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Clinical Experience

Fellows receive their clinical training at Ochsner Medical Center in New Orleans, a state-of-the art multi-specialty acute care facility and referral hospital with 767 beds that is currently expanding. All clinical rotations are at the Ochsner Main Campus location (OMC). OMC is the centerpiece and referral center of the Ochsner Health care System, which includes numerous hospitals and clinics in New Orleans and surrounding cities. It is for that reason that the patients being cared for at OMC have a high degree of acuity and complexity of clinical problems and provide an exceptional opportunity for the fellow to experience all aspects of clinical nephrology.

Clinical training provides a complete range of consultative, diagnostic and treatment services for patients with kidney diseases. The scope of care encompasses all stages of kidney disease, from earliest detectable changes in kidney function through end-stage kidney disease, as well as people with high blood pressure, kidney stones, and other kidney-related problems. As part of the curriculum, fellows participate in rotations in general inpatient/outpatient nephrology, outpatient chronic dialysis, as well as in kidney transplantation services and interventional nephrology.  In addition, the clinical education of the fellow includes training in performance of percutaneous kidney biopsies (transplant and native kidneys) and hands-on training in renal ultrasonography.

There are 3 inpatient consultation teams, each staffed by an individual faculty member. Two teams with house staff (residents, interns and students) and support by APPs for patients with acute conditions covering the entire field of nephrology (mainly, all forms of AKI, electrolyte imbalances, critical care nephrology) and one team is dedicated for caring for patients with ESKD who need dialysis support in the hospital while being inpatient. The ESKD team is mainly run by APPs and faculty with fellows rotating. The nephrology fellow functions as a junior attending, directs the management of the consultations, supervises the rotating residents and plays an active role in educating the medical house-staff and rotating medical students.

Fellows participate in one weekly outpatient clinic (half day) and follow individual patients longitudinally throughout the fellowship. Patients have a high degree of complexity (including the entire spectrum of glomerular pathology). Each patient is discussed with a faculty member staffing the clinic.

At Ochsner Health System, we take pride in providing a healthy learning environment for our fellows. In recent years, we focused on building a team of advanced practice providers to support our fellows and staff in their clinical duties. Because of that, even though our department sees a large number of patients every day with an exceptional clinical diversity, our fellows are responsible for a limited amount of daily progress notes and therefore can focus on excelling in academic nephrology.

Weekday Call

We have six clinical fellows. Each fellow takes overnight home call every 1 in 6 nights; The on-call fellow will only cover patients at the Ochsner main campus (one hospital). Fellows are encouraged to go home early on post-call days

Weekend Call

Every fellow covers 1 in 6 weekends. On weekends there will be APP and resident support.

For our 6 clinical fellows (3 first-year fellows and 3 second-year fellows)

Year
Rotation
# of weeks
1st year
Consult team 1
12 wks
Consult team 2
12 wks
ESKD
4 wks
Transplant
8 wks
Elective/Research
8 wks
Interventional
6 wks
Vacation
4 wks
2nd year
Consult team 1
8 wks
Consult team 2
8 wks
ESKD
4 wks
Transplant
4 wks
Palliative care
2 wks
Elective/Research
12 wks
Interventional
4 wks
Vacation
4 wks

Our fellows will have the opportunity to choose from clinical electives in multiple subspecialties to gain in depth knowledge in certain fields important for the care of patients with kidney failure.

  • Interventional (at LSU Baptist hospital in New Orleans and LSU Shreveport campus)
  • Cardiorenal elective
  • Vascular surgery elective
  • Blood bank (Apheresis) elective
  • Research elective
  • Ultrasound elective
  • Other electives possible (off campus)
  • Palliative care elective

Our Department is equipped with a state-of-the-art clinical laboratory for the performance of microscopic examination of the urinary sediment. Fellows perform bright field, dark field, phase contrast and polarized light microscopy under direct supervision and guidance from our faculty. Specimens are inspected with and without Sternheimer-Malbin stain for cell and cast matrix enhancement. Our microscope is attached to a digital camera for teaching purposes as well as allowing fellows to capture images for clinical care and/or oral presentations.

The Nephrology Department was created in 1967 by Dr. Julio Figueroa and the chronic dialysis program was initiated in 1972. It has expanded through the years and now includes eight hemodialysis units, peritoneal dialysis, and home hemodialysis.

The main unit in New Orleans, only a couple of blocks from OMC, which opened in 1985, contains a 30 station hemodialysis unit with approximately 110 patients, running six days per week. State-of-the art facilities include centralized water, bicarbonate and acid delivery to the stations, single use dialyzers, noninvasive access monitoring, and paperless computerized medical record. This site also houses the Home Dialysis program (peritoneal dialysis and home hemodialysis), which cares for approximately 30 patients. The fellows only see patients in the main unit. Each fellow follows 8-10 chronic dialysis patients on a biweekly basis.

The fellows inpatient training will include the management of various renal replacement therapies, such as Chronic Renal Replacement Therapy (CRRT), Apheresis, Peritoneal Dialysis, and Home Hemodialysis. During the ICU rotations our fellows will be trained in SLED, CVVHD and CVVHDF, including state of the art PrismaFlex and PrisMax systems.

The Ochsner Abdominal Transplant Institute performs approximately 150 kidney transplants a year and the largest number of yearly liver transplants in the United States. Our faculty is comprised of 4 transplant nephrologists and 6 transplant surgeons. In addition, 10 transplant coordinators, 4 transplant social workers, 6 nurse practitioners, and 4 Pharm D complete a team of excellence.

The transplant nephrology faculty is the core faculty for the consultative transplant nephrology service. This service provides acute care, dialytic support, and kidney and transplant expertise for all renal and non-renal solid organ transplant recipients. This service also helps to manage the chronic kidney disease that affects this population.

Outpatient kidney transplant biopsies are performed in our program to better aid in the diagnosis of kidney conditions and a number of different services are provided through the clinic, including focused transplant care, attention to blood pressure, cardiac, bone and metabolic aspects that are unique to transplantation.

Fellows have yearly month-long rotations with the transplant team.

POCUS

Interventional Nephrologists have expertise in vascular access for hemodialysis. At this time we partner with the Louisiana State University (LSU) at their Baptist hospital location (New Orleans) as well as LSU Shreveport Academic Medical Center, a well-established interventional nephrology program, to train our fellows in interventional nephrology.

In addition, we have 4 staff members proficient in renal ultrasonography and kidney biopsy performance. Our kidney biopsy program is run independently, without participation of radiologists and offers unique exposure and training of this procedure for our fellows.

Our program owns a state-of-the-art ultrasound machine and we also purchased 3 ultraportable handheld Vscan GE ultrasound devices, one for each consult team to incorporate POCUS into our clinical decision making.

The scope of the interventional nephrology training includes:

  • Ultrasound-guided percutaneous kidney biopsies
  • Diagnostic ultrasound
  • Insertion and removal of tunneled hemodialysis catheters
  • Fibrin sheath removal from chronically indwelling central catheters
  • Mechanical thrombectomies of clotted hemodialysis catheters
  • Angiograms
  • Angioplasties
  • Mechanical thrombectomies of clotted AVFs and AVGs
  • Diagnostic sonography
  • Accessory vein ligation

The fellows have a unique opportunity to master the procedure skills guided by fully trained interventional nephrologists, which reduces procedural morbidity for patients and those in need of invasive procedures.

  • Transplant Nephrology
  • Nephrology & Critical Care Medicine

Ochsner Medical Center offers an additional 1-year fellowship in either Critical Care Medicine (ACGME accredited, combined LSU/Ochsner Clinic Foundation training program) or Transplant Nephrology. These career tracks will be available as PGY6 for Ochsner Nephrology fellows completing a 2-year clinical fellowship training and graduating in excellent standing.