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After graduation, ISN Sister Renal Centers or ISN-TTS Sister Transplant Centers partnerships can opt to support a third emerging center within the region through the ISN SRC Trio Program.

Three recently graduated Trio partnerships demonstrate the valuable impact these collaborations can have on local nephrology capacity.

Emerging Institution: Nephrology Institute, Zhengzhou University, Zhengzhou (NIZU), China; Supporting Institution: Institute of Nephrology, Peking University, Beijing (INPU), China; Mentoring Institution: Renal Division, Brigham and Women’s Hospital (BWH), Harvard University.

Prior to 2014, the NIZU had a large number of patients with kidney disease but lacked diagnostic expertise and equipment in renal pathology. With the help of INPU and the BWH, they were able to set up their own pathology department for kidney diseases in Henan Province. Nurses and doctors received training in clinical and pathology skills to improve expertise and accuracy in the diagnosis and treatment of rare and complex diseases, and their prognosis.

The hospital wards grew from three to six, increasing bed capacity from 193 to 308. The renal replacement therapy center expanded to include two blood purification centers and two peritoneal dialysis centers. Equipment increased to include 132 blood dialysis machines, over 170 blood purification machines, and 45 continuous renal replacement therapy units. A peritoneal dialysis hotline was set up to provide better services for patients.

NIZU joined the TESTING and C-STRIDE clinical research trials initiated by INPU. 36 national projects were allocated to NIZU by various organizations including the Ministry of science and technology, the Medical Management Institute of National Health and Family Planning Commission, and the National Natural Science Foundation of China. 200 articles were published in Chinese medical journals.

In 2018, NIZU established the first Dialysis Pathway Operation Center for Uremia in the Henan Province. According to China Hospital Science and Technology Influence Ranking, the institute rose from 17^th place in 2016 to 11^th place in 2018.

Emerging Institution: Tikur Anbessa Specialized Hospital (TASH), Ethiopia; Supporting Institution: St. John’s Medical College, India; Mentoring Institution: Montreal Children’s Hospital, Canada.

The goal here was to establish a pediatric nephrology service in Ethiopia, transfer knowledge and skills, and equip the emerging center in data collection and analysis to produce reliable, reputable studies.

The emerging center, initially run by only one senior pediatric nephrologist, expanded to acquire two additional pediatric nephrologists trained through the SRC Program. Two renal follow-up centers have now been set up, one in the emerging center and an additional institution in the capital as an outreach program. The supporting center provided acute PD and HD catheters, biopsy guns, and BP apparatus for all age groups. Children who have received transplants abroad can now receive post-operative care within the emerging center. The total number of pediatric nephrologists has increased to five in Ethiopia.

A pediatric nephrology subspecialty curriculum was developed for the emerging institution. Teaching materials were produced and Continual Medical Education (CME) meetings were held to reach pediatricians caring for children with kidney diseases.

With the support of the program, TASH made multiple poster presentations both nationally and internationally. In 2019, they received the best abstract award at the AFPNA congress in India for sharing their experience of using improvised acute PD solutions to provide RRT via rigid catheters. A research grant was awarded to TASH through the ISN Clinical Research Program to conduct the first large prospective AKI study in Ethiopia.

Bezaye Abebe, liaison officer at the emerging center, states: “The bright faces we see when our children beat death and come back for [a] follow-up, is a reason to push through every day against all the limitations in the country.”

Emerging Institution: Susana López de Valencia, Colombia; Supporting Institution: Fundación Valle del Lili (FVL), Colombia Mentoring Institution: Boston Children’s Hospital.

The goal was to improve pediatric nephrology in the Southwest region of Colombia by:

• creating an outpatient clinic Learning Center Program to support children with renal diseases,
• training healthcare professionals in detection, prevention, and treatment innovations for renal diseases,
• developing strategies to improve AKI treatment,
• setting up an in-utero CAKUT database,
• evaluating patients to detect early hypertension and proteinuria.

Through the program, staff from SLV were able to visit Boston Children’s Hospital to receive training. The emerging center benefitted from additional ISN programs, including fifteen Continuing Medical Education (CME) meetings hosting international speakers, and an Educational Ambassador (EA) Program visit from Dr Guido Filler, from the Children’s Hospital of Eastern Ontario, Canada.

Support from the urology and nephrology teams from Boston Children’s Hospital helped develop a myelodysplasia clinic as well as a pediatric nephrology unit in Popoyàn for the assistance and follow-up of pediatric patients with renal pathology. An approved AKI network was established in Cali and Popayàn Intensive Care Units.

Both the supporting and mentoring institutions provided training to two transplant surgeons, one adult nephrologist, one pediatric nephrologist, and one pediatric intensivist as well as three nurses enabling the development of a pediatric renal transplant service at Hospital San Jose-Popayàn including a transition program for adolescents with kidney transplants.

Several research studies were carried out and a research group on kidney diseases in the indigenous population was initiated as part of an effort to increase awareness and associated risks of renal diseases in children in the TOTORO aboriginal community.

In a final report on the impact of the program, the emerging center stated: “We have always received permanent and timely support for everything requested from the ISN…We believe that ISN is an example of excellent support for the entire nephrology community that encourages people to work in an organized way, impacting the prevention of kidney disease in the world.”