SIU School of Medicine

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Department of Internal Medicine

Resident Information

Welcome to the Division of Nephrology. You are now a member of the Division and we hope your rotation through our service will be a pleasant and productive experience.

I. EDUCATIONAL PURPOSE

The Nephrology elective is designed to provide the resident with an understanding of the pathophysiologic basis of renal disease. The emphasis is placed on active resident participation in the diagnosis and management of patients with renal disease and renal failure based on an understanding of the physiologic changes that occur in the disease process. Understanding normal physiology of fluid and electrolyte balance and alterations in disease states will be an integral part of Nephrology elective. Diagnosis and management of primary and secondary hypertension will also be included.

Acute medical problems in dialysis patients are frequently encountered. Nephrology elective will provide extensive exposure to common and serious medical emergencies in chronically ill patients. This rotation is an integral part of your general medicine training as well as a subspecialty experience.

II. OBJECTIVES

  1. Insight into the diagnosis and management of renal diseases, e.g. glomerulonephritis, nephrotic syndrome, acute renal failure and chronic kidney disease, based on the pathophysiology of the disease process.
  2. Significance and limitations of laboratory tests employed for the assessment of renal function and the physiologic bases for these tests.
  3. The diagnosis and management of fluid and electrolyte and acid base disorders.
  4. The management of hypertension with particular emphasis on hypertension in patients with chronic kidney disease and the diagnosis of secondary forms of hypertension.
  5. Diagnosis and management of acute and chronic medical problems in patients with chronic kidney disease and diseases of multiple organ systems.
  6. Understanding of the effects of chronic kidney disease on other organ systems eg. Secondary hyperparathyroidism, anemia of chronic kidney disease, and all of the manifestations of uremia.

III. TEACHING METHODS

Teaching methods include daily bedside teaching rounds two to three hours in the morning Monday through Sunday every week and discussion of selected topics by faculty in the afternoon as time permits.

Residents attend renal pathology conference with the renal pathologist and renal staff one to two times per month.

IV. SERVICE ASSIGNMENT

Nephrology assignment for residents is for a period of four weeks.

V. PHYSICIAN SUPERVISION

While assigned to the inpatient service residents will be under the supervision and guidance of the physician on call during the week. Residents will write all orders and progress notes and dictate history and physical exams and discharge summaries. It is expected that the history and physical will be dictated on the day of admission and the discharge summary will be dictated on the day of discharge.

VI. PROCEDURES

a) Residents will be trained to do urinalysis and look at cellular elements and sediments under the microscope.
b) Observe percutaneous renal biopsy.
c) Miscellaneous medical procedures with faculty or senior resident supervision.

VII. INPATIENT ACTIVITIES

  1. Complete history and physical are mandatory immediately upon patient admission.
  2. Progress notes are to be written daily according to SIU Department of Internal Medicine standard format for chart and clinic notes.
  3. Discharge summaries are to be dictated within 24 hours of patient's discharge. Please specify in your dictation that a copy of the summary must be sent to Central Illinois Kidney & Dialysis Associates.
  4. The residents will also see all inpatient consultations. The residents should dictate a formal consultation note on all consultations.
  5. Nephrology on-call physicians available 24 hours per day. Notify on-call physician of all new admissions/patients presenting in ER, and serious and difficult problems with hospitalized patients.
  6. Common medical problems encountered during nephrology rotation:
    a) Acute renal failure (often in association with multi-organ failure).
    b) Chronic renal disease, proteinuria, nephrotic syndrome, patients with chronic renal insufficiency.
    c) Acute glomerulonephritis, vasculitis.
    d) End stage renal disease, hemodialysis, peritoneal dialysis, CVVHD.
    e) Renal osteodystrophy, secondary hyperparathyroidism, disorders of calcium and phosphate metabolism.
    f) Primary and secondary hypertension.
    g) Fluid, electrolytes and acid base problems.
    h) Limited exposure to patients with kidney and kidney/pancreas transplant.
  7. Residents are expected to attend Grand Rounds and resident conferences.

VIII. ON CALL SCHEDULE AND DAYS OFF

Resident call schedule is established by the senior resident. Calls can be taken from home. Each resident gets one day off each weekend.

IX. VACATION

No vacation days permitted per department policy.

X. RESIDENT DUTIES AND RESPONSIBILITIES

Senior resident will assign patients to interns and junior residents. No more than five new patients per day can be assigned to a resident. The total number of patients followed by a resident will not exceed twelve. Senior resident is expected to be involved in teaching of students and interns.

XI. RESIDENT EVALUATION

Written report of faculty using standard evaluation forms. Attending physicians are expected to discuss resident performance at the end of the rotation.


XII. FACULTY EVALUATION

Each resident evaluates faculty member using the standard evaluation form.

XIII. FACULTY

Pradeep Mehta, M.D.
Lawrence Smith, M.D., Chief
Ashraf Tamizuddin, M.D., F.A.C.P., M.R.C.P. (UK)

Allen S. Krall, M.D.
Xueguang Chen, M.D., Ph.D.

XIV. RECOMMENDED BOOKS, JOURNALS AND ARTICLES

UpToDate: Sections on the following topics should be read during the course of the rotation. It is also strongly recommended that the UpToDate sections pertaining to the general medical problems of your patients be reviewed.

1. Chronic Renal Failure
2. Acute Renal Failure
3. Simple and Mixed Acid Base Disorders
4. Hyponatremia
5. Hypernatremia
6. Hyperkalemia
7. Hypokalemia
8. Hypertension: Primary and Secondary.
9. Complications of Dialysis
10. Uremia.
11. Diabetic Nephropathy
12. Secondary Hyperparathyroidism.

Internet: Residents should read the executive summary at www.kdoqi.org. There is a vast amount of evidence based material on this website. Additionally, the NIH site for JNC VII is mandatory reading for understanding the management of hypertension. These are the relevant links.

1. Kidney Disease Outcomes Quality Initiative
2. Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

Books:

1. The Kidney, 2000. 6th Edition
Brenner and Rector. W.B. Saunders and Company
2. Primer on Kidney Diseases, 2001. 3rd Edition
National Kidney Foundation
3. Clinical Physiology of Acid-Base and Electrolyte Disorders, 2001. 5th Edition
Burton David Rose, Theodore W. Post. McGraw Hill
4. Clinical Hypertension. 7th Edition
Norman Kaplan. Williams and Wilkins
5. Manual of Nephrology, 2000. 5th Edition
Editor Robert W. Schrier. Lippincot, Williams and Wilkins

Articles: Available through the library or by clicking the following links.

1. Adrogue HJ, Madias NE
Hyponatremia.
N Engl J Med. 2000; 342:1581-9

2. Adrogue HJ, Madias NE
Hypernatremia.
N Engl J Med. 2000; 342:1493-9

3. Schrier, RW, Wang W.
Acute Renal Failure in Sepsis
N Engl J Med. 2004: 351: 159-169

4. Alcagar SM, Rodicio JL
Ischemic nephropathy: clinical characteristics and treatment.
Am J Kidney Dis. 2000; 36:883-93

5. Nondiabetic Kidney Disease
Levey, A. S.
N Engl J Med 2002; 347:1505-1511, Nov 7, 2002.

6. Ifudu, O
Current Concepts: Care of Patients Undergoing Hemodialysis
N Engl J Med 1998; 339:1054-1062, Oct 8, 1998.

7. Drug-associated renal dysfunction and injury

8. A Practical Approach to the Diagnosis of Acid Base Disorders

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