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Nephrology Rotation for 4th Year Students

Location:  Critical care Units, General floors and Hemodialysis unit

Length:     4 Weeks


To meet the objectives in strengthening knowledge, skills, attitude and behavior while managing patients on nephrology consult service.


A. Knowledge:

The student should demonstrate ability to evaluate and manage patients with the following conditions, initiate management and know when to refer patients for appropriate subspecialty care:

Oliguria /Anuria

Pre renal azotemia

Acute kidney injury (AKI)

Acute kidney injury on chronic kidney disease

Medical management issued of patients with ESRD

Initial assessment and plans for patients diagnosed with advanced CKD

Adjustment of medications and avoidance of renal toxic agents in CKD

Fluid and electrolyte abnormalities

Acid base disorders

Hematuria, Proteinuria, Pyuria

Glomerular diseases

Hypertension- benign, accelerated, malignant, essential and secondary

Renal disease in pregnancy

Understand the pathology, diagnosis and treatment of the conditions being managed while reading necessary texts and articles simultaneously making evidence based care decisions.

The student should become competent in performing and accurately recording complete history and physical with assessment, differential diagnosis and plan independently.

B. Skills:

The student should be able to

Accurately perform and record history and physicals with assessment, differential diagnosis and plan under the guidance of fellow.

•         Develop skills to assess kidney function.

•         Recognize limitations of different methods to assess GFR.

•         Correctly interpret urinanalysis, urine electrolytes and urine protein/ creatinine.

•         Accurately classify patients with regard to stage of CKD.

•         List appropriate interventions based on stage of CKD.

•         Recognize when to refer patients for dialysis access placement.

•         Make general recommendations regarding long term plans for ESRD         treatment.

•         List the risks and benefits of erythropoeitic agents.

Describe the principles related to the use of phosphate binders, vitamin D supplemnts and calcimetic drugs for treatment of bone disease and hyperparathyroidism.

Recognize urgent and emergent indications for hemodialysis.

Effectively communicate with patients and families using appropriate language and avoiding jargon and medical terminology.

C. Behavior:

The student should be

Able to provide compassionate and empathic patient care in acute and chronic care settings.

Sensitive to the diverse factors affecting patients and their health care beliefs and needs including race, culture, income and ethnicity.

Develop effective communication skills with the staff including other physicians, nurses, respiratory therapists and social workers for better patient care delivery.

D. Attitudes:

The student should be able to

Practice and respect patient privacy and confidentiality while maintaining highest standards of professionalism.

Discuss renal care issues with the patient and family.


•         Adult patient care with above described disease mix aiming at two inpatient consults per day.

•         Case presentation during rounds with complete assessment, differential diagnosis and plan.

•         Evaluate patients in nephrology clinics under the supervision of fellows.

•         Maintain patient log seen by the student to assess meeting the above mentioned objectives.

•         Read core topics in Harrison’s Textbook Of  Internal Medicine.

•         Presentation and attendance in nephrology conferences on Tuesday and Wednesday.

•         Mandatory attendance in noon conferences.

•         Write consultation notes.

•         The student can choose to be on transplant service for week if interested.


Review of student’s case presentations, documentation, professionalism and counseling skills during management rounds and conferences.

End of rotation evaluation forms.

Student satisfaction assessment once every two weeks with appropriate feedback to assure individual needs are met.


The student will be  

•         Responsible for patient managed by him/her under the guidance of senior resident/fellow.

•         Responsible for communication with the primary team as well as consultants wherever indicated.

•         Demonstrating highest standards of professionalism with patients and colleagues.


The student should sit with the 4th year director at the end of the rotation to discuss and fill out an evaluation form.