Nephrology in China: a great mission and momentous challenge.

Nephrological work in China started in early 60s, but it was not until the middle of the 1980s before it became an independent discipline and linked with the international nephrology community. Due to the huge population and enormous territory, nephrologists are facing a great mission and momentous challenges. Most nephrologists reside in the coastal region, which has a higher education background than most of the rest of the country. Among them, Beijing, Shanghai, Guanzhong and Nangjing are the major centers for training graduate students to conduct basic and clinical research. Renal biopsy is widely performed in China. IgA nephropathy is the leading cause among the primary causes of glomerulonephritis that are diagnosed by renal biopsy, while lupus nephritis is the most prominent among the causes of second glomerulopathy. Though diabetic nephropathy now constitutes only about 10% of the cause of secondary glomerulopathy, the rapid rise of diabetes mellitus predicts a future prominent role of this disease in managing progressive renal failure in China. Both hemodialysis and peritoneal dialysis are widely used in China, with approximately a 40 to 50% survival rate in three years. About two thirds of the end-stage renal disease (ESRD) patients received erythropoietin; however, the hematocrit levels of most cases are less ideal. A variety of sources, mainly from the government, in several big cities provide financial support for ESRD dialysis, which has already become a heavy burden to public health. About 5000 patients receive renal transplantation every year in which the organs are mainly from brain dead cadavers. Renal disease registration has been established since 1999. Controlling the high incidence of diabetes and early treatment, studying the genetic and environmental mechanisms possibly related to the high incidence of IgA nephropathy in rural areas, and establishing a nationwide network to apply guidelines for dialysis and transplantation in a fashion relevant to real situations in China are major challenges to the Chinese nephrologists.