Kathryn O’Brien, DO, Joins UPMC Children’s Division of Pediatric Nephrology

Kathryn O’Brien, DO, assistant professor of pediatrics and medicine, joined the Division of Pediatric Nephrology at UPMC Children’s Hospital of Pittsburgh in July after completing a four-year combined fellowship in adult and pediatric nephrology at UPMC. Her clinical practice at UPMC includes both pediatric and adult nephrology patients.

Dr. O’Brien earned her medical degree from Edward Via College of Osteopathic Medicine in Blacksburg, Va. Shey then completed a combined internal medicine-pediatrics residency at Baystate Medical Center in Springfield, Mass. before coming to UPMC for dual fellowship training.

Nephrology was not initially a subspecialty Dr. O’Brien intended to pursue. During her fourth year of medical school, an elective in pediatric nephrology exposed her to a clinical mix of patients that included sickle cell-associated kidney disease, acute dialysis, and inherited tubular disorders like Bartter syndrome and Gitelman syndrome. The rotation became her favorite experience during medical school training.

“I went into the rotation without any expectation that I would pursue nephrology,” Dr. O’Brien says. “But I loved the range of patients and conditions, and the physiology of the kidney was something that I found quite interesting in its complexity.”

Dr. O’Brien’s interest in nephrology expanded further during her residency, when an adult nephrology rotation proved equally compelling as her prior pediatric nephrology elective. With her dual med-peds background already shaping her overall training, Dr. O’Brien decided she wanted to continue in both pediatric and adult nephrology rather than make a choice between the two disciplines.

A Combined Fellowship Program at UPMC

Finding a fellowship program that could support dual pediatric and adult nephrology training left Dr. O’Brien with a limited number of options as there are very few programs of the sort currently operating in the United States or that have equally robust pediatric and adult nephrology capabilities within the same system. Dr. O’Brien chose UPMC and the University of Pittsburgh School of Medicine because she saw comparable strength in the adult and pediatric nephrology programs and felt equally comfortable with the faculty in both.

“I wanted robust training on both sides,” Dr. O’Brien says. “I didn’t want one part of the fellowship to be secondary to the other, and during the interview process I felt that I could get the depth of training I wanted in both programs here.”

Dr. O’Brien became the first physician at UPMC to complete the combined pediatric and adult nephrology fellowship. The four-year pathway combined training that usually consists of separate two-year adult and three-year pediatric nephrology fellowships. Because the combined structure was new to UPMC, the adult and pediatric nephrology divisions coordinated clinic schedules, rotations, and other requirements throughout Dr. O’Brien’s fellowship to facility and streamline the rigorous training curricula that each program supports.

The dual training also gave Dr. O’Brien a high clinical volume and sustained exposure to the different clinical dynamics that predominate on each side of the nephrology spectrum while allowing her to follow the overlap that often occurs when pediatric patients with chronic kidney issues transition into adult care.

“The fellowship was long and demanding, but I was able to see the full breadth of nephrology,” Dr. O’Brien says. “I had excellent teachers in both programs, and both sides worked together to make sure I had the clinical experience I needed to excel in patient care in both worlds.”

Clinical Practice Across Pediatric and Adult Nephrology

Dr. O’Brien has now taken all of her combined training into put it into practice at UPMC working with children and adults with kidney disease.

The clinical mix differs across the two settings. Congenital, structural, and inherited kidney disorders account for a larger share of pediatric practice, while Dr. O’Brien’s adult clinical duties includes more acquired chronic kidney disease and associated comorbidities. At the same time, conditions like autoimmune kidney disease cross age groups with substantial overlap in how these conditions are best managed over time.

Working in both settings also allows experience from one side of Dr. O’Brien’s clinical practice to inform the other. The connection is relevant for adolescents and young adults whose kidney disease began in childhood. Dr. O’Brien is familiar with the pediatric treatment framework these patients are leaving as well as the adult nephrology setting, they are entering. This becomes clinically important when care guidelines differ across age groups or when years of pediatric subspecialty care have involved a high level of family participation in managing a child and adolescent’s kidney condition.

“For some diseases, the pediatric and adult approaches to care are very similar,” Dr. O’Brien says. “For others, when a patient reaches 17 or 18, there can be a real clinical question about whether to continue following the pediatric approach or move to adult guidelines.”

Dr. O’Brien’s combined practice also creates an option for patients who would benefit from greater continuity during the transition period.

“If a patient is aging out of pediatric nephrology and needs an adult provider who understands how their care has been managed on the pediatric side, I can be that transition point and help to facilitate those discussions,” Dr. O’Brien says.

The relevance of that role is likely to increase as the population of adults with childhood-onset medical conditions continues to expand because of the advances in medicine and research that more and more allow patients born with very complex to survive into adulthood. Patients born extremely prematurely are one good example of this dynamic that plays out with ever more frequency. More extremely premature infants now survive into adulthood, but they may carry renal and other chronic conditions that stem from their premature birth. This creates a growing need for adult physicians comfortable managing medical histories that began very early in life, a dynamic that Dr. O’Brien is well-positioned to handle, but also to help educate other clinicians.

Developing an Onconephrology Focus

Dr. O’Brien’s adult fellowship training also led to a developing interest in onconephrology. During her third year of fellowship, a required rotation at UPMC Shadyside, which is home to UPMC Hillman Cancer Center, brought her into the care of patients with renal complications related to malignancy and cancer treatment. She found the work compelling enough to pursue additional training in the care of these patient populations before completing fellowship.

“I enjoyed that part of my training enough that I went back for additional experience in onconephrology,” Dr. O’Brien says. “It became an area I knew I wanted to continue developing clinically.”

At UPMC Children’s, Dr. O’Brien sees an opportunity to build additional expertise around kidney disease associated with chemotherapy and other nephrotoxic therapies while continuing similar work in her adult practice. Her longer-term goal is to become a pediatric nephrology resource for children and adolescents who develop renal complications during cancer treatment.

“I’d like to continue expanding my onconephrology experience and bring more of that expertise to the pediatric side,” Dr. O’Brien says. “At the same time, I can continue working in the field with adult patients, so it is an area that fits well with the way I trained and the way I practice.”