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This paper by Mauro Sasdelli describes the dawn and the development of nephrology first in Bologna, where Sasdelli studied in the nineteen-sixties, and later in Arezzo; the author tells us of the dedication, the enthusiasm, the hard work of all involved, but also of their conflicts and banter. The paper describes the important contributions to nephrology made by prominent personalities such as Domenico Campanacci, Vittorio Bonomini and Pietro Zucchelli, not only at a local level but also more broadly. Finally, text and images of this "personal history" can also be read as the integration of an article published on this same journal in 2016, "The dawn of Nephrology and Dialysis in Bologna with Vittorio Bonomini and Pietro Zucchelli" (Giornale Italiano di Nefrologia, vol. 33, n. 4)., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

The SIN Workforce Working Group has carried out an initial demographic study project that highlights the situation of nephrological workforce in European and non-European countries, noting in particular the apparent discrepancies between the number of nephrologists in other health systems and in the Italian one. Italy seems to have the highest number of nephrologists per capita: in fact, the number of nephrologists has decreased in recent years due to the number of retirements far higher than the entry of new specialists. The project arises from the need to define the actual number of nephrologists in Italy in relation to the population and the epidemiology of chronic renal disease, taking into account the trends of ageing and feminization of our specialty. The tools used to collect data on the demographics of Italian nephrologists are a database for demographic data collection by presidents of SIN regional sections and a questionnaire for a survey to describe demography, workload, the adhesion to the discipline and the recruitment and retirement programs of the Italian nephrological community., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

The complete digitalization of the health system is an objective that Italy, from 2014, is pursuing with great difficulty, spurred by the many European initiatives dedicated to it. Despite the social and cultural background seems to be clearly ready for an application of the renewal strategies, e-Health and m-Health are struggling to get off the ground throughout the territory. The main difficulties are find at local level and don't spare any medical discipline, nephrology included. The characteristics of the official websites belonging to the local health centers demonstrate it. Today, these institutions are still sparsely present on Social Media or in the Italian Smart Mobile Technology landscape. The article illustrates the main features of the phenomenon and calls for reflection on the necessity to accelerate the digital innovation of the communication with patients. This is a possible strategy for reducing chronicity through prevention, and, potentially, for decreasing health costs., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

Healthcare is in the middle of a digital revolution. Physicians are adopting mobile apps that make them more effective and patients are taking to ones that give them more control over their healthcare. Mobile technology is changing Medicine. A new movement for free open access medical education (FOAMed) is growing through Social Media. E-learning is increasing access to new and exciting learning opportunities, deeply changing the traditional concept of continuous medical education. What will be the future of Nephrology in the era of Digital Health?

In 1987, the first Kidney-Heart meeting was held in Assisi, Italy and in 1991 the term Cardionephrology was coined in medical practice. Since then, nephrologists and cardiologists realized the utility of a tight cooperation among them and organized an agenda of scientific meetings which take place every two years within European countries. The cooperation was strengthened by daily observation which shows renal replacement therapy had solved many problems but imposed or added new disorders to cardiovascular system. Soon, the nephrologists learned that hemodialyisis techniques had not only blood detoxification effect but also cardiovascular consequences. Therefore, the nephrologists started to adopt cardiological tools and apply them to renal patients. The cardiologists realized that in some aspects kidney patients are different from non-renal cardiological patients and have to be treated differently. In Assisi Cardionephrology meetings a clear message was launched: the necessity to bring nephrologists and cardiologists together with the potential benefit of learning from others experiences and transferring the outcome for the benefit of our patients. As result, many foundations and journals have been emerged on this topic. Is there a future for Cardionephrolgy? The answer is yes, with a unique limitation: to continue the spirit of Assisi, following the culture of cooperation and relying on RCTs hypothesis.

Young people are the future of research, especially in nephrology. The prevalence of young nephrologists within the main scientific European societies varies from the 12% to 34% and the 20% of the ERA-EDTA members are less than 40 years old in 2013. Recently, the ERA-EDTA has launched a new platform, the Young Nephrologists Platform (YNP), which the aim is to become the first modern network of young nephrologists from Europe and beyond. YNP aims at promoting the aggregation of young people through modern communication channels such as social networks, blogs and through the construction of a database collecting information on attitudes and personal experiences of each young nephrologist. A mentorship program, focused and young-oriented clinical courses on hot topics and the direct involvement of young nephrologists in working groups and scientific studies are some of the other interesting initiatives driven by YNP. The future of nephrology belongs to the young and YNP could represent a good springboard for the professional growth of young nephrologists.

In this article, the Italian Society of Nephrology discusses the risks for the Medical Specialty in Nephrology and the possible lack of job opportunities by young nephrologists, that arises from the actions taken in the last years by National and Regional Italian Governments. The article reports the main legislative rules required to access the work system both in public and private hospital. Finally, we examined the different criteria and the standards requested for Regional Accreditation by Italian National Health System, and to obtain reimbursement by private and public providers. These requirements might be useful to guarantee both the specificity of nephrology specialty in the assistance to patients affected by kidney diseases, and a stable and qualified job for young nephrologists.

New media tools such as web 2.0 are increasingly being used in the medical field. RSS feeds, podcasts, blogs, wikis, online social networks and social media have all been proposed as innovative tools for the education and updating of clinicians, nurses, other health workers and medical students because of their ease of access and widespread use. Nephrology is one of the medical fields where these technologies have been successfully applied. Medical journals such as the American Journal Kidney Diseases and the Journal of the American Society of Nephrology, and medical societies such as the American Society of Nephrology, are all using these new and powerful communication tools. In addition, blogs and social networks have been developed to allow physicians to distribute, share and comment medical material concerning issues related to nephrology and kidney disease, including images, videos, slides, scientific abstracts and clinical trials updates. This review provides background information on the evolution of both web 2.0 and the social media and describes some of the most interesting applications of web 2.0 and its correlated tools in the field of nephrology.

The current treatment of chronic inflammatory bowel diseases involves the administration of different immunosuppressive drugs, whose use is associated with several side effects. Among the treatment alternatives, clinicians are attracted by leukapheresis, a method able to selectively remove from the circulation molecules involved in the onset and maintenance of inflammation. From 2007 to 2008, six patients were recruited from our clinics; four patients were affected by ulcerative colitis and two by Crohn's disease. They presented symptoms including abdominal pain and diarrhea despite treatment with steroids and sulfasalazine. Leukapheresis sessions were performed weekly (1 hour/week) for five consecutive weeks. The leukapheresis sessions resulted in a significant improvement in the patients' clinical as well as general conditions. The abdominal pain disappeared and significant reduction of diarrhea and fecal calprotectin levels was observed. No side effects occurred. The clinical benefits were supported by resolution of ulcerative lesions. After six months of follow-up no disease relapse was observed. The leukapheresis treatment has also prevented surgical interventions in all patients enrolled in the study. Our results suggest that leukapheresis may be helpful in patients affected by inflammatory bowel diseases, allowing early reduction of immunosuppressive drug administration.

The activity of nephrologists in the hospital is not limited to kidney disease, as they also have a role as advisors for all those disciplines that treat conditions involving kidney function. An analysis based on discharge reports from nephrology wards of Italian hospitals has been conducted for the last biennium available (2005-2006) in the ministerial database of hospital discharge reports that classifies the main diagnoses into diagnosis-related groups (DRGs) according to a national classification system. All discharges from nephrology wards were defined as nephrological. Taking this first sample as the starting point, further analyses were carried out on the 20 most frequent DRGs identified. The aim was to clarify the position of nephrology within the national hospital activity. The nephrological activity proved to be concentrated on the first four DRGs (59%). The first 20 DRGs accounted for 80% of the total activity, while the remaining 400 DRGs were fragmented, each representing less than 1% of the total activity. Analyzing the same data cross-sectionally, we see that the ''nephrology market'' is ''owned'' by nephrology wards for only 18% of the total. Nephrology does not have a precise position in the hospital activities and shows considerable overlap with general medicine and general surgery (kidney transplants in particular). The Italian DRG classification has no specific nephrological diagnosis group; this could partially explain the fragmentation. An improved classification system could help in identifying a more precise outline of the nephrological activity.

An acceleration in the professionalization of Italian nurses has taken place in recent years. This pattern, together with the increasing prevalence of kidney diseases and the decreasing number of active nephrologists, makes a new collaborative structure between nurses and nephrologists both possible and welcome. This article describes the recent changes and future prospects of the Italian nursing profession. Observations about nephrology are based on interviews conducted with key opinion leaders of nursing in nephrology and dialysis. Italian nurses have recently acquired a status of professional autonomy. Nursing training is now fully integrated in the university system and nurses have obtained more responsibilities and a higher status within healthcare organizations. Future developments may be related to the internal articulation of the profession, supported by master courses and specialist training. Another possible evolution refers to the ongoing restructuring of the healthcare system with an emphasis on nursing activities and skills rather than medical specialties, which will lead to new and stronger managerial roles for nurses. The increase in the prevalence of kidney diseases and the declining number of nephrologists will result in a change in the distribution and utilization of nephrology services. The professionalization of nurses allows a new work division with a task shift from doctors to nurses. Italian nephrologists should seek a preferential relationship with the nursing profession, also considering the nursing shortage in several regions. Possible means to accomplish this preferential relationship could be, in addition to task shifting, nurses' involvement in research, and support for postgraduate training.

For many years Italy has had more active physicians than most Western countries. However, the numerus clausus introduced in 1986 for entry into medical schools together with a sharp decrease in places available in specialty training have changed the situation dramatically and today several specialties suffer actual shortages. In such a situation, professional demography is crucial to outline possible developments for the medical profession and nephrology in particular. Our analysis of the medical profession as a whole was based on data from OECD (international comparative analysis) and the yearly estimate of the General Accounts Office (Italian NHS employees). For calculation of the nephrologists we used the administrative data of the members of the Italian Nephrology Society (SIN) and a survey run among nephrology units in the Lombardy region. Data for the university system (medical and specialty schools) were provided by the University Ministry. We found that Italy is no longer an outlier in terms of physician density compared with other Western countries. This ''normalization'' conceals the high concentration of doctors in the older cohorts and the insufficient number of new doctors to replace those leaving the profession for retirement or other reasons. These patterns are similar - and often more severe - in the case of Italian nephrologists. The aging and increasingly female population of Italian nephrologists calls for a major task shift of many activities to nurses and other healthcare professionals.

During the last 10-15 years the International, but especially, the American Nephrology have been more and more colonized by the basic sciences. This has led to advocate for the future a nephrologist oriented towards the basic sciences. While nobody would deny that the basic sciences will be useful for the development of nephrolologic knowledge in the next decades, there are very urgent clinical problems in the present that should alert against this attitude. The most actual problem is represented by the new kind of patients affected by renal diseases who are older and much more complicated than in the past. Furthermore, todays patients need to interact with the clinician and require to be informed about the diagnostic and therapeutic procedures proposed. Although it is obvious that a deep knowledge in the basic sciences may be useful in improving the clinical care, the existing situation makes it impossible to propose a nephrologist being able at the same time to take care of all clinical and relational problems of patients with renal diseases and also to be well oriented in the basic sciences. This imposes a choice: If the aim of nephrologist involved in the clinical care is directed to the development of nephrologic knowledge to be applied in the next decades, then it may be reasonable to have more and more people oriented towards the basic sciences. On the contrary, if the aim of nephrologist is directed to offer the best available care to the patients, then there is no choice: no chance for a basic sciences oriented nephrologist.

During the thirty years from its birth, the activity of the Department of Nephrology and Dialysis at the Carlo Poma Hospital in Mantova has witnessed the progressive increase in the number of kidney patients (300/year), uraemic patients in RRT, both peritoneal and extracorporeal (>220 patients) and kidney transplants (84). During the same period there has also been an increase in the following activities: from kidney biopsy by echocolordoppler for glomerular illness to metabolic studies for the prevention of kidney stones, therapy and follow-up for hypertension during pregnancy to echo-studies of the renal vascular bed, long-term follow-up of kidney transplant patients to territorial distribution of 4 limited-care dialysis facilities. Vascular access surgery, 100 interventions per year, and home peritoneal dialysis (CAPD and APD (today more than 50 pts in treatment) are increasing. During the last three years there has been a rapid increased in requests for CRRT in the ICU's. After acknowledging the work of all doctors active throughout the years, this presentation ends with a report on the goals for the near future.

Some recent historical celebrations of modern Italian nephrology offer the opportunity to write about the meaning of the history of medicine and nephrology. First of all, the question "what do we learn from history" is wrongly phrased. It is from trying to learn about history, from the effort required to achieve a historical and epistemological perspective, that we may learn how people as individuals or as a group solved the problems of meeting their common human needs. Medicine is itself an eminently historical endeavour. There is history in medicine as well as history of medicine. According to Paracelsus, the history of medicine is medical science and medical science is essential history in the widest sense of the word. The word "history" embraces the concepts of human nature, the world in which human nature is revealed and the thoughts guiding it through life. If the history of medicine and nephrology is observed in all aspects of their evolution, we can see how it had a beneficial role on the work of physicians by reminding them that, prior to the light of achievement, the discovery of all medical principles is preceded by errors and doubts. We report on nephrological debates, controversies and achievements and we call attention to the need to focus on the present through the involvement of medical historians in the analysis of contemporary health policy issues and clinical methodology.