Nephrology
Nephrology Elective Curriculum
Location: Einstein- Weiler Campus (2 weeks) and Moses (2 weeks)
Staff/Faculty
· The faculty and fellow assigned to the service during the rotation will supervise students and residents in the evaluation and management of patients.
Goals: to provide broad experience in nephrology to medical students and internal medicine residents rotating through our renal elective. At the end of the rotation, the rotator should be comfortable with the initial evaluation and long-term management of patients with both acute and chronic renal diseases, hypertension, fluid and electrolyte abnormalities, acid-base disturbances, and have some insight into renal transplantation.
Rotation Breakdown
· Einstein (Weiler) Inpatient Nephrology Consult-2 weeks
o During these two weeks, you will rotate in the nephrology consult service at Weiler evaluating patients with acute renal injury, electrolyte abnormalities, and acid/bases disorders in the general floors and Intensive Care Units.
o You will attend the renal fellows’ clinic on Wednesdays from 1-5PM at Morris Park
· Moses Silver Service- 1 week:
o This week, you will rotate in the silver service at Moses providing consultations for patients in the ER, Foreman general floors, and Intensive Care Units.
· Moses Transplant Service- 1 week:
o This week you will rotate through the transplant service at Moses. This service consists of a primary service, which manages fresh renal transplant recipients, patients transplanted within a year or patients admitted with rejection. The service also includes a consult service that follows all admitted patients at Moses with a renal transplant or recipients of other solid organ transplants with renal problems.
o You will attend clinic on Tuesday at 9AM with Dr. Azzi to observe and perform outpatient management of renal transplant recipients.
o You will attend clinic on Thursday at 9AM with Dr. Liriano-Ward to observe and perform the initial evaluation of potential renal transplant candidates.
The rotator in transplant will have the option to go to the OR to observe a transplant case if they so desire, but this is not required.
· Visit to Monte 4 outpatient dialysis unit:
o During the elective, the rotators will attend rounds one morning (Wednesday or Friday) at the Monte 4 dialysis unit (1776 Eastchester Rd Ste 190, Bronx, NY 10461) with Dr. Deep Sharma to observe the outpatient management of ESRD patients and learn more about dialysis. You will be provided with specific details during your rotation.
Objectives:
To develop competency in performing and recording complete history and physical with differential diagnosis, assessments, and plan when performing renal consultations.
To become competent in the interpretation of laboratory tests, medical imaging and diagnostic studies employed in the assessment of renal function.
To identify the signs, symptoms, and management of common renal syndromes including acute kidney injury and chronic renal failure.
To learn how to prepare urinary sediment and be able to identify cells, casts, and crystals during the evaluation of patients with acute kidney injury.
Recognize urgent and emergent indications for hemodialysis.
Understand the diagnosis and management of fluid, electrolyte and acid-base disorders.
Understand the diagnosis and management of primary and secondary hypertension.
Understand the principles related to the use of phosphate binders, vitamin D supplements and calcimimetic drugs for treatment of bone mineral disease and hyperparathyroidism.
Understanding transplant eligibility criteria, evaluation, and inpatient management of transplant patients
Understanding mechanism of action and management of immunosuppression medications.
Teaching Methods
A. Supervised Direct Patient Care:
· You will learn through direct patient care with fellow and attending supervision in the inpatient setting.
· You will be responsible for primary evaluation of patients and development of an initial assessment and plan.
· You will present the patient to the fellows and attendings for discussion during teaching and management rounds.
· You are responsible for the initial and follow up consultation notes.
B. Didactic Lectures:
· Case discussions with fellows and attendings will occur during rounds.
· You are also required to attend weekly Grand Rounds and Journal Clubs as well as the weekly fellows’ clinical conference.
· In addition to the above required lectures, while in transplant, you are required to attend the transplant lectures/meetings.
· You will meet once a week with the directors of the nephrology elective (Dr. Azzi and Dr. Liriano-Ward) to discuss an interesting case of your choice seen during the rotation.
· See schedule at the end of the syllabus for complete list of required lectures/conferences
C. Independent Reading:
· You are required to read independently to answer questions about patient care that arise during the elective. You may use UpToDate, primary literature, or other sources suggested by the fellows/attending on service.
· You are responsible for reviewing these topics during the nephrology elective:
o Acute kidney injury
o Primary and secondary arterial hypertension
o Disorders of sodium and water homeostasis
o Potassium disorders
o Disorders of calcium, magnesium and phosphorus
o Acid-Base disorders
o Glomerular disorders and nephrotic syndrome
o Tubulointerstitial disease
o Nephrolithiasis
o Vascular disorders to the kidney
o Polycystic kidney disease
o Dialysis in the treatment of renal failure
o Obstructive uropathy
o Urinary tract infections, pyelonephritis
o Transplantation in the treatment of renal failure
Responsibilities/Expectations:
You are responsible for the management of your patients under the guidance of the nephrology fellow.
You are responsible for communication with the primary team for the patients you are following.
You are expected to have the highest standards of professionalism with patients and colleagues.
Evaluations of the Rotator:
· Review of your case presentations and documentation during management rounds
· End of rotation evaluation forms- we will obtain evaluation from the fellows and attending physicians you rotated with and this will be compiled by the elective director to complete your final evaluation.
Evaluation of Rotation: the rotators will complete an evaluation of the course and will be able to provide feedback to help us improve the elective. You may also speak directly with one of the elective directors to discuss the experience and provide feedback. In the end, our goal is to optimize your learning while at the same time fostering a positive environment.
Luz Liriano-Ward, MD Yorg Al Azzi, MD
Assistant Professor of Medicine Assistant Professor of Medicine
Director, 4th year Medical Student Elective Director, IM Resident Elective
lliriano@montefiore.org yazzi@montefiore.org
Amanda C. Raff, MD Michal L. Melamed, MD, MH
Professor of Medicine Professor of Medicine and
Associate Chair of Medicine for Epidemiology & Population Health
Undergraduate Medical Education Nephrology Fellowship Program
araff@montefiore.org Director: michal.melamed@einsteinmed.org
