The clinical training program is divided among five services:
1. University Consult Service at KUMC: three to four months a year
The Nephrology Consult Service performs most of the adult nephrology consultations in KU Hospital. The service is divided into A and B services staffed by two faculty and two fellows. The service is weighted toward acute kidney injury, and fluid and electrolyte disorders in patients in the medical and surgical intensive care units. Fellows learn to manage a broad spectrum of kidney disorders in critically ill patients with cardiac disease, liver failure, post-solid organ and bone marrow transplant and multi-organ failure. They have ample opportunity to get hands-on experience at acute hemodialysis, continuous venovenous hemofiltration, hemodialysis catheter placement and kidney biopsies.
2. Inpatient Transplant Service: one to two months a year
The Inpatient Service at KU hospital takes primary responsibility for the care of patients receiving kidney transplants as well as transplant recipients readmitted for medical complications. We perform more than 100 kidney transplants per year. Fellows learn acute management of post-op transplant patients, dosing of immunosuppressive medications, and the diagnosis and management of acute and chronic rejection, opportunistic infections, and other complications. They learn to interface closely with the transplant surgical team and with various consult services, including infectious diseases. In addition, the Inpatient Service admits hemodialysis and peritoneal dialysis patients that require inpatient care, including fluid, infectious and vascular access complications. On this service, the fellow supervises and teaches 2-3 internal medicine residents who have primary responsibility for admissions, discharges and the day-to-day care of patients.
3. Outpatient Transplant Service: one to two months a year
On the Outpatient Transplant Service at KU, nephrology fellows learn pre-transplant donor and recipient evaluation and post-transplant care of patients with kidney, simultaneous pancreas-kidney and simultaneous liver-kidney transplant patients in the clinic setting. They also participate in regular multidisciplinary meetings in which individual patients are presented and discussed in detail.
4. Outpatient Dialysis Service: one to two months a year
On the Outpatient Dialysis Service, fellows round daily in the University's 40-station outpatient dialysis unit located nearby the hospital. The emphasis of the rotation is on learning to evaluate and manage patients undergoing in-center hemodialysis including managing dialysis prescriptions, hematologic and bone mineral parameters, and handling infectious and vascular access complications. Fellows attend a weekly home dialysis clinic where we follow 24 patients who receive home hemodialysis and continuous ambulatory or cycling peritoneal dialysis. Fellows receive education in water treatment, dialysis machine operation, and are trained in cannulating hemodialysis accesses and performing peritoneal exchanges. They actively participate in multidisciplinary patient evaluations, and in the quality improvement activities of the dialysis unit.
5. Kansas City Veteran's Affairs Hospital: three to four months a year
At the KCVA, fellows participate in the full spectrum of clinical nephrology services, including inpatient consult-based care, outpatient general nephrology clinic, outpatient chronic hemodialysis and an outpatient peritoneal dialysis clinic. Fellows gain ample exposure to veteran patients with hypertension, vascular diseases and chronic kidney disease.
Continuity Clinic Outpatient ExperienceThe continuity clinics for the nephrology fellows at KU Medical Center have been designed so that each fellow is paired with an attending physician and participates in their clinic for a half-day per week for the entirety of their fellowship training. In this way, the fellow can follow the same group of patients throughout. Clinical skills are developed through feedback from the attending physician. The clinics are structured such that the fellow sees a wide variety of patients including those with acute and chronic kidney diseases, refractory hypertension, proteinuria, hematuria, electrolyte abnormalities, acid-base disturbances, cystic diseases, nephrolithiasis, and renal abnormalities associated with other medical illnesses such as end-stage liver disease, lupus and multiple myeloma. Due to the chronicity of many diseases seen in these clinics, most patients will be seen in follow-up several times per year by the same fellow.