Curriculum
Ambulatory Clinics
Chronic Kidney Disease Clinic
This is a weekly clinic for both fellows and internal medicine housestaff. The outpatient clinic experience provides trainees with the opportunity to see a vast array of renal disorders in various stages of progression. The list of disorders evaluated in clinic includes, but is not limited to: hematuria, proteinuria, difficult-to-treat hypertension, monogenic hypertension, glomerular diseases, congenital kidney anomalies, diabetic kidney disease, HIV associated kidney diseases, vasculitis, tubulointerstitial disorders, cystic kidney diseases, multiple electrolyte abnormalities, nephrolithiasis, and chronic kidney disease. Adults of all ages and all ethnic background are seen.
Kidney Transplant and Acute Glomerular Disease Clinic
This is a weekly fellow designated continuity of care clinic which focuses on long-term care for kidney transplant recipients and management of patients with newly diagnosed glomerular or tubulointerstitial diseases. Fellows are given the opportunity to biopsy patients with acute intrinsic diseases, initiate a treatment plan, and follow their own patients over their two-year of fellowship with full faculty guidance.
Inpatient Consultation
Fellows typically rotate through the inpatient consult service 6 months per year depending on the need of the entire program. Each rotation will be staffed by one attending, 3 fellows, one medicine housestaff, and possibly a medical student. Patient census is typically below 20 to 30. Common reasons for consult include acute kidney injury ranging from simple contrast induced kidney injury to hemodynamic compromise from sepsis, cardiac decompensation, liver failure, rapidly progressive glomerulonephritis, drug-induced tubulointerstitial diseases, to various renal, electrolyte, and hypertensive complications associated with pregnancy. Management of all dialysis modalities including hemodialysis, peritoneal dialysis, and continuous renal replacement therapy will be part of inpatient consult care.
Inpatient Kidney Replacement Therapy and Plasmapheresis
Intermittent Kidney Replacement Therapy: The inpatient intermittent (single-pass) kidney replacement service was started in April 2019. Our service is equipped with top-of-the-line hemodialysis machines and advanced crit-line devices to ensure the safest possible kidney replacement therapy for our patients. Peritoneal dialysis is supported by the use of the Amia automated PD system with Sharesource connectivity. “Amia automated peritoneal dialysis (APD) with the Sharesource remote patient monitoring platform is the first and only APD system to include user-friendly features that help guide end-stage renal disease patients through home peritoneal dialysis (PD) therapy, while keeping them remotely connected with their healthcare providers.” The intermittent KRT service is staffed by a group of outstanding and highly competent dialysis nurses.
Continuous Kidney Replacement Therapy (also known as continuous renal replacement therapy [CRRT]): The continuous kidney replacement therapy service uses Prismaflex machines designed to provide ALL modalities of CKRT including slow continuous ultrafiltration (SCUF), continuous venovenous hemofiltration (CVVH), continuous venovenous hemodiafiltration (CVVHD), and continuous venovenous hemodiafiltration (CVVHDF). The CKRT service is staffed by our most competent Intensive Care Unit nursing staff.
Plasmapheresis: Plasmapheresis is provided by contractor service. Renal fellows are trained to write their own plasmapheresis orders for renal indications.
Outpatient Dialysis
Fellows rotate through the North Hollywood Davita Dialysis unit 1.5 to 2.0 months a year where they learn about water treatments and rounding on patients receiving both hemodialysis and peritoneal dialysis. Rounds will focus on the mechanics of dialysis, writing optimal dialysis prescriptions, surveilling and managing vascular access complications, familiarizing with both dialytic and non-dialytic approach to the management of blood pressure, providing routine medical care of patients receiving chronic renal replacement therapy, and understanding the responsibilities of the medical director at the dialysis unit.
Fellows also have the opportunity to rotate through Kaiser Permanente at Panorama City to learn about home hemodialysis treatments and nocturnal dialysis.
Kidney Transplant
Fellows will rotate through the inpatient kidney transplant at Ronald Reagan Medical Center at UCLA service for two months during the 2-year fellowship. Fellows will care for patients receiving a fresh kidney with or without pancreas or liver transplant, manage immunosuppressive therapy in both the perioperative and late transplant periods, and both immunosuppressive therapy and non-immunosuppressive therapy related complications. The latter range from infectious, malignant, cardiovascular to various electrolyte complications, among others. Fellows will also have the opportunity to care for post acute kidney transplants, and evaluation of potential kidney transplant donors and recipients during their second year of training.
Research + Electives
There will be one month of research during the first year of fellowship and a total of 3 months for research and/or elective during the second year. Fellows will receive close supervision to perform both quality improvement projects and clinical or basic science research from our faculty, the latter per individual preference.
Fellows may elect to rotate through various other services such as critical care medicine, interventional radiology, renal pathology, or outpatient care for newly transplanted kidney patients. Electives may be designed per individual need with prior approval from the program director.
NOTE: The number of months on each rotation may be changed by the program director based on the program’s need.
Training Sites Outside of Olive View – UCLA
North Hollywood Davita Dialysis
Faculty: Toscano, Edgar, MD, Director of the Fellowship Outpatient Dialysis
Hemodialysis and Peritoneal Dialysis
Kaiser Permanente Panorama City
Faculty: Martin Lin, MD
Home hemodialysis and Peritoneal dialysis
Ronald Reagan Medical Center at UCLA
Faculty: Kidney Transplant Department