The General Nephrology Consult Service performs adult nephrology consultations at KU Hospital. The service is divided into A, B, C and D services staffed by four faculty. Fellows learn to manage a broad spectrum of kidney disorders including challenging fluid and electrolyte problems, AKI and acute glomerulonephritis in critically ill patients with cardiac disease, liver failure, cancer, solid organ and bone marrow transplants and multi-organ failure. They are expected to teach internal medicine residents and medical students rotating on the service. There is ample opportunity to get hands-on experience at acute hemodialysis, continuous venovenous hemodiafiltration, catheter placement and kidney biopsies.

The inpatient Renal Transplant Consult Service at KU hospital takes primary responsibility for the care of patients receiving kidney and kidney/pancreas transplants as well as transplant recipients readmitted for medical complications. We performed 196 kidney transplants last 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.

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, pancreas only, 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.

On the Outpatient Dialysis Service, fellows round daily at one of our three outpatient dialysis units that care for over 250 in-center hemodialysis patients. During the month, they also attend two home dialysis clinics per week where we follow 50-60 patients receiving daily or nocturnal home hemodialysis, or peritoneal dialysis.

The emphasis of the rotation is on learning to evaluate and manage patients undergoing chronic dialysis, including managing dialysis prescriptions, hematologic and bone mineral parameters, and handling infectious and vascular access complications.

Fellows receive education in water treatment, dialysis machine operation, and are trained in cannulating hemodialysis accesses and performing peritoneal exchanges. They participate in a multidisciplinary team that includes a dietician and social worker, and participate in the quality improvement activities of the dialysis unit.

Fellows can customize this rotation to fit their interest. Options include:

• Research: Fellows design and carry out a research project in an area of interest, guided by a mentor selected from the program faculty.
• Interventional Nephrology: Fellows rotate in an outpatient access center and observe an interventional nephrologist perform procedures on dialysis patients.
• Renal pathology: This rotation is spent with our outstanding renal pathologist Dr. Timothy Fields, reading and interpretingl kidney biopsies that are performed over the month
• Plasmapheresis: KUMC has a strong plasmapheresis program that is managed by pathology. This rotation allows fellows to learn in more depth how to prescribe and manage plasmapheresis.
• Additional Outpatient Dialysis: Fellows can choose to gain additional experience in the outpatient dialysis unit, focusing on either home or in-center dialysis.
• Additional Transplant Rotation: Fellows can choose to spend more time working with the clinical transplant team, or to learn about the work of our organ procurement organization, the Midwest Transplant Network.
• Attend Specialty Clinics: Fellows can elect to attend one or more of our four disease-specific specialty outpatient clinics: Glomerular Disease Clinic, PKD Clinic, Fabry Disease Clinic, and Stone Clinic.

Continuity Clinic

The General Nephrology Continuity Clinics have been designed so that each fellow has their own clinic and patient panel with rotating attending preceptors. The clinic is 1 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 disease, glomerular disorders, refractory hypertension, electrolyte and acid-base disturbances, cystic kidney diseases, nephrolithiasis, and renal complications of other medical illnesses such as liver disease, lupus, cancer 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.

Home Dialysis Clinic

The Division has 3 faculty that specialize in home dialysis with 50-60 home patients. This includes peritoneal dialysis, home hemodialysis, and nocturnal dialysis. Fellows attend one-half-day clinic a month throughout the year, in addition to eight clinics during each month that they are on their dialysis rotation.