Curriculum

Didactic and bedside teaching subjects

July (Each academic year)

• Basic approaches to renal disease for the first year fellow
• Causes of acute renal failure (ARF)
• Indications for acute dialysis
• Vascular access for acute hemodialysis
• Common problems of chronic hemodialysis patients

August (Each academic year)

• Infection in the patient with ARF and CKD
• Emergency disorders of electrolytes and minerals and their treatment
• Emergency treatment of malignant hypertension
• Evaluation, diagnosis, and treatment of acute vasculidites including system and renal

Subjects covered during hospital and clinic rotations (three subjects/month) using M&M, Physiology, Journal Club, and Biopsy Conferences over the course of two years:

• The macro role of the kidneys in the regulation of body chemistries
• Determinants of renal blood flow and glomerular filtration (PC)
• Renal handling of water (PC)
• Systemic regulation of sodium (PC)
• Renal handling of sodium (PC)
• Systemic and renal handling of potassium (PC)
• Role of the kidneys in calcium-phosphorus metabolism (PC)
• Secondary hyperparathyroidism (PC)
• Mediators of glomeruolar and interstitial damage (PC)
• Mechanisms of proteinuria (PC)
• Anti-proteinuric measures (PC)
• Indications for renal biopsy
• Pathophysiology of SLE, diagnosis, renal involvement
• WHO classification and modifications of renal pathology in SLE
• Treatment of renal disease in SLE
• Nephrotic syndrome, diagnosis and causes
• Nephrotic syndrome: Primary diseases:  Membranous nephropathy (MN)
• Nephrotic syndrome: Primary diseases: Focal and Segmental GS (FSGS)
• Nephrotic syndrome: Primary diseases: Membranoproliferative GN (MPGN)
• Nephrotic syndrome: Primary diseases: Minimal change disease (MCD)
• Nephrotic syndrome: Secondary diseases: Diabetes Mellitus
• Nephrotic syndrome: Secondary diseases: MN/FSGS/MPGN
• Non-nephrotic proteinuria: evaluation, follow-up, role of biopsy
• Hematuria: anatomic and primary renal
• Pyuria: infectious/non-infectious
• Nephritic syndrome: Diagnosis, approach to classification, indications for biopsy
• Nephritic syndrome: Pathophysiology and treatment
• Inherited renal diseases (PC)
• Essential hypertension
• Secondary hypertension
• Disorders of potassium metabolism: Gordon's, Liddle's, Bartter's (PC)
• Esoteric disorders: HGPRTase, APRTase deficiencies (PC)
• Disorders dues to heavy metals

Subjects during transplant rotations:

• Transplantation guidelines and evaluation
• Transplant immunology pre-transplantation (PC)
• Transplant immunology: post-transplant (PC)
• Transplant immunology: immunosupprive drugs
• Transplantation techniques: harvesting, transplantation
• Diagnosis and treatment of acute rejection
• Chronic immunosuppression
• Delayed and chronic rejection
• Morbidities of transplantation and transplantation immunosuppressives

Subjects to be covered on dialysis rotations:

• Following patients with CKD, stages 3, 4, 5
• Nutrition in CKD by stage
• Nutrition in ESRD
• Nutrition in ARF
• Planning for renal replacement therapy (RRT)
• Education of patients about RRT
• Indications for chronic RRT and planning for vascular access or peritoneal access
• Initiation of hemodialysis
• Patient and family management during the initiation of dialysis
• Role and indications for home dialysis
• Expectations of RRT, patient and  medical perspectives
• Choosing the dialysis regimen
• Complications during chronic dialysis therapy
• Monthly evaluation and care of chronic dialysis patients
• Evaluation of dialysis efficiency: role of Kt/V and URR (PC)
• Water treatment and water/dialysis systems used for chronic hemodialysis
• Management of a chronic hemodialysis unit using QA/TQI, Statistical Process 
• Control techniques, and compliance with CMS, ESRD Network, Texas Department of Health regulations and CDC recommendations for infection control
• Ethical considerations in the provision and withdrawal of dialysis therapy 
• The professional role of the nephrologist in the dialysis unit, the professional community and in national societies

** All documents are in pdf format unless otherwise noted. **

This curriculum is designed to be completed over a two-year fellowship. At the end of each month, the fellow(s) will debrief with the program director, noting the subjects covered and adjusting the conferences every six months. Any subjects not covered prior to the 19-24 months will be delivered during this time.

The fellow and the program director will complete a monthly evaluation form for the curriculum. This form will list the subjects covered, the senior staff who conducted the educational episode, and the manner in which it was covered (didactic, bedside, PC, M&M, JC, etc.). It is anticipated that the renal parenchymal diseases (glomerulonephridities, interstitial nephritis, etc.) will be covered primarily in the Renal Biopsy Conference and the Clinical Conference. Each renal biopsy conference and the subsequent fellow's paper will also be used to meet the curriculum requirements. See the schedule for the PCs.

This curriculum was prepared by using resources on the Web. In particular, the author would like to cite the outstanding resources provided by the University of Utah.

The author has also drawn upon web-based resources from the nephrology programs at The University of California-Davis, Walter Reed Army Medical Center, Bethesda Naval Hospital, University of Virginia, Stanford University, University of Illinois at Chicago, University of Kentucky, University of Maryland, Wayne State University, Uniformed Services University for the Health Sciences, Medical College of Wisconsin, University of Iowa, and Columbia University; and resources from Bandolier, the Cochrane Collaboration, the National Kidney Foundation (KDOQI) and the American Journal of Kidney Diseases.

Amgen has generously donated $30,000 to the division for the support of the fellowship program. These funds will be used for educational meetings and research support.

View the educational resources that have been compiled for learning purposes.

View the JCAHO Annual Update for 2007-2008

We support the ACGME Outcome Project.

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