Nephrology Fellowship

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Hospital ward rotation

The Division of Nephrology-Hypertension operates a full-time hospital service with a small (5-10) number of primary care dialysis patients and a much larger consultative service of 15–20 patients. The rotations this year have changed to 1week blocks. There has been more time allotted for elective, outpatient clinic, and exposure to Home HD/PD for the first-year fellows. The rotation implementation for the second-year fellows is 1 week of hospital service a month in the second half of the year. This allows extra elective time for first year fellows and sharpens hospital skills for second year fellows.

Consultative patients include, but are not limited to, patients with:

• Acid-base disorders
• Electrolyte/metabolic disorders
• Chronic and acute renal diseases
• Systemic diseases
• Renal replacement therapies

More than 1,200 renal replacement treatments are done yearly in the hospital, with conventional HD and some PD. CVVH, CVVHD, conventional HD and SLED are done in the ICU with more than 500 sessions/year.

The hospital service operates with one nephrology staff, one or two nephrology fellows and usually one upper-level medical resident and one intern. Occasional urology interns and fourth-year medical students also participate.

The nephrology fellows are responsible for review of all cases seen and evaluated by the team members, giving directions and advice and direct care when needed. The fellows direct work rounds as well as team preparation for "teaching rounds." Final patient care decisions are the responsibility of the senior nephrology staff on service.

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Transplant rotation

The transplant service consists of one nephrology staff and two transplant surgeons staffing the service, with one upper-level surgical/urology resident and one nephrology fellow.

The transplant program averages about 40 renal transplants per year (and six pancreas transplants) with an average hospital census of about four to eight primary patients. Exposure on this service includes two full days per week of transplant clinic, where the service follows more than 600 transplant patients at various stages post-transplant, as well as donor and recipient evaluations for upcoming transplants.

The nephrology fellows see all admissions to the transplant service, as well as consults, and follow those patients with the transplant staff. Fellows are also responsible for the evaluation of any patient called for an urgent deceased donor renal transplant. Final patient care decisions are the responsibility of the senior transplant staff physician on service.

This service also includes nephrology continuity clinic plus one half-day general nephrology clinic.