Nephrology Rotation

Duration: 2-4 week rotation
Course Offered: Throughout the year

The student will have a diverse 2-4-week nephrology experience.  The experience is completed at Spartanburg Medical Center and the offices of Spartanburg Nephrology Associates and will involve both inpatient and outpatient management. There will be occasionally, opportunities to evaluate patients at dialysis centers. A typical day begins at 830 am in office and after office patients are seen, hospital patients will be seen. On call days, there is no overnight call and usually no patients to be seen in the office. 

Educational Purpose, Rationale or Value:  During the patient encounter in the hospital or office setting, the student will see patients with the attending and learn how to obtain pertinent history perform the pertinent exam and appropriate lab studies to order, pertinent differential diagnosis and management plan will be discussed with the student, students will also learn how to interpret the studies ordered during the previous patient encounters.  Once students gain comfort and confidence he or she may be asked to review the original history and physical, past medical history, lab work, radiology studies, urine, etc., and asked to outline a plan in appropriate straight forward cases. The patient (and write-up) is then reviewed by the Attending on hospital rounds or office and he will make the final recommendations in writing/ dictation to the primary team. The principal teaching methods include direct interaction with patients in inpatient and outpatient settings, one-to-one precepting, teaching rounds, direct observation by faculty, and independent study.  

Education Objectives: Nephrology

By completion of training the student should become familiar with knowledge of the

1. Natural history, pathophysiology, clinical presentation, diagnosis through differential diagnosis and management of clinical problems as listed.

Acid-Base Fluid and Electrolyte Disorder

• Hypokalemia
  • Hypernatremia/Hyponatremia
  • Hypercalcemia/Hypocalcemia
  • Hypermagnesemia/Hypomagnesemia
  • Hyperphosphatemia/Hypophosphatemia
  • Varied acid-based disturbances: metabolic and respiratory
  • Acute Uric Acid Nephropathy
  • Fluid overload

• Nutrition
  • Dietary restriction 
• Complications of Acid-base Fluid and Electrolyte Disorders
  • Diagnosis
  • Management and Treatment

Glomerular Disease

• Diagnosis
• Management
  • Minimal Change Disease
  • Membranoproliferative Glomerulonephritis
  • Focal Segmental Glomerulosclerosis
  • Membranous Nephropathy
  • Immunoglobulin A Nephropathy
• Education
• Diet and Pharmacologic agents

Chronic Renal Failure

• Diagnosis
• Management
  • Bone disorders in CKD
  • Cardiac complications
  • Endocrine and Neurologic complications
  • Hematologic complications
  • Pain management: NSAIDs vs analgesics
• Diet and Pharmacologic agents
• Education
• Preparation for fistula/ shunt placement, hemodialysis/ peritoneal dialysis and transplantation

Outpatient Dialysis

• Hemodialysis
• Continuous ambulatory peritoneal dialysis

Hypertension

• Ambulatory
  • Differential diagnosis
  • Diet
  • Drug therapy: diuretics, ACEI, ARBS, BB, CCB, alpha blockers, centrally acting agents and Direct Renin Inhibitors
  • Antihypertensive goals

Renal Stone Disease

• Diagnosis
• Management and Treatment

Pharmacologic Agents and Renal Failure

Urinary Tract Infections

• Diagnosis
• Management and Treatment

2.      Skill in data gathering, recording and interpretation including: taking and recording a focused history, performing a focused physical examination, using diagnostic studies (use of creatinine (BMP/ CMP), PTH and vitamin D levels, 24 hour urine collections, ultrasonography) and interpreting data related to renal dysfunction.

3.      Knowledge concerning the indications, contraindications, complications and limitations of renal diagnostic procedures and skill in interpreting data gained. These procedures include: urinalysis, contrast radiography, ultrasound, isotope scans, renal angiography, and renal biopsy.

4.      Medical and psychosocial management of patients with chronic renal disease including disability, life adjustment to this chronic illness, its effect on the family and the effect of illness on the mental health of patient and family.

5.      Appropriate use of prescription of drugs considering risk factors, patient education regarding possible side effects, and monitoring of efficacy and side effects. Special attention will be given to drugs, which require dosage adjustment in renal failure and those that have nephrotoxic potential.

Students Report To:

Kimberly Harris
Medical Student Coordinator
[email protected]
864-560-6748