Division of nephrology

Nephrology Fellowship

Nephrology Fellowship Overview

The goals of the MUSC Nephrology Fellowship are to:·         ·         ·         

  • To train excellent nephrologists with exposure to a multitude of renal diseases including renal transplantation 
  • To provide experience with nephrology related procedures 
  • To encourage an academic approach to medicine
  • To equip the fellow for a variety of practice settings including an academic career

The Nephrology Fellowship Training Program has ten fellows divided between research and clinical tracks.  The ABIM requires a minimum of 24 months training with at least 12 months involved in direct patient care. Currently, our clinical fellows do a minimum of 15 months of clinical activity with the option to do more during their elective time. Clinical fellows are also expected to participate in research during their elective months.  Research fellows participate in the NIH T32 training grant for a total of three years with 24 months of research and 12 months of clinical time.

Clinical Rotations

Nephrology Consult Services which are s divided into three services (ART (Ashley River Tower) Consult, Team A and Team B Consults at the Main Hospital).  These are demanding services that evaluate patients on other services in the hospital with renal disease, renal dysfunction, hypertension or other renal related problems. A wide array of disease states are encountered on these services including acute renal injury, acute glomerulonephritis and the care of the hospitalized end stage renal disease patient.  One attending and one fellow cover each of the three consult services.  Medical students and medicine housestaff may also rotate on service.  Exposure to acute hemodialysis and continuous renal replacement therapies is extensive. 

Renal Transplant Service is a medical-surgical service that performs a large number of renal transplants.  Two hundred twenty renal transplants were performed at MUSC in 2011. The general nephrology fellow is part of the medical-surgical team and rounds with the transplant attending, transplant fellow and the attendings on all renal transplant patients.  In addition, the fellow is involved with them in Transplant clinics, pre-transplant evaluations, and management of medical complications post transplant. The fellow is responsible for the dialysis support for transplant patients with primary non-function, etc.  Specifics of transplant medicine such as immunosuppression, treatment of rejection and management of opportunistic infections and when and how to perform renal transplant biopsy are emphasized. 

The VA Nephrology Service is involved in acute inpatient and outpatient services for acute and chronic renal disease and hypertension.  The fellow rounds with an attending at the VA as a consultant and sees all nephrology patients that are admitted to the hospital as well as any new consultations. With the attending physician for that rotation, the fellow at the VA is responsible for running the outpatient dialysis unit associated with the hospital.  The fellow will gain experience rounding on outpatient dialysis patients and the management of dialysis access problems, anemia and bone mineral disorders.  The attending and fellow also provide primary care to the VA patients who have dialysis services provided outside of the VA system and for the veterans with renal transplants.  

Home Dialysis Month:  Home dialysis modalities (peritoneal dialysis and home hemodialysis) are an important part of renal replacement therapy.   MUSC currently has 41 patients receiving home therapies.  Each fellow is required to spend a month in the Home Unit to learn management of PD and home hemodialysis.

Elective Months:  When not on a clinical service, there are many opportunities for further study.  Electives available include Pediatric Nephrology, Interventional Nephrology, Interventional Radiology, Renal Pathology, and Plasmapheresis. 

Outpatient Clinics

The Rutledge Tower Teaching Clinic is a continuity clinic for the patients with any renal disease or hypertension at MUSC.  Patients with a myriad of renal diseases are seen and followed over two years by a fellow in continuity. Typically each fellow will experience four to six patient visits during a 1/2-day clinic every other week.   

The VA Teaching Clinic is a similar continuity clinic except that it is located in the Ralph Johnson Veteran's Administration Hospital. Activity in this clinic consists of four to six  patient visits during a 1/2-day clinic for each fellow every other week.  The VA ESRD Clinic is attended in lieu of the VA Teaching clinic when the fellow is on service at the VA. Veterans who receive dialysis therapy outside of the VA system and veterans with renal transplants receive their primary care in this clinic.

The Transplant Clinic is attended four days a week when the fellow is assigned to the Transplant service. The fellow may see patients at all stages of the transplant process.  Several faculty members attend each clinic and serve as educational resources and assist in the patient care.  

Procedures

Fellows will learn how to perform percutaneous native and transplant biopsies and temporary line placement for dialysis.  In addition, fellows will learn the fundamentals of renal ultrasound.

Call

Fellows take home call nightly and take telephone calls from patients, dialysis calls, and after hour consults from the VA or MUSC. Weekend call is from Saturday 7AM to Sunday 5PM.  One fellow and one attending round together on all of the consult services each weekend. 

Conferences

Fellows participate in 4 weekly noon-time conferences including journal club, clinical case conference, renal biopsy conference, research conference and salt and water conference.  Fellows present at all of these conferences. 

Research

All fellows are expected to complete a research project during their fellowship and present a poster at the MUSC Department of Medicine Research Conference.  In addition, fellows are strongly encouraged to submit their projects for publication and to present abstracts at regional and national meetings.  Numerous clinical and basic research projects are ongoing in the Division.  Fellows who are interested in bench research are strongly encouraged to spend at least 24 months in the laboratory. The research interests of the Division faculty are as described in their faculty biographies. However, research fellows are not constrained to work only in the division of Nephrology laboratories. In particular, strong programs on campus in Pharmacology, Molecular and Cell Biology, and Pathology offer additional outstanding opportunities for postdoctoral research training.   There are multiple opportunities to participate in mentored clinical research. 

If you are interested in a more comprehension research program, please refer to the Research Fellowship Program.  This fellowship is a three year program (2 years research, 1 year clinical).

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