Nephrology

During the initial year of training, the Nephrology / Hypertension Fellowship develops the physician’s confidence in clinical diagnosis, pathophysiology and medical treatment of disorders of the kidney, urologic abnormalities, hypertension, and disorders of body fluid physiology in pediatric patients. Fellows learn how to manage patients and perform procedures in a variety of clinical settings, including the dialysis unit, the intensive care unit, and outpatient clinics. The program director meets monthly with fellows to ensure they stay on track to exceed national guidelines and meet the division’s expectations for its training goals and objectives. 

Our curriculum provides comprehensive training in the finer points of the pediatric nephrology / hypertension subspecialty. Along with instruction and experience in the operational aspects of a pediatric nephrology service, including the dialysis facility at Cincinnati Children’s, we instruct fellows in skill areas that go beyond the bedside:

• Staffing needs
• Unit management
• Preparation of grant proposals
• Quality improvement programs
• Appropriate communications with the referring physicians
• Planning for program development

In addition, fellows attend a Cincinnati Children’s-sponsored program on professionalism. The program includes training on a range of topics:

• Introduction to clinical research
• Ethics in research
• Dealing with the impaired physician
• Presenting and writing skills
• Fellows teaching workshop
• Grant fundamentals

These courses and experiences prepare our fellows not only to be elite pediatric subspecialists, but also to be competent, ethical professionals.

During the initial year of the Nephrology / Hypertension Fellowship, training focuses on the clinical program. Fellows spend six months on in-patient service and three months on dialysis service. They also attend nephrology clinics that occur two mornings of the week and develop an outpatient continuity clinic. A full-time faculty member is always available and makes daily rounds with the trainee.

Fellows spend the remaining three months of the initial year in electives such as, urology, pathology, radiology, or research. For a typical month, there are weekly outpatient clinical care conferences, monthly dialysis patient care conferences, twice-monthly clinical pathologic reviews of cases, weekly clinical case teaching discussions, and a weekly formal lecture or didactic session with full-time faculty. Fellows also participate in nephrology division research conferences.

Cincinnati Children's is a quaternary primary pediatric healthcare center, with a vast group of subspecialty training programs. Fellows have numerous opportunities to explore other training programs for additional clinical and research education and practical experiences.

The second and third years of the Nephrology / Hypertension Fellowship focus on research. The research training program is supervised by Prasad Devarajan, MD, and is based in the laboratories of the Division of Nephrology and Hypertension, and a number of cooperating laboratories across the academic medical center. Training is focused in six major areas, chosen because of their relevance to childhood kidney disease:

• Focus area 1: Genetic Renal Disease
• Focus area 2: Renal Development
• Focus area 3: Acute Kidney Injury
• Focus area 4: Chronic Kidney Disease
• Focus area 5: Renal Transplantation
• Focus area 6: Quality Improvement and Outcomes Research

Toward the end of his or her first year, each fellow selects a focus area and plans a project with a faculty mentor. The final two years of the fellowship are spent following one of three pathways:

• Clinical research
• Basic science research
• Clinical education

The goal for each fellow, regardless of pathway, is to produce two first-author publications during his or her fellowship. The fellow’s clinical responsibility in these latter years is reduced to weekday night and weekend call. In addition to pathway work, fellows regularly participate in journal clubs and research seminar series.

We encourage graduates who intend to undertake basic research to pursue additional supervised research opportunities before assuming faculty positions.

One such opportunity offered at Cincinnati Children’s is the William Cooper Procter Research Scholar Program. This program provides an additional three years of basic science training to physicians who have completed a standard fellowship. Some graduates of the Nephrology / Hypertension Fellowship have become Procter Scholars. Interested fellows should plan to apply for this program early in their third year of fellowship.

The Division of Nephrology and Hypertension at Cincinnati Children’s believes that evaluation is most beneficial when it is a two-way process. While fellows are formally evaluated every month (first-year fellows), four months (advanced fellows) and annually (all fellows), they have the opportunity to provide confidential, candid semi-annual evaluations of the training program and faculty.

All fellows meet monthly for lunch with the program director, at which time they discuss training and the current state of academic pediatrics and pediatric nephrology.

In addition, all fellows annually take the American Board of Pediatrics in-training exam in pediatric nephrology.