Second Year Clinical Training Program

The second year clinical experience is designed to build upon skills acquired during first year primarily through a wide array of outpatient clinical rotations.

• Outpatient Chronic Hemodialysis 

Through this experience, fellows along with a dedicated attending manage a cohort of patients undergoing chronic hemodialysis in the ambulatory setting for 3 to 6 months, depending on their career goals. Clinical issues encountered during this rotation include:

o Hemodialysis initiation
o Hemodialysis prescription and evaluation of adequacy
o Management and evaluation of vascular access and related complications
o Work-up and management of anemia
o Work-up and management of mineral bone disease and related complications
o Evaluation and management of risk factors for cardiovascular and peripheral arterial disease
o Evaluation and management of nutritional issues unique to patients receiving chronic hemodialysis
o Transplant referral and evaluation

• Outpatient Chronic Peritoneal Dialysis Rotation and Home Hemodialysis

During this rotation, fellows will follow a cohort of patients undergoing chronic peritoneal dialysis and home hemodialysis under the supervision of a dedicated attending. Skills gained during this experience include:

o Evaluation of potential candidates for home dialysis therapies
o Referral, evaluation, and management of peritoneal dialysis catheters
o Diagnosis and management of acute and chronic peritoneal dialysis and home hemodialysis complications
o Evaluation and management of nutritional issues unique to patients receiving home dialysis therapies
o Transplant referral and evaluation

• Ambulatory Continuity Clinic

As in the first year, fellows will evaluate and manage ambulatory patients with various renal issues longitudinally under the supervision of nephrology attendings in this one-half day weekly clinic. 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

• Ambulatory Acute Follow-up Clinic

During this one-half day clinic, fellows evaluate and manage patients who were recently hospitalized or who need urgent outpatient evaluation. Fellows alternate in staffing this clinic under the supervision of a nephrology attending. Renal issues encountered during this ambulatory experience include:

o Issues following hospitalization complicated by acute kidney injury
o Acute or sub-acute exacerbation of renal conditions

• Ambulatory Subspecialty Renal Clinic

Second year fellows may also elect to follow outpatients in nephrology subspecialty clinics and/ or renal transplant clinic with nephrology faculty to gain additional specialized longitudinal experience. Subspecialty clinics available include:

o Inherited renal diseases
o Lupus nephritis
o Nephrolithiasis
o Vasculitis
o Secondary hypertension
o HIV-related kidney disease
o Retroperitoneal fibrosis
o Nephrotic syndrome