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On this rotation, fellows respond to requests for nephrology consultation from other services or attendings throughout the hospital and are the first from nephrology to evaluate the patient. Frequently encountered problems include acute and chronic kidney disease, hypertension, and fluid and electrolyte disorders. In addition, daily evaluation of each patient undergoing inpatient hemodialysis either for acute renal failure or for end stage renal disease requiring inpatient care for co-morbid condition occurs. Fellows are responsible for placing and maintaining all temporary vascular access devices, managing all dialysis complications, and assessing the adequacy of dialysis. Extensive experience in continuous venovenous renal replacement therapy, plasmapheresis, and percutaneous renal biopsy is provided.
During this rotation, the fellow is expected to evaluate end stage renal disease patients referred for transplantation and potential living kidney donors as well as provide and supervise all transplant care. Patients admitted to the hospital for transplantation are followed by the fellow under the guidance of the transplant nephrologist and surgeon. The fellow is responsible for the interpretation of histocompatibility and cross match data, implementation of immunosuppression protocols and day-to-day care of the transplant recipients in the postoperative phase. While on this service, the nephrology fellow evaluates patients readmitted with transplant complications. In addition, fellows see both short- and long-term outpatient transplant follow up at the Maine Transplant Program, becoming familiar with both early and late complications of this mode of therapy.
Southern Maine Dialysis Facility is a freestanding dialysis unit that provides in-center hemodialysis for approximately 100 patients and supervises care of 20 peritoneal dialysis and home hemodialysis patients. During this time, the fellow is responsible for all phases of care under the supervision of the attending nephrologist and the unit medical director. In addition to all aspects of chronic dialysis patient care, the fellow will learn important technical aspects of dialysis including water quality standards, the nature of dialysate delivery systems, and dialysis membrane characteristics, and will become familiar with relevant federal regulations concerning hemodialysis. Home dialysis training techniques of all forms of dialysis are also part of the curriculum. There is complete access to professionals in nursing, social work, and nutrition.
In the second year, a continuity experience with a single hemodialysis shift and several selected home dialysis patients occurs at the York County Dialysis Unit in Biddeford, Maine.
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 attends a renal outpatient clinic at Maine Nephrology Associates, PA, the private offices of the nephrology faculty. The office facility supports a group practice and includes nurse specialists in nephrology, with onsite phlebotomy and laboratory services. It provides excellent training in the management of an outpatient practice. Over the course of fellowship training, fellows have a general nephrology clinic for 1/2 day each week and additional renal transplantation clinics during the renal transplant service months.
Although the fellow receives exposure in the area of nephropathology throughout both years of the fellowship program, this rotation consists of a highly structured combination of lectures and case review. Supervised by Douglas Dressel, M.D., the fellow will become familiar with how various renal diseases affect renal cells, and how the evaluation of histopathology can assist in patient diagnosis and treatment. A practical examination at the end of the rotation reinforces these concepts.
Second year fellows spend one month working under the supervision of the interventional nephrology faculty, Dr. Robert Zimmerman and Dr. Mihai Cosma, at the Vascular Access Center. Fellows gain hands-on experience and improved knowledge of indications for fistulography, fistula and graft thrombolysis and angioplasty, and tunneled hemodialysis access catheter placement and removal. Some fellows opt to gain additional experience during elective time during the second year. A number of 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.