Inpatient Service

Our training program provides a comprehensive approach to inpatient nephrology consultative services. After an initial orientation that includes didactic lectures on major clinical topics, the fellows start rotations in one of the inpatient consultative services. These include:

Consult 1

This service covers the Cardiac Care Unit (CCU), Neuro-Intensive Care Unit (NeuroICU), Intermediate Medical Care (IMC), Labor and Delivery (L&D), in addition to several Medical/Surgical Wards including our Bone Marrow Transplant (BMT) Unit and Oncological Ward. The average census is approximately 18-22 patients. The team includes one fellow and one attending plus occasional residents or medical students who rotate on service. Nephrology services in these units will focus on management of AKI, CKD, and fluid-electrolyte disturbances. Trainees will also have exposure to advanced heart failure and patients with complicated renal issues in the setting of neurologic emergencies, in addition to various onco-nephrology and glomerulonephritis cases.

Consult 2

This services covers the Medical Intensive Care Unit (MICU), Cardiac Surgery Intensive Care Unit (CSICU), Surgical Intensive Care Unit (SICU), in addition to the famous Shock Trauma Building. The average census is approximately 15-20 patients. The team includes one fellow and one attending plus occasional residents, medical students, and critical care fellows who rotate on service. Nephrology services in these units span around extensive extracorporeal therapies which include CVVH, CVVHD, CVVHDF, and exposure to all aspects of ICU nephrology, fluid-electrolyte balance, and hemodialysis in critically ill patients.

Night Float

To enhance quality of life for trainees, we have implemented a night float system to cover new consults after hours. The night float fellow covers 6 nights a week with a day off on Friday night. This is a home call system with fellows coming in to see new consults from the VA, University, and Transplant services. A call room with adequate facilities for the night float fellow is provided to use as needed. A newly added benefit is the incorporation of telemedicine consults for VA patients admitted to the ED. Overnight fellows do not have any daytime responsibilities and are required to go home and rest during their off time. We make every effort to record daytime lectures and educational activities as well as ensuring important communication and information is passed along for the night float fellow to review at their convenience. Attendings are available at all hours of the night and trainees are encouraged to contact faculty at any time to discuss cases that they may have questions or concerns. The night float system allows the convenience of very little night coverage for the daytime fellows; on average, fellows have 24-hour calls every 5-6 weeks per calendar year.

Inpatient Transplant

Transplant Nephrology Services provide comprehensive and multidisciplinary care to organ transplant recipients. The average census is approximately 20 patients. The team consists of one fellow and one transplant nephrology attending. Trainees will co-manage newly transplanted individuals with Transplant Surgery and Pharmacy during multi-disciplinary rounds. Transplant Surgery and Internal Medicine serve as the primary admitting services, allowing trainees to focus on medical management of these complex cases as a consultant. They will learn how to manage immunosuppression in new and established transplant recipients in addition to being able to identify and handle the complications associated with transplantation.

VA Medical Center

This service covers the Baltimore Veterans Affairs Medical Center (VAMC). The VAMC is physically attached to the University of Maryland allowing trainees to walk over from the Nephrology Office. The average census is 10-15 patients. The service consists of one fellow and one attending. Trainees will see a variety of general nephrology consults, critical care patients, and End-Stage Kidney Disease (ESKD) patients. We have also have a Point of Care Ultrasound (POCUS) Device at the VA for fellows to use during their assessment of patients. Fellows will have the opportunity to learn from our POCUS trained Nephrology Attendings to become better proficient in the use of POCUS.

Outpatient Service/Electives

The remainder of the training years will be divided between research and elective time. Elective activities include but are not limited to: 

Polycystic Kidney Disease (PKD) Clinic

The University of Maryland is home to one of three NIDDK-funded PKD research and Translation Core Centers that provide innovative research resources to a national and international community of investigators. Fellows will rotate through our Polycystic Kidney Disease Subspecialty clinic for an in-depth learning experience. Under the supervision of our world-renowned PKD expert, Dr. Terry Watnick, trainees will see a variety of PKD patients from around the region and learn about different management options for these complex patients.

Glomerulonephritis (GN) Clinic

Fellows will rotate through our Glomerulonephritis Sub-specialty clinic for a more comprehensive approach to complex GN patients. Under the supervision of our GN specialist, Dr. Preeti Chandra, trainees will see a variety of GN pathologies and engage in discussions regarding management options and associated complications. 

Transplant Clinic

Fellows will learn to manage post-transplant recipients in the outpatient setting. They will gain experience managing immunosuppression and assessing for complications that are unique to transplant recipients. Trainees will also have the opportunity to assess pre-transplant individuals and participate in multi-disciplinary discussions regarding candidacy.

University Continuity Clinic

Fellows attend a once-a-week outpatient clinics throughout their 2 years of training where they follow their own panel of patients allowing for adequate continuity of care. They see patients with various pathologies including CKD, GNs, Nephrolithiasis, advanced CKD care planning for different dialysis modalities as well as conservative care approach.

VA Continuity Clinic

Fellows attend a half-day outpatient continuity clinic while on the in-patient VAMC service and during their elective rotation. They will see a unique population of patients with a variety of pathologies including AKI, CKD, Electrolyte Disorders, Nephrolithiasis, and Complex Hypertension.

Toxicology

The University of Maryland is home to the Maryland Poison Center, one of 53 poison centers across the United States. Under the supervision of Dr. Joshua King, Medical Director of the Maryland Poison Center and dual boarded in Nephrology and Toxicology, fellows will have the opportunity to learn about complex toxicology cases and discuss management options including indications for medical management and extracorporeal treatment of poisonings. 

Hemodialysis/Peritoneal Dialysis

Second-year fellows have a weekly dialysis clinic at the Parkview IDF unit on Mondays, during which they manage chronic hemodialysis patients and peritoneal dialysis patients. This is protected time for the fellows so they can focus on their ESKD outpatient experience. We are also expanding our outpatient dialysis training to include a rotation at one of the Davita Home Dialysis Units to allow for more PD and Home HD exposure.

Vascular Surgery

Trainees will have an opportunity during their second year of training to round with our vascular surgeon in the outpatient clinic. They will learn to properly assess and manage an AV access including complications such as stenosis, aneurysm, and infection.

Schedule

We strictly adhere to ACGME work hour rules in all clinical and elective rotations for the fellows. We take this VERY seriously. Trainee wellness and work-life balance is important to us.