Constituting a major threat to US public health, kidney disease is now an epidemic, with the number of affected persons escalating at a rate that produces an increase of 10-12% dialysis patients annually. The dialysis entitlement program currently consumes 5% of the Medicare budget for only 0.6% of Medicare recipients (approximately 20 billion US dollars annually). Beyond training more clinical nephrologists to shoulder the increasing burden of caring for chronic & end-stage kidney disease populations, the largest impact may only be realized by focusing efforts upstream on early diagnosis, pathogenesis & progression of the disease processes itself, which can only be accomplished through research. Central to meeting this need is to supply highly trained & skilled physician-scientists to conduct the research necessary to address this escalating public health problem. The need for energetic research efforts focused on better diagnostic tools, causes of kidney disease & novel treatment strategies is irrefutable. The purpose of this training grant is to train MD & MD, PhD physicians for independent academic research careers in kidney disease by providing training in basic & clinical sciences. We will integrate instruction across disciplines to ensure that trainees emerge highly skilled at translational research. Specific goals of the training program are to: (i)Provide trainees with skills necessary to become independent & complete academic clinician-scientists in basic, clinical and/or translational kidney-related research; (ii)Foster research efforts between basic & clinical trainees, & across departments and disciplines; (iii)Nurture & facilitate the transition from trainee status to independent academic faculty position. Despite the historical success of this training program (well over 2/3 of graduates in academic positions), we must continue to build on our commitment to train the next generation of physician-scientists in translational kidney-related research. Improving our capacity to bridge the gap between bench & bedside is essential to obtain funding by several agencies (NIH Roadmap) & will improve our ability to translate new knowledge & breakthroughs into clinical benefits for patients with kidney disease. Thus, the Program Director has decided a priori to provide this training upfront in this competitive grant renewal, by aligning and integrating the very successful Division of Nephrology's clinical science training program (not currently funded by T32) with the basic science program (currently funded by T32). This paradigm shift takes advantage of the newly established Kidney Research Institute and the Division of Nephrology's four integrated and cohesive research themes. Together, this provides an ideal environment and opportunity for 360-degree training: basic scientists can test hypotheses in human studies & clinical researchers can probe mechanisms to explain findings in population-based studies. These interactions will become motivating forces for scientific creativity. In addition, our ongoing efforts to introduce further diverse perspectives into biomedical research by training underrepresented minority physician-scientists (6 recent trainees in basic and clinical science; 4 now in academia) will remain a high priority. It is our expectation that continuing our success in developing the next generation of physician-scientists will insure a vigorous pipeline for delivering novel therapeutics to patients with kidney disease.