Clinical Training

Fellows participate in the evaluation and management of patients on the pediatric inpatient service, pediatric ICU, neonatal ICU and pediatric specialty center. Patient problems encompass the full range of clinical renal disorders, including fluid and electrolyte disturbances, acute and chronic renal failure, various forms of glomerulonephritis and interstitial nephritis, nephrolithiasis, hypertension, intoxications, inherited renal diseases and urinary tract abnormalities. A pediatric nephrology faculty member serves as attending physician at all times, and conducts teaching rounds daily. These teaching sessions provide supervision and training in the practical aspects of patient management, as well as instruction in the basic scientific disciplines that underlie the clinical practice of nephrology.

Fellows receive extensive training in percutaneous renal biopsy and renal replacement therapies. They gain experience in the use of peritoneal dialysis, hemodialysis and continuous veno-venous hemofiltration/dialysis (CVVH). Experience in chronic dialysis is also provided, as fellows participate in the treatment of patients with chronic ambulatory peritoneal dialysis (CAPD) and in-center hemodialysis. Fellows are involved in an active renal transplantation program throughout their training and dedicated rotations, acquiring expertise in managing the acute postoperative care and the long-term follow-up of these patients.

Fellows participate in outpatient renal clinics under the supervision of the faculty, gaining experience in the work-up of common renal disorders not initially requiring hospitalization (e.g., proteinuria, hematuria, mild azotemia), the assessment and treatment of childhood hypertension and the long-term follow-up of patients after discharge from the inpatient and transplant services.

Several teaching conferences are devoted to clinical nephrology. Renal Grand Rounds, held weekly, and attended by all trainees and faculty from both pediatric and adult nephrology. The clinical fellows select the patients and topics for discussion. This conference provides a forum to discuss interesting diagnostic and management problems, and to review the literature on timely and controversial issues. In addition, formal Pediatric Renal Rounds is held weekly. All fellows in pediatric nephrology participate in the review of diagnostic studies, current literature and didactic peer teaching. A conference including nephrologists throughout the state is held monthly to review renal biopsies with Dr. Gilbert Moeckel Yale's outstanding renal pathologist. A clinical or research journal club meets weekly. A didactic course on dialysis and renal transplantation is held throughout the year. A course on renal physiology and pathophysiology is presented each academic year by the Section of Nephrology faculty. A renal pathology course given by Dr. Kashgarian and a course on renal imaging techniques given by members of the Department of Diagnostic Imaging are offered. The pediatric renal fellows join a weekly Research in Progress session as part of the Department of Pediatrics Child Health Research Seminar series, which includes didactic teaching in biometrics and biostatistics.