Clinical Rotations

Clinical
Rotations

hree hospitals and the Northwest Kidney Centers are teaching sites for the Division of Nephrology's fellowship program. During the clinical year, the fellow will rotate through each, as follows:

Harborview Medical Center Renal Consult Service
Northwest Kidney Centers Outpatient Dialysis Service
University of Washington Medical Center Renal Consult Service
University of Washington Medical Center Kidney-Pancreas Transplant Service
VA Puget Sound Healthcare System Nephrology Consult Service

In addition, each fellow will attend an outpatient continuity renal clinic for one half-day per week.

The University of Washington Medical Center is a 450-bed tertiary referral center for the Pacific Northwest serving a five-state region (Washington, Wyoming, Alaska, Montana and Idaho) with a large nephrology program. Approximately 800 patients with a variety of common and unusual renal diseases are followed in the renal outpatient continuity clinic.

The UWMC Renal Consult Service is a 2½-month rotation and provides inpatient consultation services for acute and chronic renal disorders. Fellows learn to manage patients on acute and chronic hemodialysis and to perform peritoneal dialysis, hemofiltration, plasmapheresis, dialysis catheter placement, and renal biopsies. The Renal Consult Service also provides care for patients with renal problems following stem cell transplantation done by the Seattle Cancer Care Alliance (formerly done at the Fred Hutchinson Cancer Resarch Center), one of the largest stem cell transplant programs in the world. The renal team includes a third-year medical resident and medical students who are supervised by the fellow. Teaching rounds are made daily with a faculty attending physician. Call is shared with the resident and the Transplant Service fellow.

The Kidney-Pancreas Transplant Service at UWMC is a 2½-month rotation with extensive responsibilities for both inpatient and outpatient care of transplant patients. The fellow attends two post-transplant clinics per week, does new recipient evaluations, and performs diagnostic and protocol transplant biopsies. Inpatient rounds are made twice daily, including attending rounds with both medical and surgical attending physicians. The service is cared for in conjunction with a transplant nephrology fellow. The program also performs the renal consults on the heart, liver and lung transplant recipients. A full-time transplant nephrologist (Dr. Connie Davis) directs medical aspects of the transplant program. Call is shared with the UWMC Renal Consult Service fellow and resident.

The VA Puget Sound Healthcare System is a 500-bed general medical hospital. VA Puget Sound Health Care System is the largest referral medical center in the Northwest Network and is part of the Veterans Integrated Service Network (VISN) 20, which includes facilities in Anchorage, Boise, Portland, Roseburg, Spokane, Seattle/Tacoma, Walla Walla, and White City. VISN 20 comprises 23% of the US landmass. During this past year, VA Puget Sound logged over 600,000 outpatient visits and more than 8,318 inpatient treatments for close to 60,000 unique patients. The renal services include peritoneal dialysis, home hemodialysis, and an in-center outpatient and inpatient dialysis unit. Five full-time faculty, under the leadership of Dr. Rudy Rodriguez, participate in an active teaching, research, and patient care program. The outpatient renal clinic is held on Tuesday mornings and Thursday afternoons and the clinic population includes patients with kidney transplants, chronic kidney disease, hypertension, renal stones, glomerulonephritis, and metabolic bone disorders among others. Call is shared with the medical resident.

Harborview Medical Center is a 300-bed county-owned hospital and a major center for the care of various common acute and chronic medical problems. The emergency service, surgical ICUs, trauma unit, burn center, and medical surgical intensive care units are the most active in the region, and Harborview provides extensive exposure to the management of severe fluid and electrolyte and acid-base disorders, acute renal failure, intoxications, and other common nephrologic disorders. Three full-time faculty conduct an active program in patient care, teaching, and research. Call is shared with the dialysis fellow and resident.

The Northwest Kidney Centers is the fourth largest non-profit independent dialysis organization in the United States, and is directed by Joyce F. Jackson (president and CEO). John C. Stivelman is the Chief Medical Officer and an Associate Professor of Medicine in the Division of Nephrology at the University of Washington. Northwest Kidney Centers coordinates the care of most end-stage renal disease patients in the Puget Sound area and serves 1,300 dialysis patients, 1,125 of which receive treatment in centers, and approximately 200 transplant patients. The home dialysis program as 175 patient and remains the largest home program in the U.S. Active hemodialysis and peritoneal dialysis programs are ongoing. Fellows will become familiar with managing patients on home dialysis and chronic ambulatory peritoneal dialysis (CAPD), as well as center dialysis during a two-and-one-half-month rotation at the Northwest Kidney Centers. The NKC fellow covers University of Washington Medical Center nephrology for parts of the day and shares call with the Harborview fellow and resident.