Nephrology Fellowship Program

Nephrology fellows spend their clinical time on four consult services: Main, Ashley River Tower (ART), VA, and Transplant. Fellows spend two months in the Home Dialysis Unit, gaining expertise in PD and home hemodialysis. Fellows have research/elective months in both the first and second years. Fellows have a weekly continuity clinic alternating between the VA and Rutledge Tower clinics.

University (Main) and ART Consults

Consult Services are divided into two services at Ashley River Tower (ART) and University Hospital. Two attendings and two fellows cover ART and one attending and two fellows cover University Hospital. Medical students and medicine house staff may also rotate on service. Fellows gain expertise in the evaluation and management of AKI, CKD and ESKD in a broad range of settings including specialty ICU settings, heart failure, and oncology. Exposure to acute hemodialysis and continuous renal replacement therapies is extensive. Fellows are also exposed to AKI in the setting of ventricular assist device therapies and ECMO. There is a team of Advanced Practice Providers who help to provide ESRD care for stable ESRD patients

Transplant Consults

The Renal Transplant Service provides consultative care for renal transplant patients. There were 410 renal transplants performed at MUSC in 2021, putting MUSC in the top five kidney transplant programs in the country for volume.. The general nephrology fellow is part of the medical-surgical team and rounds with the transplant attending, transplant fellow, and the attendings on all renal transplant patients. In addition, the fellow is involved in transplant clinics, pre-transplant evaluations, and management of medical complications post-transplant. Specifics of transplant medicine such as immunosuppression, treatment of rejection, and management of opportunistic infections and when and how to perform renal transplant biopsy are emphasized.

VA Nephrology Service

The nephrology fellow is involved in acute inpatient consults and outpatient services for acute and chronic renal disease and hypertension. The fellow rounds with an attending at the Ralph H. Johnson VA Medical Center (VAMC) as a consultant and sees all nephrology patients that are admitted to the hospital as well as any new consultations. With the attending physician, the fellow at the VAMC is responsible for running the outpatient dialysis unit associated with the hospital. The fellow will gain experience rounding on outpatient dialysis patients and the management of dialysis access problems, anemia and bone mineral disorders.

Home Dialysis Months

Home dialysis modalities (peritoneal dialysis and home hemodialysis) are an important part of renal replacement therapy. MUSC has approximately 50 patients receiving home therapies, including peritoneal dialysis and home hemodialysis. Each fellow is required to spend a month each year in the Home Unit to learn management of PD and home hemodialysis.

Elective Months

When not on a clinical service, there are many opportunities for further study. Electives available include Pediatric Nephrology, Interventional Nephrology, Interventional Radiology, Renal Pathology, and Plasmapheresis.

Outpatient Clinics

The Rutledge Tower Teaching Clinic is a nephrology continuity clinic at MUSC. In a half-day clinic, four to six patients with a myriad of renal diseases are seen and followed over two years by a fellow in continuity.

The VA Teaching Clinic is a continuity clinic located in the Ralph H. Johnson VA Medical Center. Activity in this clinic consists of four to six patient visits during a half-day clinic for each fellow every other week.

Procedures

Fellows will learn how to perform percutaneous native and transplant biopsies and temporary line placement for dialysis. In addition, fellows will learn the fundamentals of renal ultrasound.

Call

There is a night float system in place Saturday through Thursday. Friday is covered by the fellows on home dialysis, research or transplant.

Conferences

We have a rich conference schedule including a faculty-led "Intro Series" at the beginning of the academic year to orient new fellows to Nephrology. Fellows will participate in renal biopsy conference, journal club, Nephrology Grand Rounds, and research conference. There is a dedicated renal physiology conference for fellows. Conference topics will help prepare fellows for the ABIM Nephrology Boards and are supplemented with board review question sessions.

In addition to didactics, there are small group sessions throughout the year, including a series on professionalism and communication, CRRT training, finances for physicians and palliative care.

Research

All fellows are expected to complete a research project during their fellowship. In addition, fellows are strongly encouraged to submit their projects for publication and to present abstracts at regional and national meetings. Numerous clinical and basic research projects are ongoing in the Division. The research interests of the Division faculty are as described in their faculty biographies. However, research fellows are not constrained to work only in the division of Nephrology laboratories. In particular, strong programs on campus in Pharmacology, Molecular and Cell Biology, and Pathology offer additional outstanding opportunities for research training. There are multiple opportunities to participate in mentored clinical research.

Educational Environment

MUSC offers a very supportive educational environment. Our faculty are educators at heart and are dedicated to helping fellows develop into independent nephrologists. Fellows are provided with educational funds that may be used to support conference travel or to acquire approved educational materials. Senior fellows attend the American Society of Nephrology Meeting and the junior fellows attend the National Kidney Foundation Spring Meeting. Additional travel support is available for fellows who present research at regional or national meetings. Five days of CME time are provided (in addition to vacation time). The Division actively seeks input from the fellows about how to improve their learning experience. Fellows have regularly scheduled meetings with the program director to discuss any concerns related to the fellowship.

Physician Wellness

The mental and physical health of our fellows is very important to the Division. In addition to the program director, there are two faculty members with a specific interested in wellness. Dr. Natalie Freidin is the Associate Program Director for Wellness. She leads the physician finances curriculum, which is designed to empower fellows to take control of their finances, as financial stress is one of the many causes of physician burnout. Dr. Rachel Sturdivant leads the Chrysallis series that explores humanism in nephrology. All fellows are provided a membership to the MUSC Wellness Center which is open seven days per week. It is a 80,000 square foot facility with a junior Olympic swimming pool, tennis, racquetball and squash courts, extensive group fitness classes, two weight rooms, and cardiovascular equipment. There is a dedicated Nephrology Fellow lounge in the Main Hospital with lockers, computers, and a comfortable couch.

1. To train future nephrologists with exposure to a broad spectrum of renal diseases and renal replacement therapies, including renal transplantation, home dialysis, CRRT, prolonged intermittent renal replacement therapy (PIRRT), and intermittent hemodialysis.
2. To provide experience with nephrology-related procedures including percutaneous kidney biopsy and temporary hemodialysis catheter placement.
3. To practice evidence-based medicine as it applies to Nephrology.
4. To equip the fellows for a variety of practice settings (both in academia and private practice, in addition to alternative career paths).
5. To promote life-long learning and wellness.