Welcome | Faculty | Curriculum | Clincal Rotations | Conference Schedule | Scholarly Activities | Recent 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. The Division under the leadership of James Winchester, MD consists of 6 full-time faculty members, 1 part-time faculty, 1 full time Lab Director 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
Donald A. Feinfeld, 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
Viktoria Kuntsevich, PhD, Director of Laboratory Research

Part Time Staff
Nathan Levin, MD, Director of Renal Research Institute
Violette Ghali, MD, Beth Israel Pathology
Zachary Brener, MD

Off-site Rotating Physicians
Daniel Glicklich, MD, @ Montefiore Medical Center
Paul Fein, MD, @ 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. Gain competence in a variety of procedures including percutaneous renal biopsy, central venous cannulation and peritoneal catheter placement.
9. Understand the special nutritional requirements of patients undergoing hemodialysis and peritoneal dialysis.
10. Learn how to integrate health promotion, cultural, socioeconomic, ethical, occupational, environmental and behavioral concerns with medical care.
11. Develop the skills necessary to design, conduct and evaluate nephrology research.
12. Understand the significance of practice based learning, including Continuous Quality Improvement.
13. Understand the importance of and participate in multidisciplinary conferences as part of Systems Based Learning and Practice.
14. 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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Clincal Rotations

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.

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.

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. 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 Downstate Medical School. 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. 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 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.

Papers

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

Winchester JF, Audia PF: Extracorporeal strategies for the removal of middle molecules. Semin Dial 2006;19:110-114.

Winchester JF, Amerling R, Harbord N, Capponi V, Ronco C: The potential application of sorbents in peritoneal dialysis. Contrib Nephrol. 2006;150:336-343.

Brener ZZ, Harbord NB, Zhuravenko I, Nicastri A, Bergman M, Dubrow A, Feinfeld D, Winchester J: Acute renal failure in a patient with West Nile viral encephalitis. Nephrol Dial Transplant 2007;22:662-663.

Winchester JF, Harbord N, Audia P, Dubrow A, Gruber S, Feinfeld D, Amerling R: The K/DOQI guidelines for peritoneal dialysis adequacy are not adequate. Blood Purif 2007; 25:103-105.

Winchester JF, Amerling R, Dubrow A, Feinfeld DA, Gruber SG, Harbord N, Kuntsevich V. Dialysis desiderata. Hemodial Int 2007;11:S17-S20. Audia PF, Feinfeld DA, Dubrow A, Winchester JF: Metformin-induced lactic acidosis and acute pancreatitis precipitated by diuretic, celecoxib, and candesartan-associated acute kidney dysfunction. Clin Toxicol (accepted for publication).

Book Chapters

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), Little Brown, Boston, 2007 Harbord N, Brener ZZ, Feinfeld DA, Winchester JF. Dialysis and Hemoperfusion in the Treatment of Poisoning and Drug Overdose. In, Brady HR, Wilcox CS, eds., Therapy in Nephrology and Hypertension, 3rd Edition, WB Saunders Co, Philadelphia, 2007 (in press).

Harbord N, Gruber SG, Feinfeld DA, Winchester JF: Hemodialysis, hemofiltration and hemoperfusion in acute intoxication and poisoning. In, Ronco C, Bellomo R, Kellum JA, eds., Critical Care Nephrology (in press).

Abstracts Presented

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.

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Recent Peer-Reviewed Publication and Book Chapters
Full-Time Staff 2004-2007

1. Amerling R: The rediscovery of continuous flow peritoneal dialysis. Int J Artif Organs. 2004; 27:165-167.
2. Amerling R: Chasing the (MCP) codes. Nephrol News Issues. 2004;18:34.
3. Amerling R: Zen and the art of health maintenance. Nephrol News Issues. 2004;18:31-32.
4. Amerling R: Practice guidelines: do we really need them? Perit Dial Int. 2005;25:140-141
5. Amerling R: Pay-for-performance: show me the (value of) money. Nephrol News Issues. 2005;19:78-79, 83.
6. Amerling R: How reimbursement affects medical practice. Nephrol News Issues. 2005;19:52-54, 63.
7. Amerling R: Fistula First: is it time to curb our enthusiasm? Nephrol News Issues. 2006;20: 38-39.
8. Amerling R, Winchester JF, Ronco C: Guidelines for guidelines. Blood Purif. 2007; 25:36-38.
9. Amerling R: A lesson from the EPO mess: stop the cost shifting. Nephrol News Issues. 2007; 21:52, 54-55, 68.
10. Amerling R, Winchester JF: Comments on the guideline debate. Clin J Am Soc Nephrol. 2007;2:208.
11. Audia PF, Feinfeld DA, Dubrow A, Winchester JF: Metformin-induced lactic acidosis and acute pancreatitis precipitated by diuretic, celecoxib, and candesartan-associated acute kidney dysfunction. Clin Toxicol (accepted for publication).
12. Brener ZZ, Harbord NB, Zhuravenko I, Nicastri A, Bergman M, Dubrow A, Feinfeld D, Winchester J: Acute renal failure in a patient with West Nile viral encephalitis. Nephrol Dial Transplant 2007;22:662-663.
13. Feinfeld DA, Anthony VL: Renal Principles. In, Goldfrank LR, et al., eds., Goldfrank's Toxicologic Emergencies, 8th Edition, New York, McGraw-Hill 2006, pp. 427-441.
14. Feinfeld DA, Rosenberg JW, Winchester JF, Three Controversial Issues In Extracorporeal Toxin Removal. Semin Dial 2006;19:358-362
15. Harbord N, Brener ZZ, Feinfeld DA, Winchester JF. Dialysis and Hemoperfusion in the Treatment of Poisoning and Drug Overdose. In, Brady HR, Wilcox CS, eds., Therapy in Nephrology and Hypertension, 3rd Edition, WB Saunders Co, Philadelphia, 2007 (in press).
16. Harbord N, Gruber SG, Feinfeld DA, Winchester JF: Hemodialysis, hemofiltration and hemoperfusion in acute intoxication and poisoning. In, Ronco C, Bellomo R, Kellum JA, eds., Critical Care Nephrology (in press).
17. Mehrishi S, Feinfeld DA: Electrolyte Disorders. In, Raoof S, ed., Expert Guide to Critical Care, Philadelphia, American College of Physicians 2008 (in press).
18. 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. Absence of NF-kappa B activation by a new polystyrene-type adsorbent designed for hemoperfusion. Blood Purif. 2005;23:91-8.
19. Mour G, Feinfeld DA, Caraccio T, McGuigan M: Acute renal dysfunction in acetaminophen poisoning. Ren Fail 2005;27:381-383.
20. Ronco C, Wentling AG, Amerling R, Cruz C, Levin NW: New catheter design for continuous flow peritoneal dialysis. Contrib Nephrol. 2004;142:447-61.
21. Ronco C, Dell'aquila R, Rodighiero MP, DiLoreto P, Nalesso F, Spano E, Parkhill R, Amerling R, Levin N: The ''Ronco'' catheter for continuous flow peritoneal dialysis. Int J Artif Organs. 2006;29:101-112.
22. Ronco C, Amerling R, Dell'aquila R, Rodighiero MP, DiLoreto P: Evolution of technology for automated peritoneal dialysis. Contrib Nephrol. 2006;150:291-309.
23. Ronco C, Amerling R: Continuous flow peritoneal dialysis: current state-of-the-art and obstacles to further development. Contrib Nephrol. 2006;150:310-320.
24. Saydain G, Feinfeld DA: Acid-Base Disorders. In, Raoof S, ed., Expert Guide to Critical Care, Philadelphia, American College of Physicians 2008 (in press).
25. Winchester JF, Silberzweig J, Ronco C, Kuntsevich V, Levine D, Parker T, Kellum JA, Salsberg JA, Quartararo P, Levin NW. Sorbents in Acute Renal Failure and End Stage Renal Disease: Middle Molecule and Cytokine Removal. Blood Purification 2004;22:73-77
26. Winchester JF, Extracorporeal Removal of Toxic Substances in, Critical Care Toxicology, Eds Brent J, Wallace KL, Burkhart KK, Phillips SD, Donovan JW, Elsevier, Mosby, Philadelphia, 2005: 65-86
27. Winchester JF, Hemoperfusion, in Replacement of Renal Function by Dialysis, 5th edition, editors Horl W, Koch KM, Lindsay RM, Ronco C, Winchester JF (Editor in Chief) Kluwer Academic Publishers, Dordrecht, 2004: 725-738
28. Winchester JF, Lindsay RM, Bleeding disorders in renal failure, in Replacement of Renal Function by Dialysis, 5th edition, editors Horl W, Koch KM, Lindsay RM, Ronco C, Winchester JF (Editor in Chief), Kluwer Academic Publishers, Dordrecht, 2004:919-925
29. Winchester JF, Peritoneal Dialysis Program Management, in Replacement of Renal Function by Dialysis, 5th edition, editors Horl W, Koch KM, Lindsay RM, Ronco C, Winchester JF (Editor in Chief), Kluwer Academic Publishers, Dordrecht, 2004: 1567-1571
30. Winchester JF, Telemedicine and Dialysis, in Replacement of Renal Function by Dialysis, 5th edition, editors Horl W, Koch KM, Lindsay RM, Ronco C, Winchester JF (Editor in Chief), Kluwer Academic Publishers, Dordrecht, 2004:1575-1579
31. Winchester JF, Salsberg JA. Sorbents in the Treatment of Renal Failure. Minerva Urologica e Nefrologica 2004;56:215-21
32. Winchester JF. Novel Changes in ÿ2-microglobulin in Dialysis Patients. (editorial) Clinical Chemistry 2005:51:1-2
33. Winchester JF, Amerling R, Harbord N, Capponi V, Ronco C: The potential application of sorbents in peritoneal dialysis. Contrib Nephrol. 2006;150:336-343.
34. Winchester JF, Boldur A, Oleru C, Kitiyakara C Use of Dialysis And Hemoperfusion in Treatment of Poisoning., in Handbook of Dialysis (Fourth Edition), John T Daugirdas, Peter G. Blake,Todd S Ing (Eds), Little Brown, Boston, 2007
35. Winchester JF, Audia PF: Extracorporeal Strategies for the Removal of Middle Molecules. Semin Dial 2006;19:110-114.
36. Winchester JF, Feinfeld DA: Poisonings and Intoxications. In, Lerma EV, Nissenson AR, Berns JS, eds., Current Diagnosis and Treatment in Nephrology and Hypertension. New York, McGraw-Hill, (in press).
37. Winchester JF, Harbord N, Audia P, Dubrow A, Gruber S, Feinfeld D, Amerling R: The K/DOQI guidelines for peritoneal dialysis adequacy are not adequate. Blood Purif 2007; 25:103-105.
38. Winchester JF, Amerling R, Dubrow A, Feinfeld DA, Gruber SG, Harbord N, Kuntsevich V. Dialysis desiderata. Hemodial Int 2007;11:S17-S20.

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Application Process

Departmental policy for all programs with & without NRMP partixipation
Applications are requested through ERAS (Electronic Residency Application System) via phone E-mail to the respective Program Coordinator.

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 residency and fellowship training will seek Board certification, where available, upon completion of the training program

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Contact

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

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