Rotations

Renal Consultation Service (8-9 months)

The renal consultation service provides exposure to clinical nephrology, the care of patients with acute and chronic renal failure, various electrolyte and acid-base disorders, mineral disorders and nephrolithiasis. Experience in the care of patients with acute renal disease is gained by providing consultation on the general medical units and critical care areas.

Fellows also provide consultation to the surgical service where trauma, urinary tract obstruction, drug-induced nephrotoxicity, and substance abuse are common clinical problems associated with acute renal insufficiency. The renal consultation service is also responsible for performing renal biopsies (when indicated) and overseeing the continuous renal replacement therapy program (CRRT) in the ICU.

In addition, the Nephrology Division provides consultations for the Renaissance Diagnostic and Treatment Centers, a network of 5 comprehensive primary care clinics throughout Harlem. The Renaissance Centers are a part of the Health and Hospitals Corporation of New York City for which Harlem Hospital provides secondary and tertiary care. The concentration of primary glomerular disease, substance abuse, HIV infection, hypertension and diabetes in the community, provides a wide array of complex and serious renal illness. Because consultation requests are received from all of the clinical services, the fellow gains exposure to a wide range of illnesses.

Hemodialysis Service (6-8 months)

The service provides long-term follow-up of almost a 100 regular patients undergoing chronic dialysis, including their dialysis prescription and modification and assessment of adequacy of dialysis. Clinical time spent on the Hemodialysis Service provides exposure to the evaluation and management of the medical complications of hemodialysis patients during and between dialyses. The fellow learns to evaluate dialysis access and understand the pathogenesis and management of access dysfunction. The fellow also learns about drug dosage modification during dialysis and other extra-corporeal therapies.

Peritoneal Dialysis Service (1 month)

The fellow spend one or more months on the Peritoneal Dialysis Service at Columbia Presbytarian where he learns the principles and practice of peritoneal dialysis, including the establishment of peritoneal access, the principles of peritoneal dialysis, and how to choose appropriate catheters. The fellow develops an understanding of the technology of peritoneal dialysis, assessment of peritoneal dialysis efficiency using peritoneal equilibrium, and the complications of peritoneal dialysis, including peritonitis.

Transplantation Service (3 months)

The two months spent on the Transplantation Service at NewYork-Presbyterian Hospital/Columbia University Medical Center provides the fellow with instruction in the principles of immunology and histocompatibility and experience in the management of patients receiving renal transplantation. Patients are seen pre- and post-operatively in the hospital as well followed long term in the Renal Transplant Clinic by the renal fellow. Renal transplant biopsies (including protocol biopsies) and preliminary outpatient renal ultrasounds are performed by the renal fellow assigned to the service.

Renal Pathology (1 month)

The fellow spends one month at the Renal Pathology laboratory at Columbia Presbytarian during the second year of training. At this time the fellow works closely with the Director of the Renal Pathology Laboratory and is exposed to all aspects of renal pathology.

Elective Rotations (2-3 months)

Elective rotations can be arranged after discussion with the program director. Past electives inlcude pediatric nephrology at Morgan Stanley Children’s Hospital of NewYork-Presbyterian, interventional radiology and dedicated research time to complete pending projects.