This is our core consult service, providing inpatient consultative nephrology to all patients within the medical center (excluding kidney and kidney/pancreas transplant patients). This rotation provides a rich exposure to management of critical care patients with renal issues, acute kidney injury, fluid and electrolyte disorders, hemodialysis-related complications, glomerulonephritis, dialysis including continuous renal replacement therapy, etc. In addition to a nephrology faculty and a nephrology fellow, there are typically 3-4 internal medicine residents rotating through this service. The fellows and residents divide the work of the service, which allows the fellow to develop experience in a supervisory role. The fellow typically sees 8-12 patients on their own, and the remainder of the patients are seen by the residents under the supervision of the fellow. Medical students and observers often rotate on this service as well, and fellows have the opportunity to play an active role in student education.
Fellows will develop a rich transplant experience by rotating through our nationally renowned kidney and kidney-pancreas transplant program. Typically, 140-170 patients are transplanted yearly at our center, and we provide longitudinal care for more than 1,200 patients, affording fellows exposure to both acute and long-term issues in kidney transplantation. We routinely transplant patients from all across the United States, and our center frequently employs innovative strategies to living kidney transplantation including the use of kidney paired donation and transplant chains. The kidney transplant service include a transplant faculty member, a general nephrology fellow, a transplant advanced practice provider, as well as other multidisciplinary team members. The inpatient census averages approximately 10 patients. During the transplant rotation, fellows will spend time in a kidney transplant clinic devoted to short and long term post-transplant follow-up, as well as donor and recipient evaluation clinic.
The VA nephrology rotation consists of inpatient and outpatient consultative nephrology. The census typically runs between 5-10 patients, and is managed by a nephrology faculty, nephrology fellow, and a resident. During the VA block, fellows participate in two half day VA nephrology clinics.
In order to offload the consult service, we established a non-teaching ESRD inpatient consult service. This service is staffed by a nephrology faculty and APP. Fellows do not rotate on this service. Generally, stable ESRD dialysis patients are placed on this service.
Fellows will have ample opportunities to develop skills and proficiency in performing ultrasound guided kidney biopsies. Both native kidney and transplant kidney biopsies are performed with regularity in the division. Further, an early cadaver lab experience allows fellows to practice initially in a low-stress setting.