Education

First Year Clinical Training Program

During the first year of the fellowship program fellows are immersed in clinical nephrology training to develop the fundamental knowledge and skills required to become an outstanding clinical nephrologist. First year fellows participate in the four inpatient primary rotations (as described below): 1) the Intensive Care Unit Rotation; 2) the Nephrology Transplant Rotation; 3) the Inpatient Consultation Rotation; and 4) the Outpatient Dialysis Inpatient Rotation (“Bond Street”) at the Johns Hopkins Hospital. In addition, first year fellows participate in the Nephrology Outpatient Continuity Clinic at the Johns Hopkins Outpatient Center as well as the Outpatient Peritoneal Dialysis Clinic at the DaVita Bond St. Dialysis Unit. First year fellows also have 4 weeks of elective time.

• Intensive Care Unit Rotation: This rotation team consists of a nephrology fellow and attending. They may be joined by a nephrology fellow from the Johns Hopkins Bayview Hospital and/ or a Critical Care fellow from the Johns Hopkins Critical Care Fellowship Program. Patients are seen as inpatient consultations in one of the intensive care units or medical oncology units. There are no primary service patients on this rotation. Diseases seen on this rotation include acute renal failure in the intensive care unit from all causes such as sepsis, hepatorenal syndrome, intra-operative hypotension, post-operative complications, tumor lysis syndrome, medication-induced renal failure, post-bone marrow transplant renal failure, rapidly progressive glomerulonephritis/ vasculitis, acid–base and electrolyte disturbances, and chronic kidney disease and end stage renal disease patients requiring intensive care unit care. 

• Nephrology Transplant Rotation: This rotation team is comprised of a nephrology fellow, transplant nurse practitioner, and transplant nephrology attending who closely interact with the surgical transplant team, social worker and immunogenetics specialists. They may be joined by a nephrology transplant fellow and/ or a visiting nephrology fellow from the Johns Hopkins Bayview Hospital. Patients followed in this rotation include immediate post-operative kidney and kidney-pancreas transplant recipients, patients with acute or chronic allograft dysfunction, patients admitted for complications from their transplantation procedure or immunosuppressive medications, and potential renal transplant donors or recipients.

• Inpatient Consultation Rotation: This rotation team consists of a nephrology fellow, attending and possibly one or more internal medicine residents or medical students. Patients may be seen in consultation or as part of the primary service. Diseases encountered on this rotation include a wide spectrum of diseases:  1) acute renal failure from all causes (e.g., pregnancy, pre-renal, atheroemboli, obstruction, rapidly progressive glomerulonephritis/ vasculitis); 2) nephrotic syndrome (primary and secondary causes), 3) acid–base and electrolyte disturbances; 4) chronic kidney disease in all stages ( due to diabetes, hypertension, chronic glomerulonephritis, chronic tubulointerstitial disease); 5) end stage renal disease and related complications (e.g., vascular access complications, calciphylaxis) as well as other diseases.

• Outpatient Dialysis Inpatient (“Bond St”) Rotation: This rotation consists of a nephrology fellow with supervision by respective attendings for admitted patients from the Johns Hopkins DaVita dialysis unit or from subspecialty outpatient clinics. Patients may be seen for consultation or as primary service patients. Patients with all forms of end stage renal disease and end stage renal disease complications (e.g. line-related infections, AVF/ AVG complications, tertiary hyperparathyroidism requiring subtotal parathyroidectomy).  Patients may also be followed from nephrology faculty members’ outpatient continuity clinic which may include those with chronic kidney diseases at various stages, as well as nephrotic syndrome, acute renal failure, and other problems as well.

• Nephrology Outpatient Continuity Clinic: Fellows attend this clinic one half-day per week. A nephrology attending provides supervision on a weekly rotating schedule to four fellows. Fellows are routinely scheduled two new patients (allotment of 1 hour each) and three to four return patients (allotted ½ hour each) each clinic.  Fellows follow their panel of patients longitudinally. Patients seen in clinic include those with: acute renal failure; chronic renal failure; renal transplant recipients; hypertension (refractory essential hypertension and secondary hypertension); fluid, electrolyte acid base disorders; recurrent nephrolithiasis; genetic renal disease; renal disorders of pregnancy; nephrotic syndrome; tubulointerstitial disease, and abnormalities or infections of the urinary collecting system.

• Outpatient Peritoneal Dialysis Clinic: Fellows follow a small cohort of patients receiving peritoneal dialysis in monthly clinics at the DaVita Bond St. Dialysis unit. Each fellow has a dedicated nephrology attending with whom they follow these patients. Patients with all forms of end stage renal disease may be seen in this ambulatory experience including diabetes, hypertension, chronic glomerulonephritis, chronic tubulointerstitial disease, hereditary kidney diseases as well as other diseases that may result in end stage renal disease.

• Elective Time: During this rotation, fellows attend an outpatient vascular access clinic to learn about the evaluation and management of various forms of vascular access.  In addition, fellows also work with renal pathology faculty to improve their skills in the evaluation of renal pathology. Other opportunities include attending urology, renal genetics or vasculitis center clinics, and/or rounding with the pheresis service.  For fellows interested in pursuing research or  formal training in educational skills, this rotation also allows affords time to meet potential mentors and discuss projects during the second year of fellowship.

Through clinical experiences in the first year, fellows become proficient in dialysis (hemodialysis, peritoneal dialysis and continuous renal replacement therapy), placement of temporary catheters for vascular access, performance of native and transplant kidney biopsies and performance/ interpretation of urinalysis. Fellows become skillful in the work-up and management of patients with acute and/ or chronic kidney disease.