Sample Schedule
HD/PD (Two 2 Month Rotations, PGY4 Fellows)
Fellows in their first year of training, rotate in a proprietary out-patient dialysis facility less than 2 miles from the Texas Medical Center and Houston Methodist Hospital. The facility provides all modalities of in-center and home dialysis, both peritoneal and hemodialysis, and home dialysis training.

The patient population consists of approximately 150 end-stage renal disease (ESRD) patients with a gender, ethnic, and racial distribution fairly representative of the Houston adult population. Two thirds of these patients dialyze in-center; the rest at home.

During this rotation, fellows learn how to prescribe appropriately dosed peritoneal or hemodialysis, how to treat fluid overload, hypertension, anemia of chronic kidney disease, and mineral metabolism disorders in the ESRD population. They also learn about optimal dialysis access and the recognition and management of dialysis vascular access complications. Fellows also learn how to monitor the efficacy of these, treatment measured, and the application of the Continuous Quality Improvement methodology to this process. Finally, they also learn how to train ESRD patients to perform peritoneal or hemodialysis at home.

Consults/Inpatient CKD (2-Month Rotation, PGY4)
Nephrology Fellows in their first year of training are assigned to this rotation for a period of 2 months. In this rotation, fellows are assigned to one of two Nephrology services. The fellows, under the supervision of an attending Nephrologist, provide care to inpatients with different stages of CKD which could include ordering peritoneal or hemodialysis. In addition, fellows will have the opportunity to provide consultant services to other hospitalized patients. This is an opportunity for fellows to learn the care of seriously ill kidney patients, and to develop the skills of serving as a consultant.

ICU (2-Month Rotation, PGY4 and PGY5)
Fellows are assigned to one of two Nephrology services. All ICUs are staffed with intensivists. The patient population consists of patients admitted to one of the ICUs: neuro-ICU (NICU), medical ICU (MICU), surgical ICU (SICU), cardiovascular ICU (FICU), or coronary care unit (CCU), where the supervising nephrologist is either an admitting physician or consultant. The fellows will daily evaluate, examine, and recommend further work-up, where appropriate, and propose a management plan. This is then presented to the supervising nephrologist from the respective service, and together they arrive at the final work-up and/or treatment plan. In patients with CKD 5d (ESRD), or with acute kidney injury (AKI) requiring dialysis, the fellows will write the dialysis prescription whether it is for PD, HD, or CRRT.

Transplantation (2-Month Rotation, PGY4 and PGY5)
The Houston Methodist Hospital has a large multi-organ transplant enter, transplanting kidneys, pancreas, livers, lungs and hearts. The patient population in this rotation will consist of patients with chronic kidney disease (CKD) Stage 5 who just received a kidney transplant, patients with diabetic nephropathy and CKD 5 who just received a kidney/pancreas transplant, patients with type I diabetes who just received a pancreas transplant alone, or past recipients of either organ being admitted to the transplant ward for a medical or surgical event or complication.

During this rotation, the Fellows will be assigned to the service of Nephrology, Dialysis and Transplantation Associates (NDTA). The fellows will daily evaluate, examine, and recommend further work-up, where appropriate, and propose a management plan. This is then presented to the attending transplant nephrologist and surgeon from the respective service, and together will arrive at a final work-up and/or treatment plan. During this rotation, the fellows will become proficient in immunosuppression, the treatment of transplant rejection and the management of infectious complications in an immune-compromised patient.

Research (4-Month Rotation PGY5) 
An experience in research is mandatory for every trainee. Although a block of four months has been set aside for this experience, not all four months need to be taken consecutively. Further, depending on the nature of the fellow’s research project, work on the project can extend over less or more time, and the fellow can chose to do certain electives while working on the research project on the side. However, during one month of this block, the fellow needs to be available to the interventional radiologist performing ultrasound or CT-guided renal biopsies in order to acquire the required competence in the performance of this procedure.

The objective of the research experience is for the trainee to gain a good understanding of the scientific method, and develop basic statistical concepts and methods. The expectation from each trainee is to produce data that can be submitted for presentation at the meeting of a nephrology society, and ideally, present a paper/poster, and submit a manuscript for publication.

There are multiple opportunities for the research experience. This may be in the basic sciences, with one of the investigators in the Houston Methodist Research Institute, or in clinical sciences under the mentorship of one of the faculty of the Nephrology Division, the Department of Medicine, or other academic departments. Areas of clinical research such as dialysis, transplantation, and epidemiology are readily available, but multiple other opportunities also exist in the institution.

Renal Biopsy
Refer to Research section above.

Vascular Access (2-month rotation, PGY 5)
Fellows spend the allocated time at The Kidney Institute, a private Nephrology practice site where they also receive their two-year long outpatient experience in the care of CKD and of transplant patients. The Institute has a busy outpatient vascular access management center where the fellows can have a hands-on experience in the care of dialysis access during this rotation. The Institute also has an ultrasound machine on which fellows can practice after they have attended a course on diagnostic renal ultrasonography. Fellows interested in interventional Nephrology may choose to spend some of the time allocated to research, working at the access center (so long as the research effort is not compromised).

Urology (1-Month rotation, PGY5)
This is an inpatient and outpatient clinic experience with the Urology Service at the Houston Methodist Hospital. Patients encountered during this rotation consist of adult individuals of either gender, and of varied racial and ethnic groups, presenting with urologic disorders. During this rotation, fellows will learn about urinary tract infections, kidney stones, urinary tract obstruction, prostatic diseases, and the urologic complications of kidney transplantation.

HLA Laboratory (1-Month rotation, PGY5)
The large multi-organ transplant program at the Houston Methodist Hospital is supported by a modern laboratory for testing tissue typing, tissue matching, and sensitization in patients who are candidates for kidney, pancreas, liver, lung or heart transplantation, and in organ donors. During this rotation, the fellows will be assigned to the Histocompatibility Laboratory under the supervision of the laboratory director and his associates. Here, the fellows learn the different techniques of tissue typing, tissue matching and the determination of prior sensitization. The fellows will also participate in meetings dealing with the matching of donors and recipients, the identification of unacceptable HLA antigens because of prior sensitization, and the determination of the need for participation in an organ “swap” because of incompatibility of the donor and recipient.

In-Patient CKD 
Refer to Consults/In-patient CKD above.