Curriculum

Consult Service

The goal of the Mount Sinai Nephrology Consultation rotation is to provide the instruction, clinical experience, and opportunities to acquire expertise in the prevention, evaluation, and management of the following disorders:

• Disorders of mineral metabolism, including nephrolithiasis and renal osteodystrophy
• Disorders of fluid, electrolyte, and acid-base regulation
• Acute kidney failure
• Chronic kidney failure and its management by conservative methods, including nutritional management of uremia
• Hypertensive disorders
• Kidney disorders of pregnancy
• Urinary tract infections
• Tubulointerstitial kidney diseases, including inherited diseases of transport, cystic diseases, and other congenital disorders
• Glomerular and vascular diseases, including the glomerulonephritides, diabetic nephropathy, and atheroembolic renal disease
• Disorders of drug metabolism and kidney drug toxicity
• Genetic and inherited kidney disorders
• Geriatric aspects of nephrology, including disorders of the aging kidney and urinary tract
• urinalysis
• Percutaneous renal biopsy
• Placement of temporary vascular access for hemodialysis and related procedures
• Continuous kidney replacement therapy
• Intermittentrenal replacement therapy (i.e. Hemodialysis, Peritoneal Dialysis)

Our program will ensure that each fellow has the necessary knowledge and are familiar with the following procedures, including their indications, contraindications, complications, and interpretations of results, as well as their cost-effectiveness and application to patient care:

• Plasmapheresis
• Kidney ultrasound 

ESKD Service

The goal of the Mount Sinai End Stage Kidney Disease Service is to ensure that each fellow is provided with ample clinical experience and supervised involvement in decision making for patients undergoing kidney replacement therapies. Specific areas in which Fellows are to receive training and become proficient include:

• evaluation and selection of patients for acute hemodialysis or continuous kidney replacement therapies
• evaluation of end-stage kidney disease patients for various forms of therapy and their instruction regarding treatment options
• drug dosage modification during dialysis and other extracorporeal therapies
• evaluation and management of medical complications in patients during and between dialyses and other extracorporeal therapies, including dialysis access, and an understanding of the pathogenesis and prevention of such complications
• long-term follow-up of patients undergoing long-term dialysis, including their dialysis prescription and modification and assessment of adequacy of dialysis
• an understanding of the principles and practice of peritoneal dialysis, including the establishment of peritoneal access, the principles of dialysis catheters, and how to choose appropriate catheters
• an understanding of the technology of peritoneal dialysis, including the use of automated cyclers
• assessment of peritoneal dialysis efficiency, using peritoneal equilibration testing and the principles of peritoneal biopsy
• an understanding of how to write a peritoneal dialysis prescription and how to assess peritoneal dialysis adequacy
• the pharmacology of commonly used medications and their kinetic and dosage alteration with peritoneal dialysis
• an understanding of the complications of peritoneal dialysis, including peritonitis and its treatment, exit site and tunnel infections and their management, hernias, plural effusions, and other less common complications and their management
• an understanding of the special nutritional requirements of patients undergoing hemodialysis and peritoneal dialysis
• placement of temporary vascular access for hemodialysis and related procedures
• peritoneal dialysis
• acute and long-term hemodialysis
• continuous kidney replacement therapy (continuous veno-venous hemofiltration, and sustained low-efficiency dialysis)

We will also ensure that Fellows have the necessary knowledge and are familiar with the following procedures, including their indications, contraindications, complications, and interpretations of results, as well as their cost-effectiveness and application to patient care:

• Radiology of vascular access
• Balloon angioplasty of vascular access

Transplant Service

The educational goal of the Mount Sinai Transplant Nephrology Rotation is for each fellow to receive adequate experience and education to ensure that they will become proficient in the following core areas:

• evaluation and selection of transplant candidates
• preoperative evaluation and preparation of transplant recipients and donors
• immediate postoperative management of transplant recipients, including administration of immunosuppressants
• clinical diagnosis of all forms of rejection including laboratory, histopathologic, and imaging techniques
• medical management of rejection, including use of immunosuppressant drugs and other agents
• recognition and medical management of the surgical and nonsurgical complications of transplantations
• long-term follow-up of transplant recipients in the ambulatory setting
• knowledge of indications for biopsy of kidney allograft biopsy, technical expertise in performing biopsy of kidney allograft and interpretation of biopsy pathology specimens
• recognition and the management of kidney disease in non-renal organ transplant recipients

Nephrology ICU Service:

The educational goal of the ICU Nephrology Rotation is for each fellow to receive adequate experience and education to ensure that they will become proficient in the following core areas:

• demonstrate knowledge of the 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
• demonstrate knowledge of the pharmacology of medications administered to critically ill patients with kidney disease Accurate diagnosis and effective management of acute kidney injury
• demonstrate competence in the management of electrolyte and acid-base disturbances in critically ill patients
• demonstrate competence in the management of nutrition in critically ill patients with kidney disorders
• demonstrate competence in the management of disordered blood pressure regulation, including hypertension and hypotension in the critical care setting
• be able to accurately diagnosis and effectively manage patients with acute kidney injury

1st Year Fellows

First year fellows will spend the majority of the year on the inpatient consultation services at Mount Sinai Hospital with two rotations at the James J. Peter Bronx Veterans Affair (VA) hospital. 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.

ESKD - 4 Weeks
Transplant - 8 Weeks
Bronx VA - 8 Weeks
Elective - 4 weeks

Consult - 8 Weeks
Nephrology ICU - 8 Weeks
Night Float - 4 Weeks
Vacation - 4 Weeks

2nd Year Fellows

Second year fellows have limited primary inpatient service responsibilities. This year is dedicated to pursuing a scholarly project (for which there is approximately 75% 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 critical care nephrology, home dialysis modalities, kidney stone disease and interventional nephrology. Additional clinical elective opportunities are available at our affiliate Mount Sinai Beth Israel site with educational activities led by Dr. Nikolas Harbord.

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.

3rd Year Fellows

An optional third year is offered to fellows who desire a career as physician-scientists in basic, translational, or clinical research. Greater than 90% of the time is dedicated to research pursuits with minimal clinical exposure designed to enable the fellow to maintain his/her professional skills. In addition, interested fellows may pursue a 3rd year of additional subspecialty training. Opportunities are available in:

• Critical Care
• Home Dialysis
• Transplant Nephrology
• Glomerular Diseases

Nephrology Conference Schedule

Monday at 4pm: Journal Club
Tuesday at 12pm: Nephrology Case Conference/Core Curriculum
Tuesday at 4pm: Clinical Conference/Core Curriculum
Friday at 12pm: Research Conference

Department of Medicine Conferences

Tuesday at 8:30 am: Grand Rounds 
First Thursday of each month at 4pm: DOM Research Conference