Subject Matter Expert Tracks
During the second year of training, fellows are enrolled in a Subject Matter Expert Track and focus on the goals outlined in their IDP. The tracks provide close mentorship and training in a focused area in nephrology. Given the rapid pace of expansion of medical evidence and knowledge in the field of Nephrology, we believe that modern training in nephrology requires specialized and focused experience and training to ensure success in both academic and clinical practice. The tracks outlined below assure an integrated experience in both clinical and research training in each track. Fellows engage in clinical and didactic activities and complete a related scholarly project. Current subject matter expert tracks include:
Metabolic Stone and Bone Disease
Directors: Dr. Elaine Worcester and Dr. Stuart Sprague
Mineral and bone disorders are common and important complications in the general population and in those with CKD, and are associated with significant morbidity and mortality. Nephrolithiasis is an increasingly common medical problem and preventive treatment is effective in preventing recurrent stone disease. This track allows nephrologists to become well trained in the management of patients with a full spectrum of these disorders. As our understanding of the pathophysiology of mineral bone disease is evolving quickly, training in this area has significant implications for both research in nephrology and clinical practice. Management of both these conditions requires an understanding of the physiology of mineral metabolism in kidney, bone, and the gastrointestinal tract, including the impact of changes in hormonal balance, as well as acid-base and sodium balance. In addition, exposure to the varied presentations and treatment options of these disorders is provided as a critical component of training.
Directors: Dr. Mary Hammes and Dr. Rita McGill
Vascular access outcomes are a key determinant of morbidity, mortality and cost for patients with ESRD. In the last 10 years, technical advances, understanding of vascular biology, and therapeutic options have exponentially increased. There is growing recognition that dialysis-related expertise regarding vascular access placement and maintenance and management of access complications is necessary to provide appropriate care and optimize outcomes for our patients. Multidisciplinary teams including interventional radiology, vascular surgery and nephrology provide the training necessary to become a subject matter expert with regard to vascular access.
Directors: Dr. Orly Kohn and Dr. Kevin Nash
Home dialysis (both hemodialysis and peritoneal dialysis) is increasing in relative frequency throughout the United States and will become a greater part of our renal replacement therapy. Home dialysis patients represent a distinctly different patient population with regard to dialysis prescription, nutritional needs, complications and social support. This track engages multidisciplinary teams including nutritionists, nephrologists, surgeons and social workers to provide specialized training. At completion of the track, fellows demonstrate advanced competencies in the delivery of peritoneal and home hemodialysis care in adults and children. Education and understanding of patient training, dialysis adequacy, dialysis prescriptions, Nx Stage home hemodialysis training, evaluation of nutritional adequacy, pharmacology, and treatment of a range of complications related to both modalities are a part of this track.
Critical Care Nephrology and Onco-nephrology
Director: Dr. Jay Koyner
Nephrologists are increasingly consulted to care for patients with acute kidney injury (AKI), electrolyte disorders and other forms of kidney diseases in the highly subspecialized worlds of Critical Care and Oncology. Management of these patients often requires an understanding of not only the nephrologic issues but also the management and treatment options from a critical care and oncology perspective. New treatment interventions (devices, chemo therapies, immuno-therapeutics, and treatment strategies) continue to evolve and also to adversely impact patients and their kidney function. In this track, the fellow will have exposure and hands-on experience across these rapidly changing landscapes and will collaborate with nephrologists, intensive care physicians in both surgical and medical ICU’s, along with oncologists and urologists. Both clinical and translational research opportunities are available, with rotations in ICUs, BMT, and surgical oncology provided for clinical training.
Hereditary Kidney Disorders
Directors: Dr. Arlene Chapman and Dr. Bharathi Reddy
In the post-genomic era, practical and translational application of genetics in kidney disease is required in daily clinical practice and is a critical component of the study of all kidney diseases. This track will provide an understanding of Mendelian and complex medical traits and laboratory approaches to evaluation of genetic contributions to disease (direct Sanger sequencing, next generation sequencing, single cell genetic analyses). Fellows will develop a rational approach to diagnostic work ups, risk stratification, and precision management of patients with chronic kidney diseases. Through pharmacogenomics approaches, an understanding of the associations with disease severity, appropriate medication choices and dosing will be achieved. Training will also include experience in gene-based, genome wide association, microRNA, whole exome and whole genome studies. Genetically tailored therapeutic options for kidney diseases and their management will be provided. This track provides fellows with the training necessary to apply genetic concepts in practice as well as participate in basic, translational and clinical research projects.
Directors: Dr. Ben Ko and Dr. George Bakris
Hypertension occurs in over 90% of our patient population and globally, essential hypertension is one of the most common contributors to patient morbidity and mortality. Key to the nephrologist’s management of hypertension is a detailed understanding of its pathogenesis in the setting of chronic kidney disease and its consequences with regard to disease progression. This track, offered in conjunction with the University of Chicago Hypertension Center, provides specialized training in the clinical management of difficult to treat hypertension, hypertension management in chronic kidney disease, understanding of the renal tubular transporters regulating blood pressure, renal and systemic hemodynamic contributors to hypertension, and competency in the strategies that delay or prevent consequences of poorly controlled hypertension in chronic kidney disease. Special attention is paid to renal physiology, epidemiology of hypertension and kidney disease, and evidence behind treatment guidelines. Research projects in either basic, translational or clinical areas are a part of this track.