The first year of the fellowship focuses on intensive clinical training through inpatient consultation services at The Mount Sinai Hospital and the James J. Peters Department of Veterans Affairs Medical Center. This year is dedicated to clinical training and exposure to inpatient general nephrology, kidney replacement therapies, and transplantation. In addition, first year fellows will attend a weekly outpatient nephrology clinic. This rigorous year provides extensive exposure and training to both diagnose and manage a wide spectrum of kidney disease.

Second year fellows have limited primary inpatient service responsibilities. This year is dedicated to pursuing a scholarly project (for which there is approximately 75 percent protected time), while gaining more exposure to outpatient nephrology in chronic kidney disease, glomerular disease, and both inpatient and outpatient dialysis clinics. Opportunities are available in critical care nephrology, home dialysis modalities, kidney stone disease, and interventional nephrology. Fellows interested in the Clinician Educator track have the opportunity to lead small groups of first- and second-year medical students in Physiology and Kidney Pathophysiology courses, respectively, under the mentorship of Course Directors who are members of the nephrology faculty

An optional third year is offered to fellows who desire a career as physician-scientists in basic, translational, or clinical research. Greater than 90 percent of the time is dedicated to research pursuits with minimal clinical exposure designed to enable fellows to maintain their professional skills. In addition, interested fellows may pursue a third year of additional subspecialty training in one of the following tracks:

• Geriatrics
• Critical Care
• Home Dialysis
• Palliative Care
• Glomerular Diseases/Onconephrology
• Kidney Transplantation
• Physician Scientist

Fellows will be board eligible for nephrology and either geriatrics, palliative care, or critical care at the end of three years. These tracks are integrated with clinical training in joint specialties occurring over a three-year period.

During the consult rotation, fellows are trained in the prevention, evaluation, and management of the following disorders:

• Acute kidney injury
• Chronic kidney disease
• Continuous kidney replacement therapy
• Disorders of drug metabolism and kidney drug toxicity
• Disorders of fluid, electrolyte, and acid-base regulation
• Disorders of mineral metabolism, including nephrolithiasis and renal osteodystrophy
• Genetic and inherited kidney disorders
• Geriatric aspects of nephrology, including disorders of the aging kidney and urinary tract urinalysis
• Glomerular and vascular diseases, including the glomerulonephritides, diabetic nephropathy, and atheroembolic kidney disease
• Hypertensive disorders
• Intermittent kidney replacement therapy, hemodialysis, and peritoneal dialysis
• Kidney disorders of pregnancy
• Percutaneous kidney biopsy
• Urinary tract infections
• Tubulointerstitial kidney diseases, including inherited diseases of transport, cystic diseases, and other congenital disorders

In the end-stage kidney disease service rotation, fellows learn comprehensive management of hospitalized patients receiving dialysis, from initial evaluation through long-term care. Fellows will master:

• Acute and long-term hemodialysis
• Drug dosage modification during dialysis and other extracorporeal therapies
• Evaluation and management of medical complications in patients during and between dialysis treatments
• Evaluation of end-stage kidney disease patients for various forms of therapy and their instruction regarding treatment options
• Long-term follow-up of patients receiving long-term dialysis, including their dialysis prescription and modification, and assessment of adequacy of dialysis
• Nutritional requirements of patients receiving chronic hemodialysis and peritoneal dialysis
• Peritoneal dialysis efficiency, using peritoneal equilibration testing and the principles of peritoneal biopsy
• Peritoneal dialysis prescription and how to assess peritoneal dialysis adequacy
• Pharmacology of commonly used medications and their kinetic and dosage alteration with peritoneal dialysis
• Principles and practice of peritoneal dialysis (PD), including the establishment of peritoneal access, the principles of dialysis catheters, and how to choose appropriate catheters
• Technology of PD (including use of automated cyclers) and complications of PD, including peritonitis and its treatment, exit site and tunnel infections and their management, hernias, plural effusions, and other less common complications and their management

The goal of the kidney transplant nephrology rotation is for each fellow to receive adequate experience and education in the following areas:

• Clinical diagnosis of all forms of allograft rejection including laboratory, histopathologic, and imaging techniques
• Indications for biopsy of kidney allograft biopsy, technical expertise in performing biopsy of kidney allograft and interpretation of biopsy pathology specimens
• Immediate postoperative management of transplant recipients, including administration of immunosuppressants
• Long-term follow-up of transplant recipients in the ambulatory setting
• Medical management of rejection, including use of immunosuppressant drugs and other agents
• Preoperative evaluation and preparation of transplant recipients and donors
• Recognition and the management of kidney disease, electrolyte disturbances, and other nephrology topics in solid organ transplant recipients
• Recognition and medical management of the surgical and nonsurgical complications of transplantations

The nephrology ICU rotation prepares fellows to become proficient in the following core areas:

• Diagnosis and effective management of acute kidney injury
• Evaluation and selection of patients for acute hemodialysis or continuous kidney replacement therapies
• Extracorporeal therapies, including dialysis access, and an understanding of the pathogenesis and prevention of such complications
• Indications for and provision of extracorporeal kidney replacement therapy in the critical care setting, including intermittent hemodialysis, peritoneal dialysis, continuous venovenous hemofiltration, and sustained low efficiency dialysis
• Management of electrolyte and acid-base disturbances in critically ill patients
• Management of hypertension and hypotension in the critical care setting
• Pharmacology of medications administered to critically ill patients with kidney disease