The Nephrology clerkship is expected to provide the student with an introduction to the pathophysiologic basis of renal disease. The clinical application of pathophysiology is emphasized. The focus is on active student participation in the diagnosis and management of patients with acute and chronic kidney disease. This will also provide an in depth experience in the management of general medical problems in patients with multisystem disease. These conditions will include infectious disease, cardiovascular disease, neurologic disease as well as other general medical and surgical conditions. Additional emphasis will be placed on the diagnosis and management of fluid and electrolyte disorders, acid-base disorders and hypertension.
1. Understanding the signs, symptoms and management of common renal syndromes including acute and chronic renal failure, glomerulonephritis, and the nephrotic syndrome. An emphasis will be place on understanding the underlying pathophysiology of the disease process.
2. Understanding and interpreting laboratory tests employed in the assessment of renal function.
3. Understanding the diagnosis and management of fluid and electrolyte and acid-base disorders.
4. Understanding the diagnosis and management of primary and secondary hypertension.
5. Diagnosis and management of acute and chronic medical problems in patients with renal disease and renal failure.
1. Review of student H&P, patient evaluation, and written plan of patient management.
2. Participation in daily rounds.
3. Depth of understanding of the patients diagnosis and management.
It is understood that students will attend medicine clinics, mentor conferences, noon conferences and Grand Rounds during the rotation.
RECOMMENDED BOOKS, JOURNALS AND ARTICLES
UpToDate: (Available for Students in the Medical Library) 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
8. Hypertension: Primary and Secondary.
9. Complications of Dialysis
11. Diabetic Nephropathy
12. Secondary Hyperparathyroidism.
Internet: Students 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.
Books: Handbooks are available for your use in the clerkship office. In addition, these texts may be of use.
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
N Engl J Med. 2000; 342:1581-9
2. Adrogue HJ, Madias NE
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. Ifudu, O
Current Concepts: Care of Patients Undergoing Hemodialysis
N Engl J Med 1998; 339:1054-1062, Oct 8, 1998.