This first year focuses on exposure to nephrology in the hospital setting. Trainees spend a total of 4 months on Inpatient Consultation, 4 months on the Renal Inpatient Service and 4 months on Transplant Services on a rotating basis. Each service has one fellow paired with one attending and includes medical students and house staff. One-third of our patients are referred from outlying hospitals within the region, ensuring a wide variety of nephrology-related disorders and ample experience to all modes of renal replacement therapies. The experience is enhanced by the fact that TUH is a large tertiary referral center for heart failure, cardiac, lung transplant and a liver transplantation.
On the Inpatient Consult Service, a nephrology fellow, paired with a faculty member, provides care for an average of 2 to 5 initial consultations, along with follow-up consults daily. The primary responsibility of the consultation service is to aid in the diagnosis and management of nephrologic problems within the context of the patient's other medical and surgical conditions. A broad range of fluid-electrolyte, acid-base, general nephrology and hypertensive problems that are common to a busy teaching hospital are seen. Temple has the largest emergency room in the City of Philadelphia, and over one-third of consults are for critically ill patients in the medicine and surgical intensive care units. The burn unit is one of two in operation in the Philadelphia area.
The Renal Inpatient Service cares for patients with ESRD and patients initiating renal replacement therapy. The primary responsibility of the chronic nephrology service is to provide medical care for all patients admitted to the inpatient service of the Section of Nephrology, arrange for ancillary studies, and seek consultations. This service is responsible for dialysis therapies provided to the patients with end-stage renal disease (ESRD) at Temple University Hospital. A faculty member and renal fellow supervise a medical resident, a medical intern, and medical students assigned to this service. The renal fellow plays an important part in their education. This service sees an average of two new patients per day and provides daily care for 10 to 15.
The combined medical-surgical Transplant Service provides concurrent care for patients with renal and other solid organ transplants. The team, with nephrologists, a transplant surgeon, fellows, residents and students, a pharmacologist, and a social worker meets daily to discuss inpatients and active outpatient issues. Fellows also attend a weekly meeting where listing and other related solid organ transplant issues are discussed. While on the transplant service, the renal fellow attends at least one transplant clinic each week.
The second year fellow training is focused on care of ambulatory renal patients and research with less inpatient exposure. This more flexible schedule allows nephrology fellows time to solidify their knowledge base, participate in electives and outpatient practice and develop quality initiative projects. The basic clinics second year fellows participate in are listed below:
- CKD fellows clinic
- Transplant clinic
- Out-patient hemodialysis unit
- Peritoneal dialysis clinic
By the completion of fellowship, trainees are fully capable of performing the following procedures independently:
- Continuous venovenous hemofiltration (CVVHD)
- CAPD and CCPD
- Transplant and native kidney biopsy
- Urine microscopic analysis
- Temporary hemodialysis catheter placement
The Acute Hemodialysis Unit is a 12-station unit staffed to provide hemodialysis for hospitalized patients with acute or chronic renal failure requiring hospitalization for medical or surgical complications of their renal or extra-renal diseases. It also supports hemodialysis initiation and continuous venovenous hemofiltration (CVVHD) treatments. The nephrologists and nursing staff are responsible for all dialysis procedures in the hospital, including intermittent or continuous dialysis procedures in the intensive care units.