Renowned kidney disease academic Professor Charles Pusey reflects on his career and the future of renal research.

Professor Pusey will continue to support ongoing research in the Department of Immunology and Inflammation as Emeritus Professor of Medicine, having first joined Hammersmith Hospital’s renal unit in 1979 as a Senior Registrar. Later in 1981, he undertook an MRC Clinical Training Fellowship at the Royal Postgraduate Medical School, which became part of Imperial College in 1997.

With an overarching focus on understanding the causes of kidney disease, Professor Pusey’s research has shed light on the underlying mechanisms of conditions such as glomerulonephritis, anti-GBM disease and vasculitis.

We spoke to Professor Pusey about what has motivated his work, managing life as a clinical academic and the future of scientific research.

What inspired you to pursue a career in academia, specifically within the field of renal medicine?

I spent some time in the Royal Air Force after qualifying and was interested in aviation medicine for a while. I then went into hospital practice in the RAF and was initially attracted to cardiology. However, I ended up working in the RAF’s renal unit, where I developed my interest in kidneys. With kidney disease, you have the opportunity to be active and interventional. However, it becomes more complicated when you start to investigate the underlying causes, which I found fascinating. When I left the RAF, I came to Hammersmith Hospital as a Senior Registrar, because the renal team here had a very good record of understanding and treating immune-mediated kidney disease.  It was then almost inevitable that I would do academic medicine.

Did you have any mentors who supported you at the beginning of your career?

When I first moved to Hammersmith, my early career development was very influenced by Professor Sir Keith Peters. He was the leading academic in my field and encouraged my research. He supported me in applying for an MRC Fellowship, followed by a Wellcome Trust Senior Fellowship. I also worked with another very eminent nephrologist, Professor Andrew Rees, who provided me with more academic and clinical mentorship.

What has been your proudest achievement while working at Imperial?

It would probably be building up and developing the renal research team that I took over when Professor Rees left. I’m always proud to see people that I’ve encouraged and trained moving on to take up academic positions elsewhere or developing their careers here.  There is always the excitement of a crucial experiment working out, and a paper getting published, but building up the team has been the most rewarding thing overall.

What has been the biggest challenge you’ve had to face during your career?

If you’re a clinical academic, there’s always a tension between your academic work and your clinical work. It’s very demanding having the pressure from the academic side to earn grants and to publish papers, but also the pressure from the clinical side to deliver a good quality service. Over the years, the latter has become more difficult for anyone working in the NHS, with the growing lack of resources. Achieving the balance between clinical and academic work provides a real challenge.

Have you developed any strategies for dealing with those pressures?

I compartmentalise a lot, try to focus on what I’m doing, and accept that I can’t do everything at once. If I’m on a ward round or doing a clinic, I just focus on doing that as well as I can and don’t worry about the research.  Although, of course, some research questions are triggered by patients. Then, when I sit in my office writing grants, I try to focus on that and to not think about the other side…but, inevitably, my phone will go off with someone asking about a patient. You can never really put your clinical responsibilities to one side.

What advice would you give to someone in the early stages of their clinical academic career?

"My research has always been motivated by a desire to understand the diseases that I see in the clinic every week, and to try and better understand how to treat them" Professor Charles Pusey

You need to accept that it’s going to be incredibly hard work because you’re essentially going to be doing two jobs at once. You have to learn to adapt and cope with that, and you’ll need to make sacrifices. On the other hand, it’s very rewarding. Having an interest in research and teaching keeps you more interested in maintaining your clinical practice. I’ve continued my clinical work for so long because I’ve been continually invigorated by the research side of things. My research has always been motivated by a desire to understand the diseases that I see in the clinic every week, and to try and better understand how to treat them.

Another crucial piece of advice I would give is to find the right individual or group to work with. You have to do something you're genuinely interested in, rather than being pushed into doing something you don’t particularly like. Having a real interest in what you’re working on will give you the determination to pursue it properly. Ideally, you should also find someone who can advise you – that might be an external mentor or a member of your team – on how to navigate clinical academic life.

In your field, what do you think are the key research questions that need to be answered most urgently?

We need to try to focus more on prevention, as opposed to treating the consequences of kidney disease, and we’re doing that already in various ways. Through research, we’re beginning to understand the genetics of different kidney conditions, and the part played by autoimmunity and inflammation. This knowledge is allowing us to identify targets which we can use to develop new treatments to prevent kidney failure.

Are there any emerging areas of research that you’re particularly excited about in terms of potential impact?

For some patients with severe immune-mediated kidney disease, we’re seeing good results when combinations of different existing immunosuppressive drugs are used at lower doses.  Several of the newer biological agents and small molecule inhibitors of inflammatory pathways are looking promising.  There are also examples of interesting developments in stem cell therapy. At the moment, these haven’t been clinically successful, but in pre-clinical models of disease, they've been shown to be effective in limiting kidney damage.

How do you see the landscape of scientific research changing in the next ten years?

I see great advances in genetics, both in terms of helping us to understand the causes of disease and developing new treatments, including gene therapy. Also, the use of artificial intelligence (AI) will probably increase as computers become more sophisticated and can do certain things better than humans. For example, AI may make fewer errors in interpreting pathology slides and X-rays, although not everyone would agree! However, there's still a long way to go before computers can speak sympathetically to a patient and understand their problems. Ultimately, I think AI should play a supporting role in clinical practice, but it’s essential we don't forget the importance of human interactions.