During my rotation as a nephrology fellow at a high-volume liver transplantation center, I vividly remember an afternoon consultation from the medical team’s intern: “Our patient needs a simultaneous liver-kidney transplant (SLKT).”
Several questions came to mind. How do they know he needs both a liver and a kidney? Are there guidelines for this seemingly monumental decision? What determines whether and when a patient receives a kidney from the donor pool—an increasingly scarce resource, with wait times approaching a decade? I found no rules to guide me. No criteria existed to aid me in the determination of
Rare is the occasion when business training intersects with medical education.
Absent in most medical curricula and nearly taboo in academic residency and fellowship training, understanding the operational aspects of nephrology is imperative in preparing young fellows for practice. Too often, budding nephrologists are ensnared in complicated contracts, beguiled by partner promises, or seduced by transient gains. Unaware and unprepared, young and enthusiastic nephrologists often learn the business as they go, eager to see patients but often without the means or knowledge of how to achieve that goal. This must change.
Throughout training, we have short-term goals. Although
The first chapter of the American Society of Nephrology’s Geriatric Nephrology Core Curriculum reminds us that “the degree of humanity in our healthcare world will be made evident in the way we treat (or do not treat) our minorities, our underprivileged, our poor, our mentally infirm, those who have no voice to speak for themselves, and finally, the aged” (1).
The elderly population is among the fastest growing in the United States and accounts for a large percentage of those with chronic kidney disease (CKD). Kidney senescence causes gradual structural loss and functional decline during aging.
Along with sunscreen and mosquito repellent, this query was my steadfast travel companion throughout my time on the subcontinent. The only thing more ubiquitous were the auto rickshaws that careened haphazardly through the streets (effectively hailing them eventually became one of my triumphs). Conducting research in any setting has its unique set of challenges, and adding cultural uncertainty to the mix is perhaps a thing some people would prefer to avoid. I decidedly fall outside that group.
My decision to travel to India to conduct nephrology research was influenced by many factors. I am fortunate to
Many influences propelled me along the course that ultimately allowed me to train with some of the best minds in nephrology as an osteopathic medical graduate and current clinical nephrology fellow at Yale.
As many nephrologists will surely attest, it was the tutelage of talented mentors that led me to my career in nephrology. Surveys have explored the reasons behind why fellows are choosing not to pursue nephrology, and lack of mentorship is a particularly troubling reason. In one study, 33% of those polled attributed lack of quality teachers as the reason for choosing a
Many exciting opportunities and subspecialties have emerged within the field of nephrology. Among these, critical care nephrology has become an important specialty in both clinical and research settings. Acute kidney injury (AKI) is an increasingly recognized adverse outcome among critically ill patients, and its impact is both devastating and often underestimated (1).
Several critical care nephrology programs have been created in recent years to provide clinical care, research, and educational programs to interested trainees. The Center for Critical Care Nephrology in Pittsburgh is an example of the growing interest in promoting a multidisciplinary model of basic,
On January 21, 2017, I, as a blessed research fellow without call responsibilities, participated in a local Women’s Day march. The messages of the day, in the context of the last few months of political rancor, had led me to consider how our country’s political and social trajectory might affect a patient’s health.
Ask a nephrologist what the top causes of CKD are, and you will assuredly hear, “diabetes and hypertension,” perhaps followed by a comment about the proverbial hypertension chicken and egg. But what drives diabetes and hypertension? One might say obesity, but what about poverty and social disparities?
Improvised hastily by a young physician to avoid the embarrassment from direct auscultation of a particularly buxom patient’s chest, the stethoscope recently celebrated its 200th anniversary. After initial resistance, it has since become standard of care and a ubiquitous icon of the physician (1).
Technology has improved since the Napoleonic era, and more sophisticated devices are now available to augment the physical exam. Ultrasound was originally applied as sonar to hunt submarines in the First World War, but was quickly co-opted into the medical field. Early machines occupied entire rooms, but now powerful imaging devices are handheld and
We hope you, the reader, have been pleased with the reintroduction of the Fellows Corner column of Kidney News. Thanks to wonderful leadership from Robert Rope, MD, who has been serving as feature editor, we enjoyed broad participation and believe we have delivered some very informative, poignant, and reflective content. Rob will be stepping down as he completes his third year of fellowship at Stanford and joins the nephrology faculty at Oregon Health & Science University, where he started his medical training. He looks forward to continuing his work with fellows and to bolstering interest
Bloodstream infections (BSI) among hemodialysis patients are among the most challenging problems in dialysis units, and are associated with significant morbidity and mortality (1).
Approximately 37,000 vascular access–related BSIs are estimated to have occurred among US hemodialysis patients with a central venous catheter in 2008, with an average cost per hospitalization of $23,000 (2,3). A number of factors appear to have contributed to these high rates, and they apply to both dialysis staff and patients; proper gowning and gloving, hand sanitation, high catheter rate, and appropriate skin antisepsis are examples. An