Source: The Lancet, Volume 387, No. 10020, p741, 20 February 2016
www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00336-6/fulltext
Geoff Watts

Born to farming parents in China's Jiangxi Province, Xueqing Yu was among the first generation of his family to benefit from a university education. “I lived in the countryside and saw how difficult it was for people to have a good medical service”, he recalls. The idea of joining the struggle to improve health care was sown and, in due course, he became a physician: an academic whose career has taken him to the pinnacle of nephrology, his chosen specialty. Now Professor of Medicine and Director of Sun Yat-sen University's Institute of Nephrology in Guangzhou he's also the current President of the Chinese Society of Nephrology.

Yu's research interests, not least in the genetic basis of some forms of kidney disease, have built him a reputation that extends far beyond China itself. But any suggestion that his scientific achievements have eclipsed his concern for the practical needs of the people of rural China would be wrong. Recognising how the extent of kidney disease in China, especially away from its cities, made universal treatment by haemodialysis impracticable and economically impossible, he put his energies into the alternative: peritoneal dialysis. The result is the country's largest peritoneal dialysis programme, currently dealing with more than 1000 patients in the hospital affiliated with Sun Yat-sen University, and thousands more in a network of nine further centres in southern China.

Yu graduated from Sun Yat-sen University in 1987. One of his teachers had encouraged him in nephrology as a rapidly developing specialty, and he opted to make it his career. He completed a PhD, then spent a year at Monash University in Australia. He relished his stint there as a source of new ideas and an opportunity to concentrate on research. 5 years later he spent 6 months in the USA at Baylor College of Medicine. He now says that while it was his dream as a student to work abroad, as a mature doctor he changed his ideas. He still values the experience, but it became clear to him that the needs of his own country had to come first. Yu was appointed to his professorship in 1998.

Professor Richard Johnson, Chief of the Division of Renal Diseases and Hypertension at the University of Colorado, began collaborating with Yu during the latter's time at Monash. They worked on a blocking antibody to a protein expressed in glomerulonephritis. Johnson describes Yu as a man driven by his interests and enthusiasms. “He has tremendous leadership skills. He loves research, he's a proponent of good science, and he sets up a lot of collaborations.” He's also impressed by the breadth of Yu's research interests that range from the basic to the wholly clinical. Epidemiology looms large in Yu's portfolio. The prevalence of chronic kidney disease in China is fairly high, with the north and southwest topping the geographical league table. Yu and colleagues have been investigating these variations; lifestyle (urban or rural), particular foodstuffs, and even altitude seem to play a part. More generally, China is experiencing the increase in diabetes and hypertension found in many other countries: increases that fuel a rise in the prevalence of chronic kidney disease. A 2002 report in The Lancet co-authored by Yu described chronic kidney disease as “an important public health problem in China” and suggested that “special attention should be paid to residents in economically improving rural areas”—this being the group with the most rapid rises in hypertension and diabetes.

Yu and colleagues have also been studying the genetic underpinnings of IgA nephropathy in Han Chinese and, among other things, comparing them with white patients. He's long been interested in the implications such differences have for attempts to create international guidelines. “If there is no evidence from China and other parts of Asia”, he comments, “we may certainly call them international guidelines, but not worldwide guidelines”. He also hopes to see his genetic insights contributing in other ways, such as assessing susceptibility to chronic kidney disease and identifying patients most at risk of a damaging progression of their illness. Wei Chen, Professor of Medicine in the Department of Nephrology at Sun Yat-sen's First Affiliated Hospital, has worked with Yu since she joined the university more than 15 years ago. Besides Yu's major epidemiological projects, she speaks of a clutch of cohort studies that he's initiated: “For example he's followed up chronic kidney disease and end stage renal disease patients trying to figure out the risk factors that are important in influencing mortality in Chinese populations.”

Yu has lived through times of unprecedented change in China. He welcomes the benefits these changes have brought: more opportunities to study or attend meetings abroad; more and better medical care; and a burgeoning research enterprise. Johnson recalls research visits he's made with Yu to various regions of China, and describes his friend as “ebullient, high energy, kind, and keen to make friends with everybody”. Another colleague, Hui Yao Lan, Professor of Biomedical Sciences at the Chinese University of Hong Kong, has collaborated with Yu since the mid-1990s. “He's a man who provides strong leadership”, he says. “He's also very supportive to young clinicians and researchers.” There are two sides to Yu, adds Chen. “At work he's strict and asks for everything to be done very carefully. But as a friend he's a very happy man who enjoys, travel, eating, and singing.” To that list Yu himself adds mountain walking. “It gives more energy for work”, he says. “And hard work should be enjoyable.”