2020 Volume 66 Issue 5 Pages 416-423
I joined Urayasu Hospital in 1987, just a few years after its establishment in May 1984. Since then, I have spent 33 years at the institution. The number of hospital beds has increased from 250 at its establishment to 785 at present. Initially, the Department of Internal Medicine was operated by around 10 staff members, and it was subsequently reorganized and subdivided by organ system in 2014.
As of March 2020, the Department of Internal Medicine is operated by five staff members. In 2014, a blood purification center was established and I was appointed as the first head of the center. With the expansion of the hospital, I have gained experience by treating more patients. Over the past 30 years, there have been several major changes in the medical care of kidney diseases. These changes vary widely and include identification of chronic glomerulonephritis and diabetic nephropathy as the causative diseases of end-stage renal disease, approval of erythropoietin for the treatment of renal anemia, introduction of angiotensin II receptor blockers, establishment of the concept of chronic kidney disease (CKD), conceptualization of mineral and bone disorders in CKD, drug discovery for autosomal dominant polycystic kidney disease, and initiation of living-donor kidney transplants. I would like to describe the changes in clinical practice that I have experienced without discussing each disease in detail.