Clinical Trainings - Division of Nephrology and Hypertension

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 ICU/step-down unit 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: nephropathology, 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
Pathology of kidney diseases
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 twice a week conference is 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 every other week to review both internal and referred kidney biopsy cases.

Conference Schedule

Conference	Time	Topic	Leader/Organizer
Fellows' Conference	Monday (3:00-4:00 PM) and Tuesday (12:00-1:00 PM)	Core curriculum in nephrology/renal physiology	Koyal Jain, MD MPH
Nephrology Grand Rounds	Wednesday 4:00-5:00 PM	Clinical nephrology	Mark Kleman, DO
Medicine Grand Rounds	Thursday 12:00-1:00 PM	Clinical medicine	Lee Berkowitz, MD
Nephrology and Hypertension Journal Club	Monday 4:00-5:00 PM	Review of nephrology literature; study of issues related to design and analysis of clinical studies	Evan Zeitler, MD Keia Sanderson, MD MSCR
Renal Pathology	Friday 1:00-2:00 PM	Review of renal biopsies	Charles Jennette, MD Vanessa Moreno, MD

Transplant Conference Schedule

Monday	Tuesday	Wednesday	Thursday	Friday
Living donor selection conference (8-9 AM)	Top 50 (3-3:20 PM) Kidney Selection Conference (3:20-4:30 PM)	Kidney Policy Meeting (3-4 PM), every 3rd Wednesday of the month	SRF case conference (8-9:30 AM)	Renal Pathology (1-2 PM)
	Kidney Selection Conference (3:20-4:30 PM)