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
Professor of Clinical Medicine, Albert Einstein College of Medicine (AECOM)
Herman Rosen, MD, FACP, FASN, Director, Nephrology Fellowship Program
Professor of Clinical Medicine, AECOM
Richard Amerling, MD, Director, Outpatient Dialysis
Associate Professor of Clinical Medicine, AECOM
Alan Dubrow, MD, Director, Inpatient Hemodialysis Unit
Instructor of Medicine, AECOM
Steven Gruber, MD, Director, Nephrology Development Program
Assistant Professor of Medicine, AECOM
Nikolas Harbord, MD, Director, Nephrology Outreach Clinic
Assistant Professor of Medicine, AECOM
David B. Bernard, MD, Chief Medical Officer, Beth Israel Medical Center
Professor of Clinical Medicine, AECOM
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
Lawrence Kiss, MD, Renal Pathology, Beth Israel Medical Center
Andrew Pomrantz, MD, Pediatric Nephrology
Zachary Brener, MD, Clinical Conference Coordinator

Affiliated Training Physicians
Barbara Murphy, MD, Chief of Nephrology, Mt. Sinai Medical Center
Bernd Schröppel, MD, Medical Director, Transplantation, Mt. Sinai Medical Center
Jaime Uribarri, MD, Director, Peritoneal Dialysis, Mt. Sinai Medical Center

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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.
16. Show progressive proficiency in learning the six competencies for medicine: Medical Knowledge, Patient Care, Practice Based Learning and Improvement, Systems Based Practice, Interpersonal and Communications Skills, Professionalism

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. Take the American Society of Nephrology In-Training Examination annually.
6. 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 Mt. Sinai Medical Center learning about peritoneal dialysis under the supervision of the director, Dr. Jaime Uribarri. 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. Bernd Schröppel, Medical Director of Transplantation. Both first and second year fellows participate in 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.

Publications

Amerling R, Besarab A, Roy C. New developments in anemia management in chronic kidney disease. Nephrol News Issues. 2008 Mar;22(3):suppl 1-8.

Kuntsevich V, Feinfeld DA, Audia P, Young W, Capponi V, Markella M, Winchester JF: In Vitro myoglobin clearance by a novel sorbent system. Artif Cells, Blood Substitutes and Biotechnology 2009;37:45-7. Epub 2009 Jan 8

Amerling R, Harbord N, Winchester JF, Ricci Z, Ronco C. Guidelines have done more harm than good, in Chiche J-D, Moreno R, Putensen C and Rhodes A editors, Patient safety and Quality of Care in Intensive Care Medicine, European Society of Intensive care Medicine, Medizinisch Wissenschaftliche Verlagsgesellschaft, Berlin 2009: 219-223.

Brener ZZ, Bilik I, Khorets B, Winchester JF, Bergman M. Rhabdomyolysis following clarithromycin monotherapy. Am J Med Sci. 2009;338:78.

Inrig JK, Patel UD, Toto RD, Reddan DN, Himmelfarb J, Lindsay RM, Stivelman J, Winchester JF, Szczech LA. Decreased pulse pressure during hemodialysis is associated with improved 6-month outcomes. Kidney Int. 2009;76:1098-107. Epub 2009 Sep 2.

Winchester JF, Ronco C. Sorbent Augmented Hemodialysis Systems: Are We There Yet? J Am Soc Nephrol. 2010;21:209-11. Epub 2009 Jan 7.

Winchester JF, Hostetter TH, Meyer TW. p-Cresol Sulfate: Further understanding of Its Cardiovascular Disease Potential in CKD. Am J Kidney Dis. 2009;54:792-4

(Jointly) Greene T, Daugirdas JT, Depner TA, Gotch F, Kuhlman M; 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. Am J Kidney Dis. 2009 ;53:835-44. Epub 2009 Apr 1.

Winchester JF, Harbord NB, Tyagi P, Rosen H. Extracorporeal Removal of Drugs and Toxins, in Jörres A, Ronco C, Kellum JA editors, Management of Acute Kidney Problems, Springer, Heidelberg, 2010: 647-659.

Brener ZZ, Kotanko P, Thijssen S, Winchester JF, Bergman M. Clinical Benefit of Preserving Residual Renal Function in Dialysis Patients: An Update for Clinicians. Am J Med Sci. 2010;339:453-6.

Kato S, Chernyavsky S, Tokita JE, Shimada Y, Homel P, Rosen H, Winchester JF. Relationship between Proteinuria and Venous Thromboembolism. J Thromb Thrombolysis 2010;30:281-5.

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

Winchester JF, Harbord NB, Rosen H. Management of Poisonings: Core Curriculum 2010. Am J Kidney Dis. 2010;56:788-800. Epub 2010 Aug 6.

Ali F, Boldur A, Winchester JF, Homel P, Feinfeld DA. A quick and simple estimate of creatinine clearance. J Nephrol. 2010;23:408-14.

(Jointly) Rocco MV, Larive B, Eggers PW, Beck GJ, Chertow GM, Levin NW, Kliger AS; FHN Trial Group. Baseline Characteristics of Participants in the Frequent Hemodialysis Network (FHN) Daily and Nocturnal Trials. Am J Kidney Dis. 2010 Nov 29. [Epub ahead of print]

Amerling R, Harbord NB, Pullman J, Feinfeld DA. Bisphosphonate use in chronic kidney disease: association with adynamic bone disease in a bone histology series. Blood Purif. 2010;29(3):293-9. Epub 2010 Jan 21.

(Jointly) Glenn M. Chertow, M.D., M.P.H., Nathan W. Levin, M.D., Gerald J. Beck, Ph.D., Thomas A. Depner, M.D., Paul W. Eggers, Ph.D., Jennifer J. Gassman, Ph.D., Irina Gorodetskaya, Tom Greene, Ph.D., Sam James, M.B., B.Ch., Brett Larive, M.S., Robert M. Lindsay, M.D., Ravindra L. Mehta, M.D., Brent Miller, M.D., Daniel B. Ornt, M.D., Sanjay Rajagopalan, M.D., Anjay Rastogi, M.D., Ph.D., Michael V. Rocco, M.D., Brigitte Schiller, M.D., Olga Sergeyeva, M.D., Gerald Schulman, M.D., George O. Ting, M.D., Mark L. Unruh, M.D., Robert A. Star, M.D., and Alan S. Kliger, M.D.) In-Center Hemodialysis Six Times per Week versus Three Times per Week. N Engl J Med. 2010 Nov 20. [Epub ahead of print]

Samara A, Bergman M, Vitrai J, Brener ZZ, Salman H. Recovery of transient pericardial constriction following steroid administration. Heart Lung Circ. 2010 Aug;19(8):470-2. Epub 2010 Jun 11

Brener ZZ, Paiusco AD, Bergman M. Acute liver failure following hemodialysis arteriovenous graft placement: a case report. J Med Case Reports. 2010 Aug 10;4:261.

Amerling R, Ronco C, Kuhlman M , Winchester JF, Arteriovenous Fistula Toxicity Blood Purif 2011;31 (in press)

Richter A, Lerner S, Schröppel B. Current State of Combined Kidney and Pancreas Transplantation. Blood Purif 2011;31 (in press)

W Latif, L Tong, JF Winchester, CJ Arrington, RL Pisoni, MR Marshall, W Kleophas, NW Levin, A Sen and R Saran. Uric Acid as a Predictor of All-Cause and Cardiovascular Mortality in the Dialysis Population: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS) (in press)

Raimann JG, Kruse A, Thijssen S, Kuntsevich V, Diaz-Buxo JA, Levin NW, Kotanko P. Fatigue in hemodialysis patients with and without diabetes: results from a randomized controlled trial of two glucose-containing dialysates. Diabetes Care. 2010 Sep;33(9):e121.

Kuntsevich V, Bushell WC, Theise ND. Mechanisms of yogic practices in health, aging, and disease. Mt Sinai J Med. 2010 Sep-Oct;77(5):559-69.

Winchester JF, Feinfeld DA, Harbord NB, Dubrow A: Diabetic nephropathy. In, Poretsky L, ed., Principles of Diabetes Mellitus. Springer, New York. 2010: 347-355

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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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