jacob

UPPER-CROSSED SYNDROME AND DISABILITY IN SHOULDER ADHESIVE CAPSULITIS. , Aishwarya Jaideep

Study to assess the role of doppler ultrasound in evaluation of arteriovenous hemodialysis fistula and the complications of hemodialysis access , Ishank Jain

Relationship between burnout compassion fatigue, work environment & mindfulness in medical residents , Pranay Javeri

“Relationship Between Burnout, Compassion Fatigue, Work Environment and Mindfulness in Medical Residents” , Pranay Harichandra Javeri

“Dating Anxiety in Emerging Adults” , Jisha V. Jayaprakash

“Relationship Between Tolerance for Disagreement and Mindfulness in Married Males and Married Females” , Jahnavi Jha

Antibiotic usage and susceptibility patterns in Uncomplicated UTI in a Tertiary Hospital in South India , Christy John

Association of bed rise difficulty scale with trunk impairment and functional scales among stroke patients , Leena G. John

Is there a correlation between Pediatric Berg Balance Scale and Centre of Pressure Excursion measured through Dual Axis Static Force Plate™ to assess Balance in Children with Spastic Cerebral Palsy and Typically Developing? , Niharika Joshi

Comparison of Sensory Processing Responses in Cerebral Palsy Subtypes and Typically Developing Children (7-36 months): A Cross Sectional Study. , Archana Antony K

‘A study on the Role of Learned Helplessness, Selfefficacy and Perceived Social Support in Determining Resilience in Parents of Children with Neurodevelopmental Disorders’ , Benaisha Khurshed Katrak

A study of correlation of maternal serum zinc levels with breast milk and cord blood of late preterm neonates , Rashmi Katti

Correlation of histopathology and direct immunofluorescence findings in clinically diagnosed prurigo nodularis , Haritha K

Difference in proximal femur loading due to muscle activity during partial weight bearing and NWB standing- A cross-sectional study. , Smital Kshirsagar

Effect of Sesamol on neurobiochemical changes in diet induced (DIO) obesity model of Zebra fish (Danio rerio) , Rashmii K.S.

Importance of integration of medical ethics with undergraduate medical curriculum- Instructors and student’s perspectives. , Rashmii K.S.

Long-term potentiation (LTP): A simple yet powerful cellular process in learning and memory , Rashmii K.S.

Parkinson's Disease Overview: Alternative Potential Curcumin Treatment, Current Treatment and Prevalence Among Ethnic Groups , Rashmii K.S.

Smart brain of India vs. tricky drugs , Rashmii K.S.

The Role of Professionalism and Ethics Training: Instructor’s and Student’s perspectives in a medical College , Rashmii K.S.

Violence Against Doctors: A Qualitative Study On This Rising Predicament , Rashmii K.S.

Morphometric study of the gracilis muscle and its pedicles , Chettiar Ganesh Kumar

Comparative study of bed side tests to assess difficult airway in paediatric patients , S.Abinandha Kumar

Euphorbia thymifolia (Linn.)- A review on ethno pharmacological properties , Vasavi Kumblekar

COMPARISON OF KNOWLEDGE, ATTITUDE, AND PRACTICE TOWARDS THE USE OF SUNSCREEN IN DAILY LIFE BETWEEN FIRST -AND THIRD -YEAR MEDICAL STUDENTS , Aarushi Lall

‘Feminist Identity, Socio-cultural Attitude Towards Appearance, and Body Images issues in Emerging Adult Women’ , Sheena Lonappan

A novel approach to quantify the Dynamic Windlass Mechanism , Ishita Mahajan

METFORMIN VERSUS INSULIN IN THE MANAGEMENT OF GESTATIONAL DIABETES , Varikuti Manogna

Cognitive abilities among employed and unemployed middle-aged women – a systematic review , Aswini M

‘Emotional Intelligence, Job Satisfaction and Psychological Well-being Among Nurses’ , Chetna M

RELATIONSHIP OF COMPUTER AIDED DESIGN(CAD)-BASED PHOTOGRAMMETRY FOR FACIAL DYSFUNCTION WITH FACIAL GRADING SYSTEMS FOR BELL’S PALSY: A PROSPECTIVE OBSERVATIONAL STUDY , Ankita Mehendale

“Effect of Sensation Seeking and Anxious Traits on Suicidal Ideation Among Adults by Birth Order” , Haripriya G. M

Clinical & radiological assessment of intertrochanteric fractures treated with PFN A2 , Harish M

Effect of a home-based pulmonary rehabilitation programme on respiratory function, functional capacity, and quality of life in patients with chronic obstructive pulmonary disease , Vaibhavi Mhatre

Profiling Communication Characteristics of Individuals with Acquired Neuro-communication Disorder in a Tertiary Care Setup , Nikita Subudhi M

Relationship between weight bearing symmetry, trunk control and fear of fall amongst subjects with stroke: A cross sectional study , VIVIAN NEHAL MONIS

Lower extremity muscle recruitment pattern during sit to stand transfer in children with cerebral palsy as compared to typically developing children- a cross sectional study. , Kiran P. Nadgauda

Knowledge, attitudes and practices of Indian classical singers towards vocal healthcare , Raveena Muralidharan Nair

"Perspectives of Indian Speech Language Pathologists on Adolescent Language Assessment" , Rohana Muralidharan Nair

Effect Of Yoga On Perceived Stress And Pulmonary Function In High Stressed Postmenopausal Women , Vinodini NA

Refractory errors, blood groups & diabetes mellitus: A corrleative study in south Indian population , Vinodini NA

Comparison of Functional outcomes for displaced extra-articular distal radius fractures managed by Conservative versus Operative methods: A Prospective cohort study , Muhammed Ehsan Nazeer

COMPARATIVE STUDYOF THE EFFECTIVENESS OF VAPOCOOLANT SPRAY VERSUS EMLA®® CREAM IN REDUCING PAIN DURING INTRAVENOUS CANNULATION IN ADULT POPULATION , Sisla Nazer P

Assessment of attitude among public towards stuttering in a coastal city of Southern Karnataka , Prithvi N

"Severity assessment of acute pancreatitis using ct severity index and modified ct severity index: association with clinical outcomes and ranson’s criteria. " , GEETANJALI PARMAR

“The Effect of Culture Shock on Adjustment and Psychological Wellbeing Among College Going Students” , Akanksha Patra

‘Effect of Religiosity on Attitude Towards Euthanasia in Medical Students’ , Sumedha Pawar

Development Of A Questionnaire To Determine The Clinical Assessment Practices Of Speech-Language Pathologists For Children With Speech Sound Disorders In India , Prasila Elsa Philip

Correlation of oxidised LDL with oxidant and antioxidant enzymes in subjects with elevated LDL levels , Pooja p

Association of emotional intelligence of primigravida mothers with breastfeeding self efficacy in the early postpartum period and exclusive breastfeeding rates up to 6 months. , Priyanka Reddy p

Morphometric study of the Sartorius muscle and its vascular pedicles , M.D. Prameela

Comparison of the analgesic duration using ultrasound guided popliteal sciatic nerve block between diabetics with neuropathy and non-diabetics without neuropathy , GANESH PRASAD

Early follicular and Mid-luteal phase associated changes in Lower extremity Muscle strength , length and Agility in amateur female athletes – a Prospective Analytical study , Vishnu Priya

Assessment of mobile device based educational intervention on breastfeeding technique in multigravida mothers and its effect on early infant feeding pattern- A randomized controlled trial. , Keerthi Raj

THERMAL ULTRASOUND, MANIPULATION AND EXERCISE ON PAIN AND MOUTH OPENING IN CHRONIC TEMPOROMANDIBULAR JOINT DISORDER: A CASE REPORT , Suchita S. Rao

Correlation of Histopathology and Direct Immunofluorescence: Findings in clinically diagnosed Prurigo nodularis in a Tertiary care hospital , Haritha Reddy

EFFECT OF POSITIONING ON THE PAIN RESPONSE OF INFANTS VACCINATED WITH IPV AND PENTAVALENT (dtwp-HEPATITIS B-HEMOPHILUS INFLUENZA B) VACCINES , Sontosh Reddy

Assessment of the acceptable length of Right internal jugular central venous catheters. , Nivedhitha R

PRELEVANCE OF WORK RELATED DERMATOLOGICAL SYMPTOMS IN HEALTH CARE WORKERS IN COVID-19 ERA , Rana R

COMPARISON OF TWO ROUTINE FACIAL EXERCISE PROTCOLS FOR BELL’S PALSY- A RANDOMIZED CONTROLLED TRIAL , Stephanie Santiago

Profiling selected speech characteristics in individuals with Chronic Cough , Nawal Palakkal Sathar

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History, Current Advances, Problems, and Pitfalls of Nephrology in Russia

The anatomy and physiology of kidneys as well as kidney diseases have been studied in Russia since the 18th century. However, there was a surge in interest in the 1920s, with numerous researchers and clinicians making substantial advances in the understanding of the pathophysiology, pathology, and diagnostics of kidney diseases. The field of nephrology as clinical practice can be traced back to 1957–1958, when the first beds for patients with kidney diseases became available and the first hemodialysis procedure was performed. Nephrology and hemodialysis units were opened soon after, offering kidney biopsy, corticosteroid and immunosuppressive therapies, and dialysis for acute renal failure and end stage of renal disease. In 1965 kidney transplantation commenced. Between 1970 and 1990, the number of centers providing care for patients with kidney diseases increased; however, they were insufficient to meet the demands of native kidney disorders and renal replacement therapy. To address this, several educational institutions established postgraduate programs in nephrology and dialysis, and professional societies and journals were funded. While economic changes at the end of the 1990s resulted in a rapid increase of dialysis service, kidney transplantation and pathology-based diagnostics of kidney diseases remained underdeveloped. During the last 2 decades cooperation among international professional societies, continuing medical education courses, and the translation and implementation of international guidelines have resulted in substantial improvements in the quality of care provided to patients with kidney diseases.

We describe the history and development of clinical nephrology, dialysis, kidney transplantation, education in nephrology and dialysis, professional societies and journals, and registry of patients on renal replacement therapy in Russia during almost 60 years. We also present the most recent registry data analysis, address current problems and difficulties, and stress the role of incorporation into the international nephrology community.

Key Message

Nephrology in Russia, despite currently experiencing many difficulties, made great advances during the 60 years of its development. General nephrology, nephropathology, and renal replacement therapy are developing fast; implementation of international guidelines, access to modern educational tools, and cooperation with international professional societies are improving the quality of care of renal patients and ensuring further progress.

Historical Aspects

Russian scientists have been interested in the anatomy and physiology of kidneys as well as kidney diseases since the 18th century. Professor Shumlansky investigated renal anatomy and defended his thesis entitled “De structura renum: Tractatus physiologicoanatomicus” in 1776; the paper was republished in Strasburg in 1788 [ 1 ]. In 1853 Professor Polunin [ 2 ] described acute renal failure in patients with cholera, and Professor Zakharyin [ 3 ] published his paper entitled “Association between protein-containing urine and convulsions in pregnant women,” which was one of the first descriptions of eclampsia. Professor Bogolybov [ 4 ] defended his PhD thesis entitled “Renal pathology of parenchymal inflammation (Bright's disease)” in 1862, and in 1876 Professor Stolnykov [ 5 ] designed the quantitative method to detect protein levels in the urine. He also studied hemoglobinuria [ 6 ], and he published the association between renal ischemia and left ventricular hypertrophy in 1880 [ 7 ]. In 1882, Professor Ivanovsky [ 8 ] published his paper entitled “Bacterial inflammation of kidneys as a consequence of erysipelas.”

The first widely recognized historical case of kidney disease in Russia was the illness of Czar Alexander III, who suffered from severe edema, ascites, itching, dyspnea, and hemoptysis. His urinalysis showed the presence of proteins and casts, and he was diagnosed with “chronic interstitial inflammation of kidneys” and died from pulmonary edema on October 20, 1894. Among the attending doctors of Czar Alexander III during his last fatal illness were Professor Ernst Viktor von Leyden from Germany and Professor Grigory Zakharyin [ 9 ].

The most important achievement in the field of kidney diseases in 19th century Russia was the first model of nephrotoxic nephritis, developed by Professor Lindemann while working in Professor Mechnikov's laboratory. Lindemann [ 10 ] published his research entitled “Sur le mode d'action de certains poisons renaux” in the Annals of Institute Pasteur in 1900, in which he demonstrated the nephrotoxicity of heterologous anti-kidney sera in experimental animals. This model remains the most widely used animal model of crescentic glomerulonephritis.

The next phase of research commenced in the 1920s. In 1921, Professor Zymnitsky [ 11 ] implemented a simple kidney function test, based on the relative density of urine, which was known as the modified Volhard test. In 1929, Professor Tareev [ 12 ] published his book entitled “Anemia in Bright's disease.” He later published several monographs, summarizing his clinical experience, and highlighting the most important issues of pathophysiology, pathology, and clinical presentation of kidney diseases: “Kidneys and the Body” (1932), “Hypoproteinemic syndrome” (1933), “Kidney diseases” (1936), “Nephritis” (1958), “Fundamentals of Nephrology” (1972) [ 13 , 14 , 15 , 16 , 17 ], and many others, all of which became handbooks for several generations of nephrologists. In 1950, Professor Lang [ 18 ] published the monograph “Hypertensive disease,” in which he stressed the role of essential hypertension in kidney damage. In 1963, Professor Gynetsynsky [ 19 ] published “Physiological mechanisms of water-electrolyte balance,” where he described the details of water reabsorption in the distal nephron.

Development of Nephrology in Russia

General nephrology.

Nephrology as a field of medical practice started its development in Russia (which was then the Soviet Union) in 1957. An initiative of Professor Woffsy, one of the most recognized internists, introduced the first beds for patients with kidney diseases in the internal diseases unit of Moscow City Hospital No. 52 [ 20 ]. Professor Ratner, who as a resident studied internal medicine with Professor Lang in the then Leningrad (now known as Saint Petersburg), was invited to manage the patients and played a leading role during the fledging years of nephrology in Russia. Under her direction the nephrology beds transformed into the first nephrology unit in 1964, and in the same year, the first kidney biopsy in the Soviet Union was performed in the unit. Professor Ratner was also the first to successfully use corticosteroids to treat glomerulonephritis at the end of 1950s. The patient was a child with severe nephrotic syndrome. Immunosuppressants were first used by the initiative of Professor Tareev in 1959, and in 1961, Professors Woffsy and Ratner [ 21 ] published a paper entitled “Corticosteroid therapy of glomerulonephritis” in the Annals of Academy of Medical Science.

The first pediatric nephrology unit at the National Medical Research Center of Children's Health (the Research Institute of Pediatrics) was opened in 1965 by the initiative of Professor Studenikin, again headed by Professor Ratner. In 1970, Professor Veltischev started the division of inherited and acquired kidney diseases in the Research Clinical Institute of Pediatrics (which was then the Research Institute of Pediatrics and Children's Surgery), headed by Professor Ignatova till 2006 [ 22 ].

The second nephrology unit opened in Moscow City Hospital No. 52 in 1971, followed soon after with nephrology units opened in Moscow City Hospital No. 24 and the Moscow City Hospital n.a. S.P. Botkin (first headed by Dr. Alexander Lokshin). Other hospitals in Moscow, Saint Petersburg, and most big cities used the Moscow City Hospital No. 52 experience as a model when opening their respective units.

Professor Ratner was active as the leader of the rapidly growing renal service in Moscow until the end of 1980s. Her main interests were glomerulonephritis, transplanted kidney issues, and tubulointerstitial disorders, on which along with Professors Serov and Tomilina, she published a book entitled “Renal dysfunctions” in 1977 [ 23 ]. She also established a school of clinical nephrology, which is currently headed by Professor Tomilina.

In 1993 Professor Tomilina initiated the merging of two nephrology units - one for patients with native kidney diseases and the other for recipients of transplanted kidney - with the dialysis and outpatient units to create the Moscow City Nephrology Center, based in Moscow City Hospital No. 52. In 1998, the first intensive care unit for patients with kidney diseases opened in this center. The Moscow City Nephrology Center provides high-quality care for patients with any type of native and transplanted kidney diseases, not only to Moscow citizens, but also to referred patients. Professor Tomilina [ 24 ] recently summarized her clinical experience and published a monograph entitled “Selected Chapters in Nephrology.” The nephrology unit of the Moscow City Hospital n.a. S.P. Botkin also became a tertiary referral center at the beginning of 2000. The main priority of both centers is kidney biopsy with high-quality pathology diagnostics for a wide range of renal diseases. The nephropathology unit, which performs kidney biopsy readings for a vast majority of the population in Moscow, the surrounding area, and referred patients from other regions, is actually part of the Moscow City Nephrology Center.

Leading the intense development of clinical and research nephrology in Leningrad were Professor Ryabov, Professor Stavskaya, Dr. Jdanova, and Professor Bagrov - the successor of Professor Gynetsynsky, representing the Novosibirsk physiology school. For almost 50 years Professor Bagrov worked in the field of renal physiology and pathophysiology in close association with clinical practice. His monograph entitled “Water-electrolyte balance in Heart Failure” was published in 1984 [ 25 ]. A complex nephrology service, including the first outpatient unit for patients with kidney diseases, was organized in Leningrad in 1977 by Professor Ryabov. In 2003, several outpatient nephrology units in Saint Petersburg were merged under Professor Komandenko, and in 2008, the Saint Petersburg City Nephrology Center was opened. Currently, there are many nephrology units in Moscow, Saint Petersburg, and other big cities actively treating patients with glomerulonephritis, systemic diseases, diabetes, amyloidosis, chronic kidney disease (CKD) complications, and even orphan diseases such as atypical hemolytic uremic syndrome, Fabry disease, and cystinosis.

Unfortunately, the exact disease spectrum for CKD is not known, because general statistics, based on the main diagnosis only, does not represent CKD epidemiology. However, the database of the nephrology unit of the Moscow City Hospital n.a. S.P. Botkin provides some information and gives an impression of the disease spectrum. Table ​ Table1 1 represents unpublished data analysis.

Spectrum of CKD causes

Nephrology unit of Moscow City Hospital n.a. S.P. Botkin, 1994–2017 ( n = 18,368 cases).

The care and management of CKD include (1) CKD diagnostics and stratification; (2) monitoring of proteinuria, eGFR, and blood pressure; (3) treatment of underlying kidney diseases and measures for prevention of CKD progression; and (4) diagnostics, evaluation, and treatment of anemia, metabolic bone disease, cardiovascular complications, etc. Nephroprotection strategies, erythropoiesis-stimulating agents, iron supplementation, and phosphate binders are widely used. Diagnostic approaches and treatment of glomerulonephritis, including use of corticosteroids, immunosuppressants (cyclophosphamide, calcineurin inhibitors, mycophenolates, rituximab), and plasmapheresis are in agreement with international and national guidelines.

Of note, the International KDIGO Clinical Practice Guidelines for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease - Mineral and Bone Disorder; for Anemia in Chronic Kidney Disease; for Lipid Management in Chronic Kidney Disease; for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease; and for Glomerulonephritis were translated to Russian and widely implemented [ 26 , 27 , 28 , 29 , 30 ]. The translation of KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease - Mineral and Bone Disorder is currently in progress.

Hemodialysis (HD) techniques, invented and developed in western countries, immediately raised great interest in the Soviet Union. The first paper presenting an international experience of “artificial kidney” use was published by Dr. Parin [ 31 ] in 1955. The first Soviet “Artificial Kidney Apparatus” (AKA-60) was invented in 1957 by Yury Kozlov and his colleagues in the Research Institute of Experimental Surgical Technologies; production of the AKA-60 commenced in the Factory of Medical Equipment in Kazan [ 32 ].

In 1958, the first HD procedure using the Moeller dialysis machine was performed by Professors Pytel, Lopatkin, and Djavadzade at the University Clinic of Russian National Research Medical University n.a. N.I. Pyrogov (then the 2nd Moscow Medical Institute), based in Moscow City Hospital No. 1. Professor Pytel, a recognized urologist, was specifically interested in nephrology and had already studied crush syndrome and hepatorenal syndrome. In 1961, he published a monograph entitled “Artificial kidney and its clinical usage”, which was the first Russian monograph in the field [ 33 ].

Between 1958 and 1960 four “Experimental renal laboratories” for the treatment of patients with acute renal failure (ARF) opened: one in the Hematology Research Center (then the Research Institute of Blood Transfusion), one in Moscow Hospital No. 1, one in the Moscow City Hospital n.a. S.P. Botkin, and one in the 1st Moscow Medical University n.a. I.M. Sechenov (then the 1st Moscow Medical Institute). In 1960, the department of HD for patients with ARF, working in cooperation with the “Laboratory of Artificial Kidney” headed by Professor Gert Kulakov, was opened in the Moscow City Hospital n.a. S.P. Botkin. It was headed by Dr. Melikyan, who was one of the pioneers of HD in Russia and worked actively for 4 decades.

The year 1962 saw the first ever procedure not using donor blood with AKA-60 [ 34 ]. In 1964, the modified AKA-140 was invented, with production starting in Leningrad in 1969. HD was primarily used for the treatment of ARF in the setting of obstetric and surgical complications, poisoning, Hanta virus hemorrhagic fever, and crush syndrome. By 1971 more than 50 HD centers, equipped with AKA machines were successfully implemented throughout the Soviet Union. This allowed the expansion of indications for HD to chronic renal failure. The first dialysis unit for patients with end-stage renal disease (ESRD) was started in Moscow City Hospital No. 24 in 1967.

In 1963, the first pediatric patient, a 3-year-old child, was treated with HD. The first pediatric HD unit for the treatment of children with ARF was established in 1976 in the St. Vladimir Children's Hospital (then the Children's Hospital n.a. I.V. Rusakov), headed by Dr. Zverev. It was the only such unit in the country for many years, and later became the first center for children with hemolytic uremic syndrome; in 1991 peritoneal dialysis (PD) was successfully performed for the first time in Russia at this center.

Between 1971 and 1973 Hemodialysis System 6 (SHD-6) was invented by Professor Kulakov and engineer Balabanov. The new model of HD machine enabled HD procedures to be performed on 6 patients simultaneously [ 32 ]. The first two machines were introduced in 1974 in the “Laboratory of Artificial Kidney” in the Moscow City Hospital n.a. S.P. Botkin. Later, the SHD-8 replaced the SHD-6 and was introduced to clinical practice in many cities. In 1976, the first arteriovenous fistula was placed by Dr. Timokhov and Dr. Melikyan at the Moscow City Hospital n.a. S.P. Botkin, with arteriovenous fistula swiftly replacing shunts as the standard dialysis access technique in most HD units for ESRD patients soon after. The nephrology service in Leningrad first included HD units, working in cooperation with clinical nephrology and outpatient units; Professor Shostka coordinated this work.

During the next 2 decades, the number of HD units increased; however, they were insufficient to meet the demands of dialysis care for the ESRD patients. The biggest challenge for the dialysis service was the Spitak (Armenia) earthquake in 1988. At least 400 earthquake victims developed crush syndrome, and many of them with ARF were treated with HD. Most victims were evacuated from Armenia to Moscow and other major cities.

The economic changes following the collapse of the Soviet Union resulted in the substantial growth of dialysis care services. Unfortunately, this growth was not accompanied by the development of dialysis machine production, and now only imported equipment is used in the Russian Federation. While many intensive care units were equipped with dialysis machines that performed HD and continuous hemodiafiltration, the PD program for adult patients was started in 1995 to improve dialysis services; the first three units were opened in the Moscow City Clinical Hospital No. 52, Moscow City Hospital n.a. S.P. Botkin, and Moscow City Clinical Hospital No. 7, followed by Mariinskaya City Hospital, Saint Petersburg, and later in the other big cities. The PD unit of Moscow City Clinical Hospital No. 52 is actually the biggest in the Russian Federation.

In 2002, the Ministry of Health issued an order regarding “Excellence of Organization of Dialysis Care,” whereby public-private partnership implementation resulted in a rapid increase in the HD outpatient units. The International KDIGO and ERBP Guidelines concerning CKD and acute kidney injury were translated to Russian and widely implemented [ 30 , 35 , 36 ].

Evaluation of the disease spectrum of ESRD is based on the data from the Registry of patients on renal replacement therapy (RRT), started by the Russian Dialysis Society in 1998. The available individual data analysis is shown in Table ​ Table2 2 [ 37 ].

Causes of ESRD in patients on hemodialysis and peritoneal dialysis

Russian Dialysis Society Registry, 2011–2013 ( n = 15,880 patients).

The evaluation and management of patients receiving RRT include monitoring of dialysis dose and key quality indicators, blood pressure, body mass index, serum albumin, hemoglobin, total cholesterol, total calcium, serum phosphates, and parathyroid hormone. Comorbidities, treatment patterns, mortality, and survival are also evaluated on a regular basis. Patients on RRT receive antihypertensive medications, iron supplementation, erythropoiesis-stimulating agents, phosphate binders, and calcimimetics.

Transplantation

The first kidney transplantation from a deceased donor was performed by Dr. Voronoy in 1933 in Kherson (now a territory of Ukraine). While the procedure was not successful, the first ever attempt, published in 1936, enabled further developments [ 38 ]. The first successful kidney transplantation from a living donor, in this case a relative, was performed by Professor Petrovsky at the Russian Research Center of Surgery in 1965. In 1967, the National Medical Research Center of Transplantology and Artificial Organs n.a. V.I. Shumakov (then the Research Institute of Organ and Tissue Transplantation, first headed by Professor Solovyov) was created by Professor Petrovsky. Professor Petrovsky, along with Professor Solovyov and his group, published a book entitled “Kidney transplantation” in 1969 [ 39 ], when the program of kidney transplantation from deceased donors was initiated and widely implemented by Professor Shumakov, who headed the Research Institute of Organ and Tissue Transplantation for more than 30 years since 1974. The number of centers performing kidney transplantation exclusively from deceased donors increased over the next 2 decades. Professor Phyliptsev played a leading role in the implementation of kidney transplantation for almost 3 decades. In 1990, the first center for pediatric kidney transplantation was opened in the Russian Children's Clinical Hospital.

In 1992, the federal legislation regarding “transplantation of organs and/or tissues” was introduced, whereby only direct relatives are allowed to donate kidneys for transplantation. Several regulatory documents have been released since the order addressing “regalement of brain death diagnostics” (2014). The program of kidney transplantation from living donors commenced in 1999 in the National Medical Research Center of Transplantology and Artificial Organs, headed by Professor Moysuk, who summarized the experience of the first 2 years in the article “Kidney transplantation from living relative donor” [ 40 ].

The first Department of Nephrology came from the Department of Internal and Occupational Diseases of the 1st Moscow Medical University n.a. I.M Sechenov (formerly known as the Faculty of Medicine of Imperator's Moscow University, created in 1755), which started in 1930 and was headed by Professor Tareev from 1950. Under his leadership, nephrology became one of the main priorities, and in 1966 the Clinic of Nephrology, Internal and Occupational Diseases opened, merging the Department of Nephrology, the Department of Internal and Occupational Diseases, and the Nephrology and HD units. Between 1986 and 2017, the head of the Clinic of Nephrology was Professor Mukhin. In 1972, Professor Tareev initiated the Laboratory of Nephrology Problems, which was headed by his daughter, Professor Tareeva, from 1975 [ 41 ].

An educational course on hemodialysis at the Russian Medical Academy of Continuous Postgraduate Education (formerly the Central Institute of Medical Qualification, created in 1930) was initiated by Professor Kulakov in 1965, based at the “Laboratory of Artificial Kidney”. In 1982, this educational course developed into the first Department of Nephrology and Hemodialysis, headed by Professor Kulakov [ 32 ]. The Department was, and still is, based in the Moscow City Hospital n.a. S.P. Botkin; the close relationships between academia and clinical practice ensured the development of the field. Currently the Department is headed by Professor Ermolenko, one of the opinion leaders in the field, whose monograph entitled “Chronic Hemodialysis” was published in 1982 [ 42 ].

In 1996, the Research Institute of Nephrology was created at the 1st Saint Petersburg Medical University n.a. I.P. Pavlov (formerly the Women's Medical Institute, and later the 1st Leningrad Medical Institute), with Professor Ryabov as the first director. The Institute of Nephrology merged the Course of Nephrology and Dialysis (later the Department of Nephrology and Dialysis, headed by Professor Eacayan), the Department of Internal Medicine (formerly the Department of Internal Diseases, created in 1914 and headed by Professor Lang from 1919 to 1921), and several laboratories with the clinical nephrology unit.

A course of “efferent therapy” was started in 1994 at the Saint Petersburg Medical Academy of Postgraduate Education (formerly the Imperator's Clinical Institute, created in 1896). The course was later changed to the Department of Nephrology and Efferent Therapy and existed until 2011, when the Saint Petersburg Medical Academy of Postgraduate Education merged with the Saint Petersburg Medical Academy n.a. I.M. Mechnikov (formerly the Institute of Psychoneurology, created in 1907) under the name North-Western State Medical University n.a. I.M. Mechnikov.

In 2004, the Department of Nephrology, headed by Professor Tomilina, opened in the Moscow State University of Medicine and Dentistry (formerly the Moscow Institute of Medicine and Dentistry, created from the Moscow State Institute of Dentistry in 1949). This is a unique institution, providing postgraduate education in the fields of clinical nephrology, nephropathology, dialysis, and transplantation.

All of the abovementioned institutions provide professional education for residents and PhD students as well as certification courses and short-term continuing medical education (CME) courses.

The Society of Nephrology and Immunopathology, as part of the Moscow Scientific Society of Therapeutics created in 1895, started its work in 1958 and is currently active, conducts monthly meetings, and is devoted to selected issues of clinical nephrology, immunonephrology, and nephropathology.

The Scientific Society of Nephrology (SSN) was founded in 1969 by Professor Tareev, who was the President of the Society for almost 15 years. The congresses of the SSN have been conducted every 6 years since 1974, and during the intervening years Nephrology Summer Schools, initiated by Professor Natochin, the successor of Professor Gynetsynsky, were the most important events.

First contacts with ISN leadership were established by Professor Tomilina in 1994, when she invited Professor Brenner and Professor Dirks to attend the SSN meeting in Moscow. In 1995, the first CME course under the aegis of the ISN, ERA-EDTA, and IPNA was conducted in Moscow. The formal organizer was the SSN, but Professor Tomilina was the driving force. Among the invited international speakers were Professor Cameron and Professor Lameire. Unfortunately, due to formal official regulations the SSN was unable to continue its work for several years. The Scientific Society of Russian Nephrologists, the successor of the SSN, was started in 2005, conducting congresses and plenary assemblies and creating national guidelines and protocols.

In 1997, the Union of Pediatric Nephrologists was funded by an initiative of Professor Papayan [ 22 ]. In 1998, the Russian Dialysis Society (RDS) was established, with Professor Tomilina as the first president. This society is currently the most active professional society of nephrologists in Russia. It is affiliated with the ISN, ERA-EDTA, and EKHA, and cooperates with KDIGO, ERBP, and WKD leadership. The RDS is specifically dedicated to the education of nephrologists throughout the Russian Federation, and conducts up to five CME conferences each year in Moscow, Saint Petersburg, and the big cities in Siberia, Volga, Far East, North West, North, and South Regions. Numerous international leaders of nephrology deliver talks at these meetings as invited speakers, as well as conducting ISN Educational Ambassadors Courses. The RDS also supports the registry and the journal Nephrology and Dialysis (see below). Translations of most KDIGO and ERBP Guidelines and World Kidney Day Editorials were undertaken and published by RDS initiatives [ 26 , 27 , 28 , 29 , 30 , 35 , 36 , 43 , 44 ].

The first journal to publish papers with nephrology articles in Russian was Urology and Nephrology , which was started in 1968 on the basis of the Urology journal, issued since 1965. The journal Nephrology was started by Professor Smirnov in Saint Petersburg in 1997 and was the first journal to publish a wide range of articles in the field.

In 1998, the journal Nephrology and Dialysis (an official journal of the RDS) was initiated by Professor Tomilina. This journal is the most influential nephrology journal in Russia with one of the highest impact factors among all medical journals in Russia. The journal Clinical Nephrology was started in 2009, and was edited by Professor Mukhin till 2017.

In 1998, Professor Tomilina initiated the registry of patients on RRT. The registry data is published every other year in the journal Nephrology and Dialysis , providing detailed information about many aspects of RRT in Russia. These include information not only about the number of centers and patients, but also on issues of anemia, hypertension, CKD-MBD management, viral hepatitis diagnostics and treatment, and many other aspects. The registry is affiliated with the ERA-EDTA Registry, providing data for international publications.

The most recent analysis, which includes published data till the end of 2015 [ 45 ] and unpublished data up to the end of 2016, shows that the total number of centers providing RRT is 506 (including 466 providing HD, 111 for PD, and 37 for kidney transplantation), with many centers providing two or three modalities. Of note, only centers providing care to both adult and pediatric patients with ESRD were included, while centers providing care specifically to patients with acute kidney injury were not registered. The number of patients with ESRD on HD + PD by the end of 2016 was 44,771 (33,876 on HD, 8,537 on PD, and 2,358 living with transplanted kidney); the mean ratio was 305 per million inhabitants. Furthermore, the number of patients on HD in 2016 was 78% greater than that in 2010, mainly due to the development of public-private partnership.

Current Problems

• Absence of nephrology courses for students in Medical schools
• Relatively short-term professional postgraduate education (2-year residency, absence of fellowship programs)
• Lack of certified nephrologists
• Under-recognition of CKD burden by health authorities and policy makers
• Under-diagnostics of CKD in the adult population
• Lack of cooperation among nephrologists and general practitioners, endocrinologists, cardiologists, and other specialists
• Under-diagnostics of CKD and ESRD in the pediatric population
• Lack of nephrology units, disproportionate to the number of dialysis units, especially outside big industrial areas
• Lack of renal pathologists and unavailability of kidney biopsy in many regions
• Under-development of PD
• Uneven distribution of dialysis service throughout the territory of the country, with several remote regions still poorly covered by RRT
• Lack of transplantation and insufficient organ har vesting
• Insufficient funds for research

Conclusions

Nephrology in Russia, despite currently experiencing many difficulties, made great advances during the 60 years of its development. General nephrology, nephropathology, and RRT are developing fast. Implementation of international guidelines, access to modern educational tools, and cooperation with international professional societies are improving the quality of care of renal patients and ensuring further progress.

Statement of Ethics

No ethic approval is required for this type of study.

Disclosure Statement

The author declares no conflict of interest.

Acknowledgments

The author thanks Dr. Anton Andrusev, Dr. Sergey Lashutin, and Prof. Natalia Tomilina for their valuable help.

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News & Insights

‘Load Up,’ Says Raymond James About These 2 Buy-rated Stocks

March 31, 2024 — 05:26 am EDT

Written by Michael Marcus for TipRanks  ->

The good feelings engendered by last year’s bull market are still with us, and are helping to power more gains. Since their October low points, the S&P 500 is up 27.5% and the NASDAQ is up 29.5%. The gains put stocks well into bull market territory, and mark the latest installment of a secular bullish trend that has lasted more than a decade so far.

It’s clearly a positive environment for stock investors; the chief difficulty being how to locate the right stocks to buy. Last year, the gains were driven by Big Tech corporations. This year, those gains are finding a broader footing. In a recent note, Raymond James’ Chief Investment Officer Larry Adam looks at the current market strength and adds some context: “The S&P 500 is off its best start to the year since 2019, climbing ~10% and hitting its 20th record high YTD… Resilient economic data, strong earnings (2024 earnings have bucked the typical downward revision trend), AI optimism and increased investor optimism have been the key drivers. Historically, a strong start has been a positive signal for the market, with the S&P 500 up an additional ~7% on average the rest of year when Q1 performance is greater than 10%. While we remain optimistic longer term, caution is warranted in the near term.”

While Adam advocates a careful approach right now, that’s not to say there aren’t good opportunities available. Going forward, Raymond James’ analysts are selecting Buy-rated stocks where they see solid potential for gains. The firm advises investors to ‘load up’ now – and we’ve opened up the databanks at TipRanks to get a better picture of two of their picks. Let’s take a closer look.

Weave Communications ( WEAV )

The first stock we’ll look at is Weave Communications. This tech company provides a software platform optimized to streamline the way that small- and mid-sized healthcare businesses locate, contact, and interact with their patients and customers. The company operates in the US healthcare sector, and its platform can support office phone lines, messaging systems, digital forms and online assistants, email marketing and patient scheduling, and data analysis and customer insights.

The company boasts that its platform helps ensure that users – mainly medical and dental clinics – miss fewer phone calls, save work hours, and operate with greater efficiency. Smoother office communications can have a ripple effect into other areas of operations – medical clinics using Weave report better patient compliance with scheduling and billing due to text message reminders, a feature that can be automated through the system.

On the financial front, both revenues and earnings have been trending upwards for the past couple of years. This was clearly visible in the last reported quarter, Q4 2023. Weave showed a top line of $45.7 million, for a year-over-year increase of 21% and beating the forecast by $1.5 million. Like many emerging tech firms, Weave operates at a net loss; in the last quarter of 2023, that loss came to $0.8 million, or 1 cent per share. This was a strong improvement from the 6-cent EPS loss recorded in Q4 2022, and it beat the forecast by two cents per share.

Over the last 12 months, the shares are up by 131% although they have retreated a bit since the print. As such, Raymond James analyst Alexander Sklar thinks investors should take advantage. He writes up an upbeat reaction to the company’s recent earnings and its prospects: “We believe recent momentum in the business will continue in 2024 and the pullback in shares following its 4Q23 report… creates an even more favorable risk/reward setup. Our positive fundamental thesis is centered around the belief that its growth acceleration exiting 2023 can be maintained in 2024 (with a medium-term compounding opportunity) that is not reflected in shares that trade at ~4x our 2024E revenue.”

Getting into some details, Sklar adds his outline of where Weave is going, and how it will benefit investors, saying , “We see several contributors to support higher growth in 2024 including: 1) Higher take rates of its largest bundle (ARPU up); 2) Improved rep tenure/ productivity and growth in reps; 3) A broader lead-gen motion (digital, live events, partners, etc.); 4) A formal focus on large specialty medical vertical (now its 3rd largest customer base); 5) Continued product enhancements (integrations, multi-office functionality, new offerings). With an improving profitability profile, an attractive beat and raise setup, and the potential for a ~20% growth profile to continue into 2024, we believe a Strong Buy rating is warranted.”

That Strong Buy rating is backed by a $15 price target that shows his confidence in a 30.5% upside potential on the one-year time horizon. (To watch Sklar’s track record, click here .)

Overall, WEAV shares get a Moderate Buy rating from the Street consensus, based on 7 recent analyst reviews that include 5 Buys and 2 Holds. The shares are trading for $11.48 and their $14.57 average target price implies a one-year upside of 27%. (See Weave’s stock forecast .)

GoDaddy, Inc. ( GDDY )

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Historical Aspects

Development of nephrology in russia, current problems, conclusions, acknowledgments, statement of ethics, disclosure statement, history, current advances, problems, and pitfalls of nephrology in russia.

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Elena Zakharova; History, Current Advances, Problems, and Pitfalls of Nephrology in Russia. Kidney Dis 15 November 2018; 4 (4): 238–245. https://doi.org/10.1159/000492634

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Background: The anatomy and physiology of kidneys as well as kidney diseases have been studied in Russia since the 18th century. However, there was a surge in interest in the 1920s, with numerous researchers and clinicians making substantial advances in the understanding of the pathophysiology, pathology, and diagnostics of kidney diseases. The field of nephrology as clinical practice can be traced back to 1957–1958, when the first beds for patients with kidney diseases became available and the first hemodialysis procedure was performed. Nephrology and hemodialysis units were opened soon after, offering kidney biopsy, corticosteroid and immunosuppressive therapies, and dialysis for acute renal failure and end stage of renal disease. In 1965 kidney transplantation commenced. Between 1970 and 1990, the number of centers providing care for patients with kidney diseases increased; however, they were insufficient to meet the demands of native kidney disorders and renal replacement therapy. To address this, several educational institutions established postgraduate programs in nephrology and dialysis, and professional societies and journals were funded. While economic changes at the end of the 1990s resulted in a rapid increase of dialysis service, kidney transplantation and pathology-based diagnostics of kidney diseases remained underdeveloped. During the last 2 decades cooperation among international professional societies, continuing medical education courses, and the translation and implementation of international guidelines have resulted in substantial improvements in the quality of care provided to patients with kidney diseases. Summary: We describe the history and development of clinical nephrology, dialysis, kidney transplantation, education in nephrology and dialysis, professional societies and journals, and registry of patients on renal replacement therapy in Russia during almost 60 years. We also present the most recent registry data analysis, address current problems and difficulties, and stress the role of incorporation into the international nephrology community. Key Message: Nephrology in Russia, despite currently experiencing many difficulties, made great advances during the 60 years of its development. General nephrology, nephropathology, and renal replacement therapy are developing fast; implementation of international guidelines, access to modern educational tools, and cooperation with international professional societies are improving the quality of care of renal patients and ensuring further progress.

Russian scientists have been interested in the anatomy and physiology of kidneys as well as kidney diseases since the 18th century. Professor Shumlansky investigated renal anatomy and defended his thesis entitled “De structura renum: Tractatus physiologicoanatomicus” in 1776; the paper was republished in Strasburg in 1788 [ 1 ]. In 1853 Professor Polunin [ 2 ] described acute renal failure in patients with cholera, and Professor Zakharyin [ 3 ] published his paper entitled “Association between protein-containing urine and convulsions in pregnant women,” which was one of the first descriptions of eclampsia. Professor Bogolybov [ 4 ] defended his PhD thesis entitled “Renal pathology of parenchymal inflammation (Bright’s disease)” in 1862, and in 1876 Professor Stolnykov [ 5 ] designed the quantitative method to detect protein levels in the urine. He also studied hemoglobinuria [ 6 ], and he published the association between renal ischemia and left ventricular hypertrophy in 1880 [ 7 ]. In 1882, Professor Ivanovsky [ 8 ] published his paper entitled “Bacterial inflammation of kidneys as a consequence of erysipelas.”

The first widely recognized historical case of kidney disease in Russia was the illness of Czar Alexander III, who suffered from severe edema, ascites, itching, dyspnea, and hemoptysis. His urinalysis showed the presence of proteins and casts, and he was diagnosed with “chronic interstitial inflammation of kidneys” and died from pulmonary edema on October 20, 1894. Among the attending doctors of Czar Alexander III during his last fatal illness were Professor Ernst Viktor von Leyden from Germany and Professor Grigory Zakharyin [ 9 ].

The most important achievement in the field of kidney diseases in 19th century Russia was the first model of nephrotoxic nephritis, developed by Professor Lindemann while working in Professor Mechnikov’s laboratory. Lindemann [ 10 ] published his research entitled “Sur le mode d’action de certains poisons renaux” in the Annals of Institute Pasteur in 1900, in which he demonstrated the nephrotoxicity of heterologous anti-kidney sera in experimental animals. This model remains the most widely used animal model of crescentic glomerulonephritis.

The next phase of research commenced in the 1920s. In 1921, Professor Zymnitsky [ 11 ] implemented a simple kidney function test, based on the relative density of urine, which was known as the modified Volhard test. In 1929, Professor Tareev [ 12 ] published his book entitled “Anemia in Bright’s disease.” He later published several monographs, summarizing his clinical experience, and highlighting the most important issues of pathophysiology, pathology, and clinical presentation of kidney diseases: “Kidneys and the Body” (1932), “Hypoproteinemic syndrome” (1933), “Kidney diseases” (1936), “Nephritis” (1958), “Fundamentals of Nephrology” (1972) [ 13-17 ], and many others, all of which became handbooks for several generations of nephrologists. In 1950, Professor Lang [ 18 ] published the monograph “Hypertensive disease,” in which he stressed the role of essential hypertension in kidney damage. In 1963, Professor Gynetsynsky [ 19 ] published “Physiological mechanisms of water-electrolyte balance,” where he described the details of water reabsorption in the distal nephron.

General Nephrology

Nephrology as a field of medical practice started its development in Russia (which was then the Soviet Union) in 1957. An initiative of Professor Woffsy, one of the most recognized internists, introduced the first beds for patients with kidney diseases in the internal diseases unit of Moscow City Hospital No. 52 [ 20 ]. Professor Ratner, who as a resident studied internal medicine with Professor Lang in the then Leningrad (now known as Saint Petersburg), was invited to manage the patients and played a leading role during the fledging years of nephrology in Russia. Under her direction the nephrology beds transformed into the first nephrology unit in 1964, and in the same year, the first kidney biopsy in the Soviet Union was performed in the unit. Professor Ratner was also the first to successfully use corticosteroids to treat glomerulonephritis at the end of 1950s. The patient was a child with severe nephrotic syndrome. Immunosuppressants were first used by the initiative of Professor Tareev in 1959, and in 1961, Professors Woffsy and Ratner [ 21 ] published a paper entitled “Corticosteroid therapy of glomerulonephritis” in the Annals of Academy of Medical Science.

The first pediatric nephrology unit at the National Medical Research Center of Children’s Health (the Research Institute of Pediatrics) was opened in 1965 by the initiative of Professor Studenikin, again headed by Professor Ratner. In 1970, Professor Veltischev started the division of inherited and acquired kidney diseases in the Research Clinical Institute of Pediatrics (which was then the Research Institute of Pediatrics and Children’s Surgery), headed by Professor Ignatova till 2006 [ 22 ].

The second nephrology unit opened in Moscow City Hospital No. 52 in 1971, followed soon after with nephrology units opened in Moscow City Hospital No. 24 and the Moscow City Hospital n.a. S.P. Botkin (first headed by Dr. Alexander Lokshin). Other hospitals in Moscow, Saint Petersburg, and most big cities used the Moscow City Hospital No. 52 experience as a model when opening their respective units.

Professor Ratner was active as the leader of the rapidly growing renal service in Moscow until the end of 1980s. Her main interests were glomerulonephritis, transplanted kidney issues, and tubulointerstitial disorders, on which along with Professors Serov and Tomilina, she published a book entitled “Renal dysfunctions” in 1977 [ 23 ]. She also established a school of clinical nephrology, which is currently headed by Professor Tomilina.

In 1993 Professor Tomilina initiated the merging of two nephrology units – one for patients with native kidney diseases and the other for recipients of transplanted kidney – with the dialysis and outpatient units to create the Moscow City Nephrology Center, based in Moscow City Hospital No. 52. In 1998, the first intensive care unit for patients with kidney diseases opened in this center. The Moscow City Nephrology Center provides high-quality care for patients with any type of native and transplanted kidney diseases, not only to Moscow citizens, but also to referred patients. Professor Tomilina [ 24 ] recently summarized her clinical experience and published a monograph entitled “Selected Chapters in Nephrology.” The nephrology unit of the Moscow City Hospital n.a. S.P. Botkin also became a tertiary referral center at the beginning of 2000. The main priority of both centers is kidney biopsy with high-quality pathology diagnostics for a wide range of renal diseases. The nephropathology unit, which performs kidney biopsy readings for a vast majority of the population in Moscow, the surrounding area, and referred patients from other regions, is actually part of the Moscow City Nephrology Center.

Leading the intense development of clinical and research nephrology in Leningrad were Professor Ryabov, Professor Stavskaya, Dr. Jdanova, and Professor Bagrov – the successor of Professor Gynetsynsky, representing the Novosibirsk physiology school. For almost 50 years Professor Bagrov worked in the field of renal physiology and pathophysiology in close association with clinical practice. His monograph entitled “Water-electrolyte balance in Heart Failure” was published in 1984 [ 25 ]. A complex nephrology service, including the first outpatient unit for patients with kidney diseases, was organized in Leningrad in 1977 by Professor Ryabov. In 2003, several outpatient nephrology units in Saint Petersburg were merged under Professor Komandenko, and in 2008, the Saint Petersburg City Nephrology Center was opened. Currently, there are many nephrology units in Moscow, Saint Petersburg, and other big cities actively treating patients with glomerulonephritis, systemic diseases, diabetes, amyloidosis, chronic kidney disease (CKD) complications, and even orphan diseases such as atypical hemolytic uremic syndrome, Fabry disease, and cystinosis.

Unfortunately, the exact disease spectrum for CKD is not known, because general statistics, based on the main diagnosis only, does not represent CKD epidemiology. However, the database of the nephrology unit of the Moscow City Hospital n.a. S.P. Botkin provides some information and gives an impression of the disease spectrum. Table 1 represents unpublished data analysis.

Spectrum of CKD causes

The care and management of CKD include (1) CKD diagnostics and stratification; (2) monitoring of proteinuria, eGFR, and blood pressure; (3) treatment of underlying kidney diseases and measures for prevention of CKD progression; and (4) diagnostics, evaluation, and treatment of anemia, metabolic bone disease, cardiovascular complications, etc. Nephroprotection strategies, erythropoiesis-stimulating agents, iron supplementation, and phosphate binders are widely used. Diagnostic approaches and treatment of glomerulonephritis, including use of corticosteroids, immunosuppressants (cyclophosphamide, calcineurin inhibitors, mycophenolates, rituximab), and plasmapheresis are in agreement with international and national guidelines.

Of note, the International KDIGO Clinical Practice Guidelines for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease – Mineral and Bone Disorder; for Anemia in Chronic Kidney Disease; for Lipid Management in Chronic Kidney Disease; for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease; and for Glomerulonephritis were translated to Russian and widely implemented [ 26-30 ]. The translation of KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease – Mineral and Bone Disorder is currently in progress.

Hemodialysis (HD) techniques, invented and developed in western countries, immediately raised great interest in the Soviet Union. The first paper presenting an international experience of “artificial kidney” use was published by Dr. Parin [ 31 ] in 1955. The first Soviet “Artificial Kidney Apparatus” (AKA-60) was invented in 1957 by Yury Kozlov and his colleagues in the Research Institute of Experimental Surgical Technologies; production of the AKA-60 commenced in the Factory of Medical Equipment in Kazan [ 32 ].

In 1958, the first HD procedure using the Moeller dialysis machine was performed by Professors Pytel, Lopatkin, and Djavadzade at the University Clinic of Russian National Research Medical University n.a. N.I. Pyrogov (then the 2nd Moscow Medical Institute), based in Moscow City Hospital No. 1. Professor Pytel, a recognized urologist, was specifically interested in nephrology and had already studied crush syndrome and hepatorenal syndrome. In 1961, he published a monograph entitled “Artificial kidney and its clinical usage”, which was the first Russian monograph in the field [ 33 ].

Between 1958 and 1960 four “Experimental renal laboratories” for the treatment of patients with acute renal failure (ARF) opened: one in the Hematology Research Center (then the Research Institute of Blood Transfusion), one in Moscow Hospital No. 1, one in the Moscow City Hospital n.a. S.P. Botkin, and one in the 1st Moscow Medical University n.a. I.M. Sechenov (then the 1st Moscow Medical Institute). In 1960, the department of HD for patients with ARF, working in cooperation with the “Laboratory of Artificial Kidney” headed by Professor Gert Kulakov, was opened in the Moscow City Hospital n.a. S.P. Botkin. It was headed by Dr. Melikyan, who was one of the pioneers of HD in Russia and worked actively for 4 decades.

The year 1962 saw the first ever procedure not using donor blood with AKA-60 [ 34 ]. In 1964, the modified AKA-140 was invented, with production starting in Leningrad in 1969. HD was primarily used for the treatment of ARF in the setting of obstetric and surgical complications, poisoning, Hanta virus hemorrhagic fever, and crush syndrome. By 1971 more than 50 HD centers, equipped with AKA machines were successfully implemented throughout the Soviet Union. This allowed the expansion of indications for HD to chronic renal failure. The first dialysis unit for patients with end-stage renal disease (ESRD) was started in Moscow City Hospital No. 24 in 1967.

In 1963, the first pediatric patient, a 3-year-old child, was treated with HD. The first pediatric HD unit for the treatment of children with ARF was established in 1976 in the St. Vladimir Children’s Hospital (then the Children’s Hospital n.a. I.V. Rusakov), headed by Dr. Zverev. It was the only such unit in the country for many years, and later became the first center for children with hemolytic uremic syndrome; in 1991 peritoneal dialysis (PD) was successfully performed for the first time in Russia at this center.

Between 1971 and 1973 Hemodialysis System 6 (SHD-6) was invented by Professor Kulakov and engineer Balabanov. The new model of HD machine enabled HD procedures to be performed on 6 patients simultaneously [ 32 ]. The first two machines were introduced in 1974 in the “Laboratory of Artificial Kidney” in the Moscow City Hospital n.a. S.P. Botkin. Later, the SHD-8 replaced the SHD-6 and was introduced to clinical practice in many cities. In 1976, the first arteriovenous fistula was placed by Dr. Timokhov and Dr. Melikyan at the Moscow City Hospital n.a. S.P. Botkin, with arteriovenous fistula swiftly replacing shunts as the standard dialysis access technique in most HD units for ESRD patients soon after. The nephrology service in Leningrad first included HD units, working in cooperation with clinical nephrology and outpatient units; Professor Shostka coordinated this work.

During the next 2 decades, the number of HD units increased; however, they were insufficient to meet the demands of dialysis care for the ESRD patients. The biggest challenge for the dialysis service was the Spitak (Armenia) earthquake in 1988. At least 400 earthquake victims developed crush syndrome, and many of them with ARF were treated with HD. Most victims were evacuated from Armenia to Moscow and other major cities.

The economic changes following the collapse of the Soviet Union resulted in the substantial growth of dialysis care services. Unfortunately, this growth was not accompanied by the development of dialysis machine production, and now only imported equipment is used in the Russian Federation. While many intensive care units were equipped with dialysis machines that performed HD and continuous hemodiafiltration, the PD program for adult patients was started in 1995 to improve dialysis services; the first three units were opened in the Moscow City Clinical Hospital No. 52, Moscow City Hospital n.a. S.P. Botkin, and Moscow City Clinical Hospital No. 7, followed by Mariinskaya City Hospital, Saint Petersburg, and later in the other big cities. The PD unit of Moscow City Clinical Hospital No. 52 is actually the biggest in the Russian Federation.

In 2002, the Ministry of Health issued an order regarding “Excellence of Organization of Dialysis Care,” whereby public-private partnership implementation resulted in a rapid increase in the HD outpatient units. The International KDIGO and ERBP Guidelines concerning CKD and acute kidney injury were translated to Russian and widely implemented [ 30, 35, 36 ].

Evaluation of the disease spectrum of ESRD is based on the data from the Registry of patients on renal replacement therapy (RRT), started by the Russian Dialysis Society in 1998. The available individual data analysis is shown in Table 2 [ 37 ].

Causes of ESRD in patients on hemodialysis and peritoneal dialysis

The evaluation and management of patients receiving RRT include monitoring of dialysis dose and key quality indicators, blood pressure, body mass index, serum albumin, hemoglobin, total cholesterol, total calcium, serum phosphates, and parathyroid hormone. Comorbidities, treatment patterns, mortality, and survival are also evaluated on a regular basis. Patients on RRT receive antihypertensive medications, iron supplementation, erythropoiesis-stimulating agents, phosphate binders, and calcimimetics.

Transplantation

The first kidney transplantation from a deceased donor was performed by Dr. Voronoy in 1933 in Kherson (now a territory of Ukraine). While the procedure was not successful, the first ever attempt, published in 1936, enabled further developments [ 38 ]. The first successful kidney transplantation from a living donor, in this case a relative, was performed by Professor Petrovsky at the Russian Research Center of Surgery in 1965. In 1967, the National Medical Research Center of Transplantology and Artificial Organs n.a. V.I. Shumakov (then the Research Institute of Organ and Tissue Transplantation, first headed by Professor Solovyov) was created by Professor Petrovsky. Professor Petrovsky, along with Professor Solovyov and his group, published a book entitled “Kidney transplantation” in 1969 [ 39 ], when the program of kidney transplantation from deceased donors was initiated and widely implemented by Professor Shumakov, who headed the Research Institute of Organ and Tissue Transplantation for more than 30 years since 1974. The number of centers performing kidney transplantation exclusively from deceased donors increased over the next 2 decades. Professor Phyliptsev played a leading role in the implementation of kidney transplantation for almost 3 decades. In 1990, the first center for pediatric kidney transplantation was opened in the Russian Children’s Clinical Hospital.

In 1992, the federal legislation regarding “transplantation of organs and/or tissues” was introduced, whereby only direct relatives are allowed to donate kidneys for transplantation. Several regulatory documents have been released since the order addressing “regalement of brain death diagnostics” (2014). The program of kidney transplantation from living donors commenced in 1999 in the National Medical Research Center of Transplantology and Artificial Organs, headed by Professor Moysuk, who summarized the experience of the first 2 years in the article “Kidney transplantation from living relative donor” [ 40 ].

The first Department of Nephrology came from the Department of Internal and Occupational Diseases of the 1st Moscow Medical University n.a. I.M Sechenov (formerly known as the Faculty of Medicine of Imperator’s Moscow University, created in 1755), which started in 1930 and was headed by Professor Tareev from 1950. Under his leadership, nephrology became one of the main priorities, and in 1966 the Clinic of Nephrology, Internal and Occupational Diseases opened, merging the Department of Nephrology, the Department of Internal and Occupational Diseases, and the Nephrology and HD units. Between 1986 and 2017, the head of the Clinic of Nephrology was Professor Mukhin. In 1972, Professor Tareev initiated the Laboratory of Nephrology Problems, which was headed by his daughter, Professor Tareeva, from 1975 [ 41 ].

An educational course on hemodialysis at the Russian Medical Academy of Continuous Postgraduate Education (formerly the Central Institute of Medical Qualification, created in 1930) was initiated by Professor Kulakov in 1965, based at the “Laboratory of Artificial Kidney”. In 1982, this educational course developed into the first Department of Nephrology and Hemodialysis, headed by Professor Kulakov [ 32 ]. The Department was, and still is, based in the Moscow City Hospital n.a. S.P. Botkin; the close relationships between academia and clinical practice ensured the development of the field. Currently the Department is headed by Professor Ermolenko, one of the opinion leaders in the field, whose monograph entitled “Chronic Hemodialysis” was published in 1982 [ 42 ].

In 1996, the Research Institute of Nephrology was created at the 1st Saint Petersburg Medical University n.a. I.P. Pavlov (formerly the Women’s Medical Institute, and later the 1st Leningrad Medical Institute), with Professor Ryabov as the first director. The Institute of Nephrology merged the Course of Nephrology and Dialysis (later the Department of Nephrology and Dialysis, headed by Professor Eacayan), the Department of Internal Medicine (formerly the Department of Internal Diseases, created in 1914 and headed by Professor Lang from 1919 to 1921), and several laboratories with the clinical nephrology unit.

A course of “efferent therapy” was started in 1994 at the Saint Petersburg Medical Academy of Postgraduate Education (formerly the Imperator’s Clinical Institute, created in 1896). The course was later changed to the Department of Nephrology and Efferent Therapy and existed until 2011, when the Saint Petersburg Medical Academy of Postgraduate Education merged with the Saint Petersburg Medical Academy n.a. I.M. Mechnikov (formerly the Institute of Psychoneurology, created in 1907) under the name North-Western State Medical University n.a. I.M. Mechnikov.

In 2004, the Department of Nephrology, headed by Professor Tomilina, opened in the Moscow State University of Medicine and Dentistry (formerly the Moscow Institute of Medicine and Dentistry, created from the Moscow State Institute of Dentistry in 1949). This is a unique institution, providing postgraduate education in the fields of clinical nephrology, nephropathology, dialysis, and transplantation.

All of the abovementioned institutions provide professional education for residents and PhD students as well as certification courses and short-term continuing medical education (CME) courses.

The Society of Nephrology and Immunopathology, as part of the Moscow Scientific Society of Therapeutics created in 1895, started its work in 1958 and is currently active, conducts monthly meetings, and is devoted to selected issues of clinical nephrology, immunonephrology, and nephropathology.

The Scientific Society of Nephrology (SSN) was founded in 1969 by Professor Tareev, who was the President of the Society for almost 15 years. The congresses of the SSN have been conducted every 6 years since 1974, and during the intervening years Nephrology Summer Schools, initiated by Professor Natochin, the successor of Professor Gynetsynsky, were the most important events.

First contacts with ISN leadership were established by Professor Tomilina in 1994, when she invited Professor Brenner and Professor Dirks to attend the SSN meeting in Moscow. In 1995, the first CME course under the aegis of the ISN, ERA-EDTA, and IPNA was conducted in Moscow. The formal organizer was the SSN, but Professor Tomilina was the driving force. Among the invited international speakers were Professor Cameron and Professor Lameire. Unfortunately, due to formal official regulations the SSN was unable to continue its work for several years. The Scientific Society of Russian Nephrologists, the successor of the SSN, was started in 2005, conducting congresses and plenary assemblies and creating national guidelines and protocols.

In 1997, the Union of Pediatric Nephrologists was funded by an initiative of Professor Papayan [ 22 ]. In 1998, the Russian Dialysis Society (RDS) was established, with Professor Tomilina as the first president. This society is currently the most active professional society of nephrologists in Russia. It is affiliated with the ISN, ERA-EDTA, and EKHA, and cooperates with KDIGO, ERBP, and WKD leadership. The RDS is specifically dedicated to the education of nephrologists throughout the Russian Federation, and conducts up to five CME conferences each year in Moscow, Saint Petersburg, and the big cities in Siberia, Volga, Far East, North West, North, and South Regions. Numerous international leaders of nephrology deliver talks at these meetings as invited speakers, as well as conducting ISN Educational Ambassadors Courses. The RDS also supports the registry and the journal Nephrology and Dialysis (see below). Translations of most KDIGO and ERBP Guidelines and World Kidney Day Editorials were undertaken and published by RDS initiatives [ 26-30, 35, 36, 43, 44 ].

The first journal to publish papers with nephrology articles in Russian was Urology and Nephrology , which was started in 1968 on the basis of the Urology journal, issued since 1965. The journal Nephrology was started by Professor Smirnov in Saint Petersburg in 1997 and was the first journal to publish a wide range of articles in the field.

In 1998, the journal Nephrology and Dialysis (an official journal of the RDS) was initiated by Professor Tomilina. This journal is the most influential nephrology journal in Russia with one of the highest impact factors among all medical journals in Russia. The journal Clinical Nephrology was started in 2009, and was edited by Professor Mukhin till 2017.

In 1998, Professor Tomilina initiated the registry of patients on RRT. The registry data is published every other year in the journal Nephrology and Dialysis , providing detailed information about many aspects of RRT in Russia. These include information not only about the number of centers and patients, but also on issues of anemia, hypertension, CKD-MBD management, viral hepatitis diagnostics and treatment, and many other aspects. The registry is affiliated with the ERA-EDTA Registry, providing data for international publications.

The most recent analysis, which includes published data till the end of 2015 [ 45 ] and unpublished data up to the end of 2016, shows that the total number of centers providing RRT is 506 (including 466 providing HD, 111 for PD, and 37 for kidney transplantation), with many centers providing two or three modalities. Of note, only centers providing care to both adult and pediatric patients with ESRD were included, while centers providing care specifically to patients with acute kidney injury were not registered. The number of patients with ESRD on HD + PD by the end of 2016 was 44,771 (33,876 on HD, 8,537 on PD, and 2,358 living with transplanted kidney); the mean ratio was 305 per million inhabitants. Furthermore, the number of patients on HD in 2016 was 78% greater than that in 2010, mainly due to the development of public-private partnership.

Absence of nephrology courses for students in Medical schools

Relatively short-term professional postgraduate education (2-year residency, absence of fellowship programs)

Lack of certified nephrologists

Under-recognition of CKD burden by health authorities and policy makers

Under-diagnostics of CKD in the adult population

Lack of cooperation among nephrologists and general practitioners, endocrinologists, cardiologists, and other specialists

Under-diagnostics of CKD and ESRD in the pediatric population

Lack of nephrology units, disproportionate to the number of dialysis units, especially outside big industrial areas

Lack of renal pathologists and unavailability of kidney biopsy in many regions

Under-development of PD

Uneven distribution of dialysis service throughout the territory of the country, with several remote regions still poorly covered by RRT

Lack of transplantation and insufficient organ har vesting

Insufficient funds for research

Nephrology in Russia, despite currently experiencing many difficulties, made great advances during the 60 years of its development. General nephrology, nephropathology, and RRT are developing fast. Implementation of international guidelines, access to modern educational tools, and cooperation with international professional societies are improving the quality of care of renal patients and ensuring further progress.

The author thanks Dr. Anton Andrusev, Dr. Sergey Lashutin, and Prof. Natalia Tomilina for their valuable help.

No ethic approval is required for this type of study.

The author declares no conflict of interest.

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