Curriculum & Rotations

During this rotation, fellows respond to nephrology consultation requests from other hospital services and are the first from nephrology to evaluate the patient. Common issues encountered include acute and chronic kidney disease, hypertension, and fluid and electrolyte disorders. Fellows also perform daily evaluations of patients undergoing inpatient hemodialysis, whether for acute renal failure or end-stage renal disease requiring inpatient care for co-morbid conditions. Additionally, fellows gain extensive experience in therapeutic apheresis and continuous venovenous renal replacement therapy (CRRT) for ICU patients, including those on extracorporeal membrane oxygenation (ECMO).

During this rotation, the fellow, under the supervision of the transplant nephrologist, evaluates patients with end-stage renal disease referred for transplantation, as well as potential living kidney donors. The multidisciplinary team includes a transplant surgeon, transplant nephrologist, clinical pharmacist, nurse practitioner, and a medical resident. Patients admitted for transplantation are closely followed by the fellow under the guidance of both the transplant nephrologist and surgeon. While on this service, the nephrology fellow also evaluates patients who are readmitted with transplant complications or for other medical reasons. Additionally, the fellow is also given the opportunity to perform both transplant and native kidney biopsies, which are performed by nephrology.

In the outpatient setting, fellows participate in both short- and long-term follow-up care for transplant patients at the MaineHealth Transplant Program, gaining experience with early and late complications of transplantation.

The Southern Maine Dialysis Facility serves as the primary site for outpatient dialysis rotations, providing in-center hemodialysis to approximately 100 patients. Fellows will have a continuity experience with a dedicated hemodialysis shift. In addition to managing all aspects of chronic dialysis patient care, fellows will gain hands-on experience with the technical aspects of dialysis, including water quality standards, dialysate delivery systems, and dialysis membrane characteristics.

As part of the national initiative to expand access to home dialysis, our fellows are given dedicated time at the home clinic, which serves 70-100 patients on home hemodialysis and home peritoneal dialysis. Fellows are assigned a selected panel of home dialysis patients to follow longitudinally during their outpatient weeks.

For four to six weeks each year, each fellow rotates to the nephrology service at the Togus VAMC in Augusta, Maine. The experience blends nephrology experience in ambulatory clinic, inpatient consultation, and outpatient dialysis. The experience exposes the fellow to an additional patient population, and an alternative system of practice in nephrology.

Throughout both years of training, the fellow manages their own panel of patients in the outpatient nephrology office, caring for individuals with a variety of kidney diseases. The office has onsite phlebotomy and laboratory services, as well as renal ultrasound capabilities, with an ultrasound technician available.

Glomerulonephritis Clinic

Fellows may choose to attend our Glomerulonephritis (GN) clinic, which specializes in the diagnosis and management of various glomerular diseases. Common conditions encountered include ANCA vasculitis, IgA nephropathy, FSGS, infection-related GN, and lupus nephritis, among others. Fellows will have the opportunity to become familiar with treatment options, including immunosuppressive therapies and biologic agents.

Polycystic Kidney Disease Clinic

Fellows may choose to attend our Polycystic Kidney Disease (PKD) clinic, which focuses on the evaluation and management of PKD patients, with particular attention to the indications and monitoring of Tolvaptan in accordance with the REMS program.

Although the fellow gains exposure to nephropathology throughout both years of the fellowship program, this rotation provides a highly structured combination of lectures and case reviews. Under the supervision of Dr. Douglas Dressel, the fellow will become familiar with the histopathology of common kidney diseases and learn how this evaluation can aid in patient diagnosis and treatment.

On this rotation, fellows rotate through our MaineHealth Vascular Access program, gaining hands-on experience and enhanced knowledge of indications for fistulography, fistula and graft thrombolysis, angioplasty, tunneled hemodialysis access catheter placement and removal, as well as fluoroscopic peritoneal dialysis catheter placement.

Some fellows opt to gain additional experience during elective time during the second year. Several fellows have utilized this experience as a springboard to development of expertise in this area and subsequent work as interventionists in their graduate employment situations.

Fellows work on a research project throughout their fellowship, with more dedicated time during their second year, under the mentorship of a faculty member. They also participate in a short course on human subjects research, conducted by the MaineHealth Institute for Research.

Fellows may choose to focus on one of these pathways during their second year of training, providing them with additional time to gain expertise in their area of interest. The specialized pathways include:

• Home dialysis
• Transplant
• Interventional Nephrology
• Administrative

In addition to these nephrology-specific pathways, fellows can participate in GME academic tracks, including:

• Clinician educator and leadership track “CELT” for fellows
• Research
• Clinical informatics

Academic Tracks for Residents and Fellows