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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 five consultative inpatient services, renal ambulatory clinic, and ambulatory electives at the Johns Hopkins Hospital and the Johns Hopkins Bayview Medical Center.

  • Intensive Care Unit Consultation

This service team consists of a nephrology fellow, supervising attending, and occasionally a critical care fellow Fellows will gain experience in the diagnosis and management of the following:

o Acute kidney injury in the context of critical illness due to sepsis, liver disease, cardiovascular disease
o Post-operative renal complications
o Medication-induced renal failure
o Renal issues related to oncologic diseases tumor lysis syndrome, post-bone marrow transplant renal failure
o Acid-base and electrolyte disturbances
o Patients with advanced chronic kidney disease requiring intensive care

  • Inpatient Consultation

This service team is comprised of a nephrology fellow, supervising attending, and occasionally internal medicine residents and medical students.  Fellows will encounter a wide spectrum of diseases during this rotation including:

o Acute kidney injury from various causes pre-renal azotemia, pregnancy, urinary tract obstruction
o Rapidly progressive glomerulonephritis and vasculitis
o Primary or secondary nephrotic syndromes
o Acid-base and electrolyte disturbances
o Chronic kidney disease of all stages due to varying etiologies
o End-stage renal disease and related complications bone mineral disorder
o Drug toxicity

  • Inpatient "Bond Street"

This service consists of a nephrology fellow with supervision from attendings for admitted patients with end-stage renal disease or other renal diseases from the affiliated Johns Hopkins outpatient dialysis units or specialized nephrology outpatient clinics Renal issues encountered during this rotation are similar to those seen in the Inpatient Consultation Service in addition to the following:

o Dialysis catheter related infections
o AV fistula or graft complications
o Hyperparathyroidism of various severity and related complications such as calciphylaxis and peripheral vascular disease
o Autonomic dysfunction and volume management

  • Nephrology Transplantation

The Nephrology Transplantation Service is a service co-managed with the renal transplant surgery team.  The inpatient nephrology transplant team consists of a transplant nephrology fellow, general nephrology fellow, supervising transplant nephrology attending, advanced practitioner, and internal medicine residents.  During this rotation, fellows will gain substantial experience in the management of post-operative and chronic renal transplant patients.  The following issues will be encountered:

o Pre-operative evaluation and care of potential renal transplant recipients and donors
o Post-operative renal complications of renal, pancreas, and hepatic transplant recipients
o Acute or chronic allograft dysfunction due to various causes, including cellular and antibody-mediate rejection and BK nephropathy
o Metabolic, infectious, and oncologic complications due to immunosuppressive medications

  • Bayview Consultation

This service team is comprised of a nephrology fellow, supervising attending, and occasionally internal medicine residents and medical students at the Johns Hopkins Bayview Medical Center Fellows will see consultations requested by any of the hospital services (internal medicine, surgery, neurology, etc. on the general inpatient and intensive care units, which includes the John R. Burton Geriatric Care Center and Maryland's only regional burn center. Additional experiences during this rotation include:

o Management of acute and chronic kidney disease and their complications, in both the inpatient and intensive care unit settings
o Rapidly progressive glomerulonephritis, vasculitis, and nephrotic syndrome
o Use of inpatient hemodialysis, peritoneal dialysis, and continuous renal replacement therapies
o Management of kidney disease in the geriatric population
o Acid-base and electrolyte disturbances
o Complications seen in patients with renal transplants

  • Ambulatory Continuity Clinic

In this one-half day weekly clinic, evaluate and manage ambulatory patients with various renal issues longitudinally under the supervision of nephrology attendings.  Renal issues encountered during this clinic include the following:

o Acute kidney injury
o Chronic kidney disease and related complications
o Chronic post-renal transplantation care
o Hypertension
o Fluid, electrolyte, and acid-base disorders
o Nephrolithiasis
o Genetic renal diseases
o Nephrotic and nephritic syndromes
o Tubulointerstitial disease
o Abnormalities of the urinary collecting system
o Drug-related renal toxicity
o Renovascular diseases

  • Electives

Additional elective experience is arranged for the following areas to suit the fellow's needs and interests:

o Hemodialysis access evaluation and management
o Renal Pathology
o Immunology
o Community nephrology experience
o Ambulatory subspecialty renal clinics
o Therapeutic apheresis

Through clinical experiences in the first year, fellows become proficient in the performance and interpretation of urinalyses, various modalities of renal replacement therapy, placement and management of temporary vascular catheters and performance of percutaneous native and transplant kidney biopsies.


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