Welcome | Faculty | Curriculum | Clinical Rotations | Conference Schedule | Scholarly Activities | Peer_Reviewed Publication and Book Chapters | Application Process | Contact

Welcome!

Welcome to the Fellowship program for the Division of Nephrology & Hypertension at the Beth Israel Medical Center, one of New York City's premier hospitals and the Manhattan campus for the Albert Einstein College of Medicine. The Division under the leadership of James Winchester, MD consists of 7 full-time faculty physicians, 1 full time Laboratory Director, several part-time faculty, and 4 fellows (2 per year).

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Faculty

Full Time Staff
James F. Winchester, MD, FRCP (GLAS), FACP, Chief, Division of Nephrology & Hypertension
Herman Rosen, MD, FACP, FASN, Director, Nephrology Fellowship Program
Richard Amerling, MD, Director, Outpatient Dialysis
Alan Dubrow, MD, Director, Inpatient Hemodialysis Unit
Steven Gruber, MD, Director, Nephrology Development Program
Nikolas Harbord, MD, Director, Nephrology Outreach Clinic
David B. Bernard, MD, Chief Medical Officer, Beth Israel Medical Center
Viktoria Kuntsevich, PhD, Director of Laboratory Research

Part Time Staff
Nathan Levin, MD, Director of Renal Research Institute
Peter Kotanko, MD, Research Laboratory Director, Renal Research Institute
Claudio Ronco, MD, Visiting Professor, Ospedale San Bartolo, Vicenza, Italy
Violette Ghali, MD, Renal Pathology, Beth Israel Medical Center
Andrew Pomrantz, MD, Pediatric Nephrology
Zachary Brener, MD, Clinical Conference Coordinator

Affiliated Training Physicians
Enver Akalin, MD, Medical Director, Transplantation, Montefiore Medical Center
Daniel Glicklich, MD, Associate Medical Director, Transplantation, Montefiore Medical Center
Paul Fein, MD, Director, Peritoneal Dialysis, Long Island College Hospital

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Curriculum

General Goals, Objectives, and Educational Purpose

The Fellow will:

1. Gain understanding of the anatomy, physiology and pathology of renal diseases.
2. Acquire a detailed fund of knowledge regarding fluid, electrolyte, acid base, and bone and mineral disorders.
3. Understand the natural history, prevention, diagnoses and treatment of the major renal diseases including acute and chronic renal failure, glomerular and tubulo-interstitial disorders.
4. Gain understanding of the pathophysiology and treatment of primary and secondary hypertension, including disorders of pregnancy.
5. Gain a thorough understanding of the principles and practice of hemodialysis, peritoneal dialysis, and continuous renal replacement therapies.
6. Acquire knowledge of the principles and practice of renal transplantation, including immunobiology, immunosuppression, and acute and chronic rejection.
7. Develop the clinical skills necessary to identify and manage patients with renal diseases.
8. Understand the physiology and treatment principles of geriatric nephrology.
9. Gain competence in a variety of procedures including percutaneous renal biopsy, central venous cannulation and peritoneal catheter placement.
10. Understand the special nutritional requirements of patients undergoing hemodialysis and peritoneal dialysis.
11. Learn how to integrate health promotion, cultural, socioeconomic, ethical, occupational, environmental and behavioral concerns with medical care.
12. Develop the skills necessary to design, conduct and evaluate nephrology research.
13. Understand the significance of practice based learning, including Continuous Quality Improvement.
14. Understand the importance of and participate in multidisciplinary conferences as part of Systems Based Learning and Practice.
15. Incorporate patient values and humanistic health care at all times consistent with a professional attitude.

In addition, the fellow will:

1. Prepare for the monthly Journal Club, including subject review, supervised by a faculty member.
2. Present clinical information at a monthly Biopsy Conference with the renal pathologist and teaching faculty.
3. Discuss in a seminar format with faculty the material contained in the NephSAP(Nephrology Self Assessment Program) of the ASN. Topics include:
• Glomerular, Vascular, Tubulointerstitial, and Genetic Diseases
• Disorders of Divalent Ions and Nephrolithiasis
• End-Stage Renal Disease and Dialysis
• Fluid, Electrolyte and Acid-Base Disorders
• Acute Renal Failure
• Transplantation
• Chronic Renal Failure; Progression
4. Attend at least one major conference per year of fellowship.
5. The fellowship is a two-year program. The clinical rotations are similar in both years. During the second year the fellow will participate actively in the teaching of the first-year fellows and have greater responsibility for engaging in scholarly activities.

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Clinical Rotations

Each fellow follows a panel of chronic hemodialysis patients at one of these Beth Israel outpatient dialysis centers along with one of the full-time faculty nephrologists. The fellows learn the management of patients receiving chronic hemodialysis, including drug treatments and dialysis prescription. They learn management of anemia and osteodystrophy in dialysis patients. They participate in the education and instruction of patients with end stage renal disease about the various forms of therapy and their treatment options. They learn to evaluate and manage complications during and between dialysis sessions, including those related to vascular access, and understand the pathogenesis and prevention of such complications. The fellows participate in the process of Continuous Quality Improvement in Dialysis, and develop administrative and leadership skills.

The fellows on this service perform consultations on a variety of patients with acute and chronic kidney, fluid-electrolyte, and acid-base disorders under the daily supervision of the full-time faculty. Both first and second year fellows participate in this service, the first year fellows gradually achieving competence with ongoing guidance from the second year fellows as well as the faculty members. Fellows become knowledgeable in the differential diagnosis of kidney disease as well as the management of hospitalized patients who have kidney diseases or are on dialysis or have received a kidney transplant. They learn the techniques of renal biopsy and insertion of temporary hemodialysis catheters. Interesting cases from this service are presented at the weekly case discussion conference and discussed with the attending nephrologists and their colleagues.

On this rotation the fellows learn about evaluation and selection of patients for acute and chronic hemodialysis under the guidance of a faculty member. They educate and instruct patients with end stage renal disease about the various forms of therapy and their treatment options. They also evaluate and manage complications of dialysis, including vascular access, and understand the pathogenesis and prevention of such complications. The fellows learn the management of hemodialysis in inpatients with a variety of acute medical complications. They develop knowledge of the ethical decisions concerning termination of dialysis.

All fellows spend one afternoon a week in the nephrology clinic at which they follow a panel of patients with various kidney diseases, supervised by a full-time faculty member to recognize the signs and symptoms of renal disease. They learn to recognize the need for special procedures such as renal ultrasound, imaging studies, or kidney biopsy. The fellows also have the opportunity to learn to perform bone biopsy. They formulate management plans for all patients with renal diseases including laboratory and imaging studies, pharmacologic therapy, monitor for therapeutic response and request consultations from other medical specialists, nutritionists, vascular surgeons, urologists, and social services. The fellows learn to interpret studies and laboratory reports on outpatients. They initiate methods to prevent the progression of kidney disease and counsel patients about their options for treatment of end stage renal disease. During the second year the fellow will become able to provide outpatient care for patients with different renal diseases and hypertension and perform outpatient consultations for other physicians as an independent practitioner.

Both first and second year fellows spend dedicated time at Atlantic Peritoneal Dialysis under the supervision of the facility director, Dr. Paul Fein, on the faculty of State University of New York, Downstate Medical Center. During this rotation the fellows develop an understanding of the principles and practice of peritoneal dialysis, including the establishment of peritoneal access, the principles of dialysis catheters, and how to choose appropriate catheters. They also gain understanding of the technology of peritoneal dialysis, including use of automated cyclers. They are instructed in the assessment of peritoneal dialysis efficiency, using peritoneal equilibration testing and the prescribing of peritoneal biopsy. They learn the pharmacology of commonly used medications and their kinetics and dosage alteration with peritoneal dialysis and how to write a peritoneal dialysis prescription and assess peritoneal dialysis adequacy. They are taught complications of peritoneal dialysis and their treatment, including peritonitis, exit site and tunnel infections, hernias, and pleural effusions. They come to understand the special nutritional requirements of peritoneal dialysis patients and the psychosocial and ethical issues of peritoneal dialysis, including end of life care and pain management.

This rotation is supervised by Dr. Enver Akalin and Dr. Daniel Glicklich, on the faculty of Albert Einstein College of Medicine. Both first and second year fellows spend 6 weeks on this rotation, during which they develop knowledge of evaluation and selection of transplant candidates, preoperative-evaluation and preparation of donors and recipients, and immediate post operative management of transplant recipients. They are instructed about all forms of acute and chronic transplant rejection, including the use of immunosuppressive agents, perform transplant renal biopsy and learn to integrate the histopathology, laboratory, and imaging techniques in managing surgical and medical complications of renal transplantation. They follow long-term transplant recipients in the ambulatory setting.

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Conference Schedule

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Scholarly Activities

All fellows are required to demonstrate evidence of scholarly activity prior to completing the training program. This may consist of original research, comprehensive case reports or review of assigned clinical and research topics. Faculty assist fellows in such projects. All fellows are expected to develop computer skills and to participate in Evidence-Based Medicine discussions during the fellowship.

Abstracts Presented (Trainess in BOLD)

Bouchard NC, Malostovker I, Harbord N, Nelson LS, Feinfeld DA, Dubrow A, Hoffman RS, Winchester JF: Acute aluminum encephalopathy: Aluminum extraction with high flux dialysis is superior to charcoal hemoperfusion. Clin Toxicol 2005; 43:677-678.

Kuntsevich VI, Markella M, Feinfeld DA, Audia P, Young W, Capponi V, Winchester JF: In-vitro myoglobin clearance by a novel sorbent system. J Am Soc Nephrol 2006; 17;720A.

Amerling R, Harbord N, Winchester JF, Feinfeld D, Pullman J: Bisphosphonate use in chronic kidney disease associated with adynamic bone disease. ISN Nexus Symposium on the Bone and the Kidney, Copenhagen, Denmark, October, 2006.

Harbord N, Kuntsevich V, Amerling R, Dubrow A, Feinfeld D, Gruber S, Markella M, Kotanko P, Levin N, Winchester JF: Altered cytokine/chemokine profiles in hemodialysis subjects with hemodialysis catheters and fistulae. Abstracts, World Congress of Nephrology, Rio de Janeiro, Brazil, April 2007, p. 230.

Kuntsevich V, Harbord N, Amerling R, Dubrow A, Feinfeld D, Gruber S, Kotanko P, Levin N, Winchester JF: Plasma concentrations of eotaxin: differences between hemodialysis catheter and fistula hemodialysis subjects. Abstracts, World Congress of Nephrology, Rio de Janeiro, Brazil, April 2007, p. 231.

W Latif, L Tong, J Winchester, CJ Arrington, RL Pisoni, MR Marshall, W Kleophas, NW Levin, A Sen and R Saran. Association of Uric Acid With Cardiovascular Events And Mortality In Hemodialysis Patients: International Results From The DOPPS. Annual Eur Dial Transplant Meeting, Stockholm, Sweden, 2008.

V Kuntsevich, S Thijssen, T Kitzler, A Richter, E Siebert, P Kotanko, G Handelman, M Kuhlman NW Levin, J Winchester. Impact of paracalcitol administration on cytokine induction during hemodialysis. American Society of Nephrology, San Diego, 2009.

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Peer-Reviewed Publication and Book Chapters
Full-Time Staff 2005-2009

Absence of NF-kappa B Activation by a New Polystyrene-type Adsorbent Designed for Hemoperfusion. Menegatti E, Ronco C, Winchester JF, Dragonetti A, Di Simone D, Davit A, Mengozzi G, Marietti G, Loduca G, Mansouri M, Sancipriano GP, Sena LM, Roccatello D. Blood Purif. 2005;23:91-8.

Novel Changes in ?2-microglobulin in Dialysis Patients. (editorial) Winchester JF. Clinical Chemistry 2005:51:1-2

Extracorporeal Blood Treatment (EBT) Methods in SIRS/Sepsis Bellomo R, Honore PM, Matson J, Ronco C, Winchester J. Int J Artif Organs. 2005;28:450-8.

Intradialytic Blood Volume Monitoring in Ambulatory Hemodialysis Patients: a Randomized Trial. Reddan DN, Szczech LA, Hasselblad V, Lowrie EG, Lindsay RM, Himmelfarb J, Toto RD, Stivelman J, Winchester JF, Zillman LA, Califf RM, Owen WF Jr J Am Soc Nephrol. 2005;16: 2162-9.

Extracorporeal Strategies for The Removal of Middle Molecules. Winchester JF, Audia PF. Semin Dial 2006; 19: 110-114

Three Controversial Issues In Extracorporeal Toxin Removal. Feinfeld DA, Rosenberg JW, Winchester JF. Seminars in Dialysis 2006; 19:358-362

The Potential Application of Sorbents in Peritoneal Dialysis. Winchester JF, Amerling R, Harbord N, Capponi V, Ronco C. Contrib Nephrol 2006;150: 336-343.

Acute Renal Failure in a Patient with West Nile Viral Encephalitis. Brener ZZ, Harbord NB, Zhuravenko I, Nicastri AD, Bergman M, Dubrow A, Feinfeld D, Winchester J. 2007 Nephrol Dial Transplant. 22:662-663

Use of Dialysis And Hemoperfusion in Treatment of Poisoning. Winchester JF, Boldur A, Oleru C, Kitiyakara C, in Handbook of Dialysis (Fourth Edition), John T Daugirdas, Peter G. Blake,Todd S. Ing (Eds), Lippincott Willliams & Wilkins, Philadelphia, 2007: 300-319

Guidelines for Guidelines. Amerling R, Winchester JF, Ronco. C Blood Purification 2007;25:36-38

The 2006 K/DOQI Guidelines for Peritoneal Dialysis Adequacy Are Not Adequate. Winchester JF, Harbord N, Audia P, Dubrow A, Gruber S, Feinfeld D, Amerling R. Blood Purification 2007;25:103-105

National Kidney Foundation Position Paper. Analgesics and the kidney: Summary and recommendations to the Scientific Advisory Board of the National Kidney Foundation from an Ad Hoc Committee of the National Kidney Foundation. Henrich WL, Agodoa LE, Barrett B, Bennett WB, Blantz RC, Buckalew VM, D'Agati VD, De Broe ME, Duggin GG, Eknoyan G, Elseviers MM, Gomez RA, Matzke GR, Porter GA, Sabatini S, Stoff J, Striker GE, Winchester JF. American Journal of Kidney Disease 1996; 27:162 -165

Comments on the Guideline Debate. (invited) Amerling R, Winchester JF. Clinical Journal of the American Society of Nephrology. 2007;2: 208

Relationship between Interdialytic Weight Gain and Blood Pressure among Prevalent Hemodialysis Patients. Inrig JK, Patel UD, Gillespie BS, Hasselblad V, Himmelfarb, J, Lindsay RM, Reddan D, Stivelman J, Winchester JF, Toto R, Szczech LA. American Journal of Kidney Disease 2007;50:108-118

Association of Intradialytic Blood Pressure Changes with Hospitalization and Mortality Rates in Prevalent ESRD Patients. Inrig JK, Oddone EZ, Hasselblad V, Gillespie B, Patel UD, Reddan D, Toto R, Himmelfarb J, Winchester JF, Stivelman J, Lindsay RM, Szczech LA. Kidney International 2007;71: 454-461

Treatment Of Poisoning With Extracorporeal Methods, Winchester JF, Nikolas Harbord, Donald A. Feinfeld, H. in Handbook of Dialysis Therapy, (Eds) Nissenson AR, Fine RN. Saunders Elsevier, Philadelphia 2007:1507-1521

Metformin-induced Lactic Acidosis and Acute Pancreatitis Precipitated by Diuretic, Celecoxib, and Candesartan-associated Acute Kidney Dysfunction. Audia PF, Feinfeld DA, Dubrow A, Winchester JF: Clinical Toxicology 2008; 46: 164-166

Dialysis Desiderata. Winchester JF, Amerling R, Dubrow A, Feinfeld DA, Gruber SG, Harbord N, Kuntsevich V. Hemodialysis International 2007:11: S17-S20

Guidelines Have Done More Harm Than Good. Amerling R, Winchester JF, Ronco C. Blood Purification 2008;26:73-76

Dialysis and Hemoperfusion in the Treatment of Poisoning and Drug Overdose, Harbord N, Brener ZZ, Feinfeld DA, Winchester JF. in Therapy in Nephrology and Hypertension, 3rd Edition, Saunders Elsevier, Philadelphia, editor CS Wilcox, 2008: 1073-1080

Acute Non-occlusive Mesenteric Ischemia of the Small Bowel in a Patient Started on Hemodialysis: a Case Report. Brener ZZ, Bergman M, Ohm HK, Winchester JF. Cases J. 2008;1: 217

Commentary: Extracorporeal Removal of Toxins. Tyagi P, Winchester JF, Feinfeld DA: Kidney Int 2008;74: 1231-3

Kidney Disease, in Questions Patients Should Ask. Getting Better Healthcare, Winchester J, Ed. Shulkin DJ, XLibris Corporation, Philadelphia. 2008: 165-169

Poisonings and Intoxications, Winchester JF., Feinfeld DA. In Current Diagnosis and Treatment in Nephrology and Hypertension. (Editors) Lerma EV, Berns JS, Nissenson AR,. McGraw-Hill, New York. 2009: 540-546

Hemodialysis, Hemofiltration & Hemoperfusion. Harbord N, Gruber SG, Feinfeld DA, Winchester JF. in Acute Intoxication and Poisoning, in Critical Care Nephrology, editors Ronco C, Bellomo R, Kellum JA, Saunders Elsevier, Philadelphia, 2009:919-925

Use of Dialytic Therapies for Poisoning, Winchester JF, Harbord N, Feinfeld DA. in Clinical Nephrotoxins - Renal Injury from Drugs and Chemicals, 3rd edition, editors M E De Broe, G A Porter, W M Bennett, G Deray, Springer, Heidelberg, 2008:251-264

Frequent Hemodialysis Network Study Group; National Institute of Diabetes and Digestive and Kidney Diseases; National Institutes of Health. Solute clearances and fluid removal in the frequent hemodialysis network trials. (Jointly) Greene T, Daugirdas JT, Depner TA, Gotch F, Kuhlman M; Am J Kidney Dis. 2009;53:835-44

In Vitro myoglobin clearance by a novel sorbent system. Kuntsevich V, Feinfeld DA, Audia P, Young W, Capponi V, Markella M, Winchester JF: Artificial Cells, Blood Substitutes and Biotechnology 2009; 37: 1-5

History of Hemodialysis and Hemoperfusion in Poisoning, Winchester JF,Tyagi P, Harbord N. Hemodialysis International, eds Kjellstrand C, Ing T, (in press 2009)

Extracorporeal Removal of Drugs and Toxins, Winchester JF, Harbord NB, Tyagi P, Rosen H, in Jörres A ed, Management of Acute Kidney Problems, Springer (in press 2009)

Diabetic nephropathy. Winchester JF, Feinfeld DA, Harbord NB, Dubrow A In, Poretsky L, ed., Principles of Diabetes Mellitus. New York, Springer 2009 (in press).

A quick and simple estimate of creatinine clearance. Ali F, Boldur A, Winchester JF, Homel P, Feinfeld DA. J Nephrol 2009 (in press).

Sorbent augmented hemodialysis (HD) systems - Are we there yet?. Clinical Commentary. Winchester JF, Ronco C. Journal of the American Society of Nephrology 2009 (in press).

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Application Process

Applications are requested through ERAS (Electronic Residency Application System) to our program: Albert Einstein College of Medicine at Beth Israel Medical Center Program, ACGME ID 1483511055 Nephrology.

Nephrology fellows must have completed an internal medicine residency in a program approved by the American Board of Internal Medicine at the time they begin their fellowship training. Osteopathic (DO) physicians whose medical residency program has ABIM certification are welcome to apply.

It is expected that house staff selected for fellowship training will seek Board certification in Nephrology upon completion of the training program.

Those fellows with an interest in hypertension, upon recommendation of the program director, may be eligible to seek designation as Specialist in Clinical Hypertension.

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Contact

For any additional information regarding the fellowship program, please contact:

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