Nephrology

• Elective and site director: Dr. Richard Feldenberg (lrichard.feldenberg@health.slu.edu)

• Pediatric nephrology faculty

  • Dr. Anne Beck

  • Dr. Craig Belsha

  • Dr. Richard Feldenberg

  • Dr. Joe Maliakkal

• Nurse practitioners:

Ann Freihoff APRN, CPNP

• Administrative assistant: Michaela Turnbough (michaela.turnbough@health.slu.edu)

• +/- Residents (pediatric, family medicine) and/or fourth year medical students on nephrology elective (2-4w)

• +/- Third year clerkship or career exploration student (1w)

• Multidisciplinary healthcare team providers: nurse practitioners, nurses, social workers, dietitians

• Personalize your experience

  • Contact Dr. Feldenberg at least a week before starting to discuss your rotation goals, objectives, strategies, zoom links for educational conferences, any scheduled renal biopsies, as well as any schedule requests. Nephrology activities and schedule are personalized based on interest and can include nephrology clinic, urology clinic, as well as the nephrology inpatient/consult service. Clerkship and CE students typically spend all or most of nephrology block in clinic.

    • The expectation for all mini electives is a full work week in clinic potentially with a caveat that on half days a clinic is not held, you may be assigned to other tasks etc at the discretion of the site director.

  • Review EPIC for the “clinical landscape” during your time on nephrology

    • Nephrology

      • • Clinics. CG Renal

        • Inpatient/consult service

          • EPIC Systems lists

          • =CG Resident Treatment Teams

          • CG Nephrology

    • Urology

      • • Clinics. CG GU

        • Inpatient/consult service

          • EPIC Systems lists

          • =CG Resident Treatment Teams

          • CG GU

  • Review the Learners on pediatrics spreadsheet

    • Consider touching base with any outgoing learners and/or those scheduled with you.

    • Use the "insert comment" feature. We will go through to finalize

    • Orange team tab (elective students). Once you determine which week/s you will spend on the inpatient/consult service, add your name to the days you will be with the orange team.

    • Nephrology tab, +/- urology tab

      • Add the experience you want to participate in. Often multiple options: nephrology clinic, urology clinic, intern academic half day (for M4s) are available during a given half day. Potential considerations include presence of other learners, how busy a clinic is (Eg. if two clinics held during a given half day session, you might want to pick one with greater number of patients), variety of experience, and/or continuity with a specific attending. We request no more than 2 learners per clinic/attending.

  • Individual study

• Nephrology individual study

  • Read and be prepared to discuss the following articles

    1. 1. 1. • 1. • Review of Congenital Anomalies of the Kidneys and Urinary Tract

                  • Approach to the child with hematuria

• Fluid and electrolytes

• White Coat: required

Common Presenting Problems

• Blood pressure elevation/Hypertension

• Electrolyte abnormalities: Hypo and hypernatremia, hyperphosphatemia

• Acid Base Disorders

• Hematuria

• Proteinuria

Common/Diagnoses:

• Collagen-vascular disease

• Congenital abnormalities of the Kidneys and urinary tract (CAKUT): Eg.horseshoe kidneys, dysplastic kidneys, renal agenesis

• Nephrogenic Diabetes Insipidus (DI)

• Glomerulonephritis

• Hydronephrosis

• Nephritic syndrome

• Nephrolithiasis

• Acute Kidney Injury (AKI)

• Chronic Kidney Disease (CKD) and their stages I-V

• Renal transplant

• Renal tubular acidosis

• Bartter’s syndrome and Gitleman’s syndrome

• SIADH

• Urinary tract infections

• Wilm’s tumor

*Topics recommended for early review in bold

• Observed patient encounter problem based encounter possible if working with a resident or fellow

• Document required clerkship encounters (OASIS)

  • Problem based complaints

• Qualtrics self-assessment and formative feedback. Possible if working with an attending multiple times

• Observed patient encounter problem based encounter possible if working with a resident or fellow

• Document required clerkship encounters (OASIS)

  • Problem based complaints

• Qualtrics self-assessment and formative feedback. Possible if working with an attending multiple times

• Thursday clinic typically starts at 9 AM after renal conference

• After actively observing 1-2 patient visits, you may see a patient independently.

• Sometimes patients are scheduled for radiology studies prior to their nephrology appointments. Try to review study results before presenting.

• Students are encouraged to document

• Cardinal Glennon

  • Ambulatory Care Center (ACC) Ground Floor

  • EPIC: CG ACC Renal

• South County (SoCo)

  • Dr. Belsha, Thursday AM

  • 13000 Butler Crest Drive

  • St. Louis, MO 63128

  • 314-577-5662

  • 22 minutes from Cardinal Glennon

  • EPIC: CG SOCO GI

• North County (NoCo)

  • Dr. Feldenberg, Thursday PM

  • 3878 Pershall Road

  • Ferguson, MO 63135

  • 314-577-56622

  • 27 min from CG

  • EPIC: CG NOCO GI

• Seeing new consults is a great opportunity to take a history, perform a thorough physical exam, and to work on an assessment, differential, and recommendations. Elective students will often spend a week on the inpatient/consult service. Both elective students and others have an opportunity to be involved in nephrology consults outside of that time period. Let the inpatient attending know you will be interested in seeing new consults, share your contact information, and ask him or her to let you know about any consults that might come during your time on nephrology

• Nephrology serves as the primary team for the nephrology patients on the orange team. They are a consulting service for other hospitalized patients.

• In the morning the nephrology inpatient/consult team (attending, +/- NP, +/- elective resident, and/or student) discuss all patients: primary and consult. They then join orange team in their conference room (2N. Door code: 2314) to discuss floor patients on the nephrology service. Starting time is typically 10AM and 10:30 on Wednesdays to allow for grand rounds/professional development series attendance.

• Student on the nephrology inpatient/consult service should pick patients to primarily follow which includes pre-rounding, working with the team to come up with an assessment and plan, and presenting the patients during nephrology team round, +/- orange team rounds. In order to minimize overlap with orange team students and interns, those on the inpatient/consult service should primarily pick nephrology patients not on the orange team.

• Medical Documentation

  • Document a consult (initial or follow up) for each encounter

  • Route note to the supervising physician (resident or attending)

  • End each note with: “Discussed with Dr. X (attending)” so the team knows that they can act on plan.

  • Support your recommendations citing primary literature, review article, or a textbook.

Students have the opportunity to participate if interested. Please check the schedule for procedures scheduled during your time on nephrology.

Renal Conference. Thursday 8AM. Teams. Division discussion of patients on nephrology service

Pathology Conference. 2nd Thursday of the month 11AM Zoom (Dr. Brink sends link day of conference; Michaela Turnbough will send out to students 30 min prior).

RUN Conference. 1st Wednesday of month 715AM-8am. Teams.

ESRD Conference. 4th Wednesday of the month 11AM. Teams.

Transplant Conference. 2nd Thursday of the month (sometimes 12pm or 1pm) Zoom (Dr. Brink sends link day of conference; Michaela Turnbough will send out to students 30 min prior).

Student performance evaluations are assigned to Dr. Feldenberg who completes them based on his own experience as well as feedback from the team. Dr. Feldenberg is able to review your nephrology activities and physicians you worked with using the Learners on Pediatrics spreadsheet.

• Elective students will often spend a week on the inpatient/consult service. Both elective students and others have an opportunity to be involved in nephrology consults outside of that time period. Let the inpatient attending know you will be interested in seeing new consults, share your contact information, and ask him or her to let you know about any consults that might come during your time on nephrology.

• Try and read at least 1-2 articles/topics a day (especially if relevant to patients you’ve seen or are about to see) at least in the first week to really build a good foundation in Nephrology for the rest of the month.

• High yield topics

  • Renal physiology

  • Causes of hematuria (especially microscopic hematuria)

  • Dietary modifications for management of nephrolithiasis

  • Causes of and work-up for congenital hydronephrosis

  • Differential diagnosis for pediatric HTN

• Physical exam elements to pay attention to

• Vitals

  • Weights and trends

  • Blood pressures and respective percentile based on height and gender (chart available among course materials and posted on the wall in clinic)

• Ins outs: totals and trends

• PE

  • Ear pits/tags/abnormalities

  • Edema

  • Abdominal exam

  • Check for costovertebral angle tenderness.

• EPIC shortcut: .BPFAWL95 will autopopulate the BP percentiles

• Recent changes

  1. • Nephrology individual study and core topic series presentation (block 4, 20-21)

     • Opportunity for students on nephrology service to add urology clinics (block 4, 20-21)

• Planned projects

• We welcome additional ideas and student involvement!

• "Pay it forward challenge"

  • • Update clinical site information (mirror documents of information posted on the website) with anything you know now and wish you had known when starting: corrections, tips, and/or individual study resources. You should be able to edit and comment directly. We review these regularly and use this information to update the website.