Overview

Welcome to the third year medical student pediatric nephrology rotation.  The rotation will consist of ten to fifteen days of combined inpatient and outpatient experience in pediatric kidney disease and hypertension.  As this is a new rotation, your input and critique of the experience will be valued.  Please make note areas in which the rotation can improve.

The objectives of this rotation are the following:

1.  Improve oral and written presentations for pediatric patients.  Remember that effective presentations communicate the essential components of a patient's medical condition and offer a reasoned assessment and, when possible, plan.

2.  Improve the medical knowledge base in topics relevant to pediatric nephrology.  Areas of special focus should include fluid balance and resusitation, proteinuria, hematuria, hypertension, chronic kidney disease, nephrotic syndrome, and acute renal failure.

3.   Gain an understanding of the difficulties patients and their families face with chronic kidney disease.

The schedule for the inpatient service (rounds, impromptu lectures, etc.) depends on the current census and the schedule of the attending physician (either Dr. Al-Uzri or Dr. Rozansky).  Generally these will be held as early as 7:30 am and as late as 9:30 am.  Patient assignment will be at the discretion of the attending and the second year resident on the rotation.  Since medical student notes "don't matter" for billing purposes, coverage of patients should be based on the perceived educational opportunity a patient provides the resident or the student.  The student will also work with the attending and 2nd year resident to complete consults in a timely manner.

The outpatient schedule includes Monday and Thursday afternoon general nephrology clinics with Drs Al-Uzri and Rozansky. When there is a conflict with these clinics and a prearranged 3rd year clerkship event, we will defer to Dr. Bumsted as to where the student be.  There is also a weekly Tuesday morning renal transplant clinic.  Since this clinic may be of limited educational value, the decision and necessity to attend will be made with the inpatient attending on a weekly basis.  There may be opportunities to attend clinics off the hill for chronic peritoneal dialysis and hemodialysis patients, and these will be discussed with you at the beginning of the rotation.

"Competencies," according to the in-vogue educational lingo, for this rotation consist of a series of assignments that should help round out the experience.

1.  Complete two comprehensive written work-ups of nephrology patients, at least one must an inpatient. The write-ups should be no more than four pages and include a reasoned assessment and plan.  They should be turned in to Dr. Rozansky by the end of the two week session, or three days before the end of the rotation, whichever applies.

2.  Complete a problem set, and review the answers with Dr. Rozansky over a one hour period before the end of the pediatric clerkship.  (An appointment should be set up.)

3.  Prepare a 15 minute oral presentation on an in-depth topic of your choice, preferably based on an experience you had during your rotation.  Feel free to discuss the topic with either Dr. Al-Uzri or Dr. Rozansky.  Give the presentation to Dr. Slickers or Dr. Al-Uzri before the end of your pediatric clerkship .  (An appointment will need to be arranged with Dr. Al-Uzri.) 

4. Child advocacy:

Understanding renal conditions can often be difficult for families and patients.  This is in part due to the lack of familiarity with the kidney and its presumed complexity.  To help improve patient and family understanding, we are requesting that each resident and student that rotates on the service write a short (< 5 paragraph) summary of a condition that is understandable to most parents on one topic in nephrology.  A list of references or websites for further information would be desirable. The author will receive credit for the write-up should it be posted on the website for Northwest Kidney Kids Foundation, a non-profit organization seeking to provide services to patients with chronic kidney disease and associated conditions.  Please feel free to discuss your choice and plan with Dr. Rozansky prior to completing the tasks.

Topics include:

Kidney function/GFR; acute renal failure/ATN; chronic kidney disease staging; anemia of CKD; healthy bones and chronic kidney disease; growth and CKD; hemodialysis; peritoneal dialysis; kidney transplantation; immunosuppression in renal transplantation; dialysis access.

Proteinuria; hematuria; IgA nephropathy; Nephrotic syndrome presentation; clinical forms of nephrotic syndrome; FSGS; Minimal Change Nephrotic Syndrome; membranous nephropathy; Post-infectious Glomerulonephritis; Lupus nephritis; Membranoproliferative GN Type 1; MPGN type 2; Wegener’s Granulomatosis; Good Pasture’s syndrome; Alport’s syndrome; HSP nephritis; HUS; atypical HUS.

ARPKD; ADPKD; cystinosis; Fanconi’s syndrome; reflux nephropathy; obstructive uropathy; UPJ obstruction; multicystic dysplastic kidney; Wilm’s tumor; prune belly syndrome.

Gitelman’s syndrome; Bartter’s syndrome; AME, GRA,

Essential hypertension; renal vascular hypertension;

Kidney biopsy; DMSA; MAG-3; VCUG

RTA distal and effects on growth; kidney stones;

There are numerous references that you can use for pediatric nephrology.  Our own bias has been to consult general pediatric or pediatric nephrology textbooks and supplement these summaries with UpToDate.Com, a reference that was founded (and is still owned) by a superb nephrologist and educator.