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Divisions Nephrology Fellowship Thank you for expressing an interest in the Nephrology Fellowship Program at the University of Arkansas for Medical Sciences (UAMS). OVERVIEW We have 2 tracks of fellowship training, one clinical track for 2 years and one NIH-funded research training track, which includes the same clinical curriculum for 2 years and an additional research year, which can be spent in either clinical or laboratory research. The research year can also be used to acquire a “Master in Clinical Sciences” degree from the College of Public Health. Clinical Program: The clinical program has as its base two hospitals, the Central Arkansas Veterans Healthcare System (CAVHS) and the University Hospital (UAMS). Renal fellows will see patients at both hospitals, in the inpatient wards and outpatient clinics, thus they will see a large spectrum of diseases in different populations. In addition, they will treat patients with acute renal failure due to burns in the adult Burn Center at Arkansas Children’s Hospital (ACH). We have outpatient clinics, chronic hemodialysis units and peritoneal dialysis programs at both the University and VA hospitals. An active transplant program (see below) is based at UAMS. Therefore the renal fellows will be trained in all aspects of nephrology, including peritoneal dialysis (CAPD and CCPD), hemodialysis (acute and chronic intermittent dialysis, continuous therapies with active SLED and CVVHDF programs, and home hemodialysis), and transplantation. They will be actively involved in nephrology consultation services and treat patients with acute kidney injury, with chronic kidney disease, electrolyte and acid-base disorders, and hypertension. They will also be involved in quality improvement projects. The renal fellow in the clinical track is also expected to participate in a research project, either clinical or basic research in the laboratory. Protected time is available during the 2 clinical years for completion of a project. The fellows will be encouraged to present their findings at national nephrology meetings such as the meetings of the American Society of Nephrology or the National Kidney Foundation. In addition to the clinical training and research project, the fellow will participate in Morning Report once a week (clinical case conference and morbidity and mortality conference), Journal Club and Literature Review monthly, Renal Biopsy Conference once a month, Nephrology Grand Rounds once a month, Medicine Grand Rounds once a week, Renal Research Conference once every 2 months and any scheduled Teaching Conferences. Nephrology Grand Rounds are given by the fellows; they are expected to present 2-3 comprehensive lectures to faculty, fellows and residents through the course of their fellowship. The bi-monthly book club helps the fellows go through core text books of nephrology. The Division of Nephrology is composed of six full-time clinical faculty who, through their combined expertise, provide up-to-date diagnosis and treatment of patients with renal disease and related problems such as hypertension, and have a commitment to basic and clinical research. Sudhir V. Shah, M.D., Professor of Medicine and Director of Nephrology, is internationally known for his important contributions to the understanding of the role of free radicals in renal injury. Didier Portilla, M.D., Professor of Medicine, is an investigative nephrologist with a primary interest in the mechanisms of acute kidney injury, including the study of early biomarkers. Sameh R. Abul-Ezz, M.D., Professor of Medicine, is a transplant nephrologist and the nephrology director of the transplant program at UAMS. Michelle Krause, M.D., Assistant Professor, has a special interest in geriatric nephrology and is active in clinical research. Sundararaman Swaminathan, M.D., Assistant Professor, came to us from the Mayo Clinic and has expertise in transplantation and clinical research; his particular interest concerns the pathogenesis of nephrogenic systemic fibrosis. Godela Brosnahan, M.D., Assistant Professor, is the Nephrology Fellowship Program Director; she has expertise in polycystic kidney disease clinical research. Andrea Easom, APN, is very experienced and active in the outpatient peritoneal dialysis and hemodialysis programs with a special interest in anemia management and multidisplinary care of the pre-ESRD patient. In addition, Thomas E. Andreoli, M.D., Distinguished Professor, and Robert L. Safirstein, M.D., Professor and Chief of Medicine at CAVHS, participate actively in teaching rounds on the consult service. Thomas E. Andreoli, M.D., internationally known for his contributions in renal physiology, is the past editor of the highly regarded journal Kidney International and is the editor of Cecil Essentials of Medicine. He has received numerous national and international awards for his contributions to Nephrology. We are recruiting two additional clinical faculty. Dr. Bilal Malik will join us in September 2008. He has training in Geriatrics as well as Nephrology and is finishing a “Master in Clinical Sciences” degree. We are also recruiting another transplant nephrologist. Clinical Research: All the clinical faculty have keen interest in pharmaceutical and investigator initiated clinical research. We have a clinical research office with 2 full-time research coordinators based at the Freeway Kidney Center. Transplant Program: The transplant program at the University of Arkansas for Medical Sciences began in 1964. Over 700 renal transplants have been performed since that time. Dr. Gary Barone is the Director of Transplantation. He is a transplant surgeon who also performs most of our vascular access surgeries for hemodialysis. Dr. Bentley is a renal and liver transplant surgeon; he came from the transplant program in Louisville, Kentucky, and joined our program in 2007. The transplant program is very active and we do both kidney and kidney/pancreas transplants. On average, about 80 kidney and kidney/pancreas transplants and 25 liver transplants are done per year. Dr Abul-Ezz and Dr. Swaminathan are the two nephrologists associated with the transplant program. The renal fellow will be involved with the Nephrology staff in the pre-operative evaluation to determine suitability for transplantation as well as the postoperative hospital course of the recipient. This includes management of fluid and electrolyte balance, diagnostic evaluation of renal function (including biopsy), and management of immunosuppressant agents. Outpatient care and long-term follow-up of the recipient are also provided by the Nephrology staff. Fellows attend this clinic and are instructed in the chronic care of renal transplant recipients. Finally, they learn how to evaluate and manage complications when transplant recipients are readmitted to the renal service for any complication or new illness. The transplant program truly works as a team and there is a very close working relationship with the coordinators and the surgery team. Dialysis Program: We have acute dialysis units based at UAMS and the VA hospital. We provide intermittent and continuous renal replacement therapies for our patients with acute renal failure in the ICU, as well as a hybrid modality (SLED). There is ample opportunity to become well versed in the placement of temporary dialysis catheters using a real time Doppler device. Chronic dialysis care is provided by fellows and faculty. The fellows are responsible for one shift of chronic dialysis patients, either at the Freeway Kidney Center or the VA chronic dialysis unit. The fellows see these patients once a week and follow them when they are admitted to the hospital. Both dialysis programs also care for peritoneal dialysis patients. In 2007 we started a home hemodialysis program: patients and their partners are trained to perform home hemodialysis 5 or 6 times a week using the Nx Stage system. Therefore the fellows will be well trained in all forms of chronic dialysis when they finish our program. Research Training Track: The goal of our training program is to prepare clinical investigators and basic medical scientists for productive, independent investigative careers in the area of renal disease. This requires a minimum of 2 years exposure to intensive laboratory experience or clinical research working closely with one of the program faculty. The fellow will devote the first year of training entirely to research and will not have any clinical duties during that time. He/she is expected to build on this experience and continue a research project during the following 2 clinical training years. There will be protected time during the clinical years, which are described above. Our training program emphasizes both laboratory-based and clinical/translational research in the physiology and pathophysiology of the kidney. The quality and the dedicated effort of the program faculty are primary factors assuring success of the research training. Consequently, the program faculty is limited to investigators with active, ongoing funded laboratory-based or clinical/translational research programs with documented training records who can provide hands-on research experience for trainees. The program faculty represents a closely-knit interacting multidisciplinary faculty from the departments of Medicine, Pathology, Pharmacology and Toxicology, Biochemistry, Geriatrics, and Physiology and includes 6 MDs, 6 PhDs, 2 MD/PhDs, and 2 MD/MPHs. Such inter-laboratory cooperation is very useful for expanding the outlook of research fellows who become familiar with a wider variety of methods and multidisciplinary strategic approaches to the solution of scientific problems. The trainees have the option of obtaining a Master of Public Health (MPH) or Master in Clinical Science degree. They are expected to participate in regularly scheduled activities sponsored by the School of Public Health and other departments targeted toward the scientific method and statistical analysis; attend conferences sponsored by Medicine, Physiology and Biochemistry; and attend the thrice weekly conferences held in the Division of Nephrology. Basic Research: Dr. Sudhir Shah, Dr. Didier Portilla and Dr. Robert Safirstein have active research labs funded by NIH and VA merit grants. Other basic research faculty include: Gur P. Kaushal, PhD, a biochemist with an interest in metalloproteinases in renal injury, specifically diabetic nephropathy. He is also looking at models to prevent renal injury from cisplatin. Peter M. Price, PhD and Judit K Megyesi, MD, have research interests involved with acute and chronic renal failure, especially its characterization at the molecular level. They demonstrated that the transcription of specific genes in the kidney was totally repressed in response to acute renal failure. They characterized the promoter elements of one gene and were able to identify, using transgenic mice into which the controlling elements had been inserted, that this repression was at the level of trans-activation. Drs. Price and Megyesi are now investigating the role of p53 and related proteins, such as the p21 cdk inhibitor, in renal failure showing the involvement of cell-cycle events in renal failure. They showed that these proteins were regulated in acute renal failure and that the lack of the gene for the p21 protein exacerbated the course of cisplatin-induced renal failure. Using an adenovirus delivery system, they have since found that p21 expression can prevent certain types of cellular death in cultured cells and that cdk inhibitory drugs can prevent acute renal failure in mice. If you are interested in this program, you may submit an application through ERAS beginning December 1. Thank you very much for your interest in the Nephrology Training Program at the University of Arkansas for Medical Sciences, and we look forward to hearing from you. Sincerely, Godela Brosnahan, MD Assistant Professor of Medicine
For additional information, please contact: Jolynda Bowman Fellowship Program Coordinator 4301 W. Markham St. #501 Little Rock, AR 72205 501-686-5295 Fax: 501-686-7878
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