Nephrology Pathways

The fellowship program consists of 8 fellows; each year we match 3-4 fellows based on the number of research fellows. All fellows match into the clinical pathway. After six months of training, selected individuals may quality for the research pathway. On average, one research trainee is selected each year.

Clinical Pathway

The clinical pathway is appropriate for individuals interested in clinical nephrology in either the private or academic setting. Fellows who have completed this track have pursued further training in transplantation, glomerular disease, and interventional nephrology. This track is also appropriate for those interested in a career as a clinician educator.

Research Pathway

The research pathway is dedicated to candidates who are committed to a research career and are deemed by faculty to have great potential to succeed in the scientific arena. Two years of research are required after completing one year of intensive clinical training. A half-day per week continuity clinic is maintained throughout the fellowship. Trainees on this track must qualify for research funding, often through a T32 NIH training grant.

Individuals may pursue either clinical or basic science research in molecular and cell biology, immunologic, genetic, and translational aspects of kidney disease. Fellows interested in clinical research may pursue the Masters of Public Health degree through the UNC Gillings School of Global Public Health or Master of Science in Clinical Research.

Clinical Training

Clinical training consists of several rotations and a weekly continuity clinic.

Hospital consultative nephrology

This is the core rotation of the fellowship, comprising about 40% of the clinical training. Two fellows are assigned to this rotation at any one time. One fellow primarily sees new consults and ICU patients, and the other fellow sees hospitalized patients on services other than the inpatient nephrology service outside the critical care setting. On average, fellows complete 16-18 weeks of inpatient consult as a first year fellow and 10-14 weeks as a second year clinical fellow.

Subspecialty rotation

This is an outpatient rotation consisting of experience in the hypertension, transplant, vasculitis and glomerular diseases clinics. A highlight of UNC is our dedicated glomerulonephritis clinic where fellows work directly with leaders in the field gaining first-hand experience and participating in complex care decisions. Fellows see patients in the Home Therapies clinic (Peritoneal Dialysis and Home Hemodialysis) one day per week, where approximately 15 patients are seen each clinic session.

Outpatient dialysis/Interventional Nephrology

This rotation provides essential exposure to community-based dialysis in the surrounding area. Fellows learn comprehensive dialysis care, and outpatient dialysis organization and management. Fellows rotate with an attending nephrologist through outpatient dialysis units usually in 2-week blocks. Fellows evaluate and manage patients at the outpatient interventional nephrology clinic once weekly at Carolina Vascular Access, along with an interventional nephrologist. Fellows also gain experience in the kidney stone clinic.

Kidney biopsy rotation

This rotation is often considered as the procedure rotation. Fellows perform native and transplanted kidney biopsies during this rotation. On an average each fellow performs 2-3 biopsies a day during this rotation. This rotation also serves as a dedicated back-up to the inpatient consult teams.

Transplant rotation

This rotation consists of caring for hospitalized kidney transplant recipients. The fellow works with the transplant attending and rounds with the surgeons. Fellows on this service are encouraged to attend all transplant conferences, such as selection conference, living donor conference and listing meetings.

Research/Elective

This experience is generally limited to fellows in the clinical training pathway as research trainees will devote 2 years to research. Here at UNC we understand that everyone has different interests and career goals within the field of nephrology. Elective time is designed to provide flexibility so each fellow can build their fellowship to fit their goals. There are many opportunities available across the UNC system with many collaborations with other departments. Fellows can choose to do an elective in: nepropathology, critical care, oncology or myeloma/amyloidosis, interventional nephrology, geriatrics, palliative, rheumatology, gastroenterology, pediatric nephrology, apheresis, private practice rounding, and research. 8-10% of the clinical fellowship is devoted to time for clinical fellows to complete projects that may range from case reports or review articles to analysis of clinical data, presented as an abstract or original research manuscript.

Continuity clinic

Fellows see approximately 8 patients per session (6 return and 2 new patients). This averages to half a day of continuity clinic per week, throughout the fellowship.

Call/Night Float

We have a dedicated night float system to cover overnight calls. Fellows take overnight home call only for 6 weeks/year, with each block lasting 1-2 weeks at a time. The overnight home call for night float is from Monday through Friday. The weekend call is covered by the ICU/stepdown and floor fellows. Each fellow covers one of the weekend days including night to allow the other a 24-hour period off every week. A third fellow covers inpatient transplant consults Monday through Friday during the day, but does not take any call. During all other rotations, there are no weekday or weekend call responsibilities.

Back-up and Fatigue Mitigation

There is a back-up system to provide coverage primarily on critical services. The program has a fatigue mitigation policy designed to prevent and counteract the potential negative effects of fatigue and sleep deprivation. UNC nephrology fellowship program will initiate the back-up/float system for critical services in the case of fellow fatigue.

Curriculum

• Acid-base disorders
• Basic renal immunology
• Basic renal physiology
• Diabetes mellitus and diabetic nephropathy
• Dialysis
• Divalent cation metabolism, renal osteodystrophy, nephrolithiasis
• Ethics and professionalism
• Fluid and electrolyte disorders
• Glomerular diseases
• ICU nephrology
• Inherited diseases of the kidney
• Kidney transplantation
• Obstructive nephropathy
• Pathophysiology and epidemiology of hypertension
• Pharmacology of drugs and renal disease
• Regulatory and business issues in nephrology practice
• Renal disease and pregnancy
• Renal function testing
• Research design and methods
• Tubular interstitial disease
• Urinary infection

Conferences

Weekly Divisional Journal Club

Faculty and fellows are assigned to present one article two times per year on a rotating basis. One of these is a case conference.

Hypertension Journal Club

Hypertension faculty meet with fellows bimonthly to review and discuss the literature in the field of hypertension.

Nephrology Fellows Conference

This is a weekly conference devoted to fellow education covering the full spectrum of clinical nephrology.

Clinical Case Management Conference

A bimonthly conference during which interesting or challenging cases are reviewed by fellows and clinical faculty. This is integrated with the journal club.

Professional Development Seminars

These are monthly meetings devoted to exploring issues in professional development such as end of life care, ethics, considerations in choosing a private practice, the business of medicine, patient safety, CV preparation, and shared career experience.

Nephropathology Conference

The Division of Nephropathology meets with faculty and fellows on a weekly basis to review both internal and referred kidney biopsy cases.