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PRINCE GEORGE’S HOSPITAL CENTER
INTERNAL MEDICINE RESIDENCY PROGRAM
SECTION 15: NEPHROLOGY
This section has been reviewed and approved by the Chief, Division of Nephrology as well as
the Program Director, Internal Medicine Residency Program at Prince George’s Hospital Center.
________________________
Chief, Division Of Nephrology
I.
_____________________________
Program Director, Residency Program
Overview
Nephrology involves disease of the kidneys, its contiguous collecting systems, and its
vasculature. The kidneys play a key role in fluid, electrolyte, and acid-base regulation and
are affected by a wide range of systemic disorders, drugs, and toxins.
The general internist should be competent to evaluate and appropriately refer patients with
glomerular disorders, asymptomatic urine abnormalities, tubulointerstitial diseases, renal
vascular disease, renal failure, nephrolithiasis, tubular defects, and infections and
neoplasms of the kidneys, bladder, and urethra, and should also be able to provide principle
treatment for some of these conditions. He/she should be able to manage fluid, electrolyte,
and acid-base disorders; understand the ways in which systemic diseases may affect the
kidneys; and recognize the potential nephrotoxicity of various therapeutic and diagnosis
agents. The general internist must also be familiar with guidelines for pre-dialysis
management of patients with renal failure and be able to recognize indications for dialysis
and for referral to a nephrologist.
II.
Principle Teaching Methods
It consists of frequent encounters with the attending physician regarding patient care. The
resident will discuss all patients with the attending physician and interpret clinical data to
formulate a differential. The attending will assign reading topics on a regular basis and
review the material with the residents. This will include accepted national guidelines used in
the diagnosis and treatment of various renal diseases. The faculty will also critique the
residents consult notes, examination and management plan. Rounds will include short 15-30
minute discussions on current topics driven by patient encounters and initiated by resident
and completed by the attending physician on most days. Latest information dealing with the
topic as provided by literature search and pertinent articles should be discussed.
The residents will also gain outpatient experience in nephrology and related urologic topics
by rounding with Dr. Singh/Sidhu/Pollak at their Largo Dialysis Center two to three mornings
in the week. The residents must contact Dr. Singh at the beginning of the rotation to learn
the exact dates and times of the rounds.
III.
Strengths and Limitations
The residents will be exposed to a broad range of clinical problems typical of a communitybased practice with emphasis on inpatient illness and care. The teaching faculty for the
rotation is committed to teaching and patient care with strong role model presentation.
There is on site CVVH, Hemodialysis. Residents learn about peritoneal dialysis if a patient is
admitted to the hospital, which is typical of a community-based hospital. The hospital does
not have a renal transplant unit and does a limited number of renal biopsies. For patients
with exceptionally unusual clinical problems, the care may require transfer to a tertiary
referral center. Patients in the continuity clinic at Glenridge Medical Center also offer
learning opportunities in management of patients with chronic renal failure and/ or
deteriorating renal functions.
The outpatient dialysis center will provide exposure to patients on Continuous Ambulatory
Peritoneal Dialysis (CAPD), as well residents will gain insight on outpatient management of
patients with End Stage Renal Disease. The Urology office offers exposure to management
of hematuria, obstructive uropathy, renal cancer patients as well as patients with erectile
dysfunction (since it is a common side effect of many anti-hypertensives).
During the rotation the residents will be required to interpret a minimum number of
laboratory data as well analyse a minimum number of urine samples personally. Residents
are also required to review all renal biopsy results in pathology along with the staff
nephrologist irrespective of whether the patient is admitted to the staff service or other
nephrology service. This will provide residents opportunity to learn about the indications for
renal biopsy and management of the disease condition specific to the biopsy case. The
minimum requirement of the above stated tests is listed in a logsheet at the end of this
section. Residents are required to make a double-sided copy of the logsheet and have it
signed during the rotation. Residents must turn in a completed and signed logsheet as well
as attendance sheet to the program coordinator as requirement for successful completion of
the rotation.
IV.
Goals and Objectives
During the course of the year, residents typically receive two lectures a month in
nephrology. One in the form of Morning report and the other is a noon lecture. While
morning report is a presentation of a case by one of the floor teams, the noon lecture is a
didactic session by the nephrology resident for the month and the a staff nephrologist. The
residents are required to chose cases or lecture topics in a manner that by the end of the
year all the following topics are discussed. It is therefore essential for the internal medicine
intern and nephrology resident to discuss with the chief residents as well as Dr. Singh
regarding an case/ topic well in advance of the conference. The topics to be covered in the
course of a year are as follows:
 Acute Renal Failure
 Rapidly Progressive Renal Failure
 Chronic Renal Failure
 Nephrotic Syndrome
 Vasculitis and Renal Disease
 Glomerulonephritis
 Renal Replacement Therapy
 Pre-transplant Evaluation of Patient, Transplant medications
 Management of Transplant Recipients
 HIV Nephropathy
 Electrolyte Disturbances
Legend of Learning Activities
Learning Venues:
1. Direct patient care/ consultation
2. Attending rounds
3. Core lecture series
4. Self study
5. Morning report and noon conference
Evaluation methods
A. Attending rounds on consult patients
B. Attending evaluation of urine and serum electrolytes and ABG interpretation skills
C. Direct Observation
D. Nurse’s evaluation
E. In-training examination
Competency: Patient Care
Demonstrate the ability to use history, physical exam,
laboratory, and ancillary tests to assess clinical volume
status
Demonstrate ability to generate differential diagnosis,
diagnostic strategy, and to define appropriate
therapeutic plan and modifications to ongoing therapy
in patient with acute renal failure
Demonstrate the ability to generate differential
diagnosis, diagnostic strategy, and to define
appropriate therapeutic plan and modifications to
ongoing therapy in patient with a serious fluid,
electrolyte, or complex acid-base disorders
Competency: Medical Knowledge
Articulate the pathophysiology, evaluation, and
management (including dialysis) of acute renal failure
Articulate the pathophysiology, evaluation, and
management (including dialysis) of chronic kidney
disease (CKD) and endstage renal disease (ESRD)
Articulate the pathophysiology, evaluation, and
management of common disorders of sodium,
potassium, and water metabolism
Articulate the pathophysiology, evaluation, and
management of common acid-base disorders, including
renal tubular acidosis
Articulate the pathophysiology, evaluation, and
management of primary and secondary glomerular
diseases
Articulate the pathophysiology, evaluation, and
management of essential and secondary hypertension
Learning
Venues
Evaluation
Methods
1,2,4
A,B,C,E
1,2,3,4,5
A,B,C,E
1,2,3,4,5
A,B,C,E
Learning
Venues
Evaluation
Methods
1,2,3,4,5
A,B,C,E
1,2,3,4,5
A,B,C,E
1,2,3,4,5
A,B,C,E
1,2,3,4,5
A,B,C,E
1,2,3,4,5
A,B,C,E
1,2,3,4,5
A,B,C,E
Competency: Interpersonal and Communication
Skills
Interact in an effective way with physicians and nurses
participating in the care of patients requiring renal
consultation or care (including physicians requesting
consultation, fellows, attendings, medical students, and
dialysis unit personnel)
Show understanding of differing patient preferences in
diagnostic evaluation and management of renal
disorders
Competency: Professionalism
Treat team members, primary care-givers, and patients
with respect
Actively participate in consultations and rounds
Attend and participate in all scheduled conferences ,
outpatient clinics
Competency: Practice-Based Learning
Identify limitations of medical knowledge in evaluation
and management of patients with renal disorders and
use medical literature (primary and reference) to
address these gaps in medical knowledge
Competency: Systems-Based Practice
Understand barriers to optimal care of patients with
hypertension, CKD, and ESRD
Understand how financing of ESRD care can influence
patient care
Understand need for effective communication between
multiple caregivers and sites (eg, nephrologists,
primary care physicians, surgeons, interventional
radiologists, dialysis nurses, dieticians, social workers,
hospitals, in- and out-patient dialsysis units in delivering
optimal care to ESRD patients
V.
Learning
Venues
Evaluation
Methods
1,2
A,C,D
1,2
A,B,D
Learning
Venues
Evaluation
Methods
1,2
A,C,D
1,2
A,C
Learning
Venues
Sign in sheet,
attendance sheet
Evaluation
Methods
1,2,4,5
A,E
Learning
Venues
1,2,3,4
Evaluation
Methods
A
1,2,3,4
A
1,2,3,4
A
Educational Content
A. Acid-base disorders
1) Residents should be able to interpret double and triple acid base disorders
B. Acute renal failure
1) Residents should understand the causes, presentation, management and prevention
(where appropriate) of
 Acute (ischemic) tubular necrosis including secondary to Rhabdomyolysis
 Atheroembolic
 Drug-induced (radiocontrast, analgesics, etc.)
 Interstitial
2) Order appropriate tests and interpret results of
 Kidney function test
 Urine analysis including identification of casts
3) Calculate creatinine clearance and adjust doses of medications appropriately
C. Chronic renal failure
1) Residents should understand the causes, presentation, management of patients
with:
 Conservative management (before dialysis)
 Hemodialysis
 Peritoneal dialysis
 Transplantation
2) Understand issues related to vascular access
D. Fluid and electrolyte disorders
1) Causes, presentation, management and complications of:
 Hypernatremia
 Hyponatremia
 Hyperkalemia
2) Understand the pathophysiology of disease and order appropriate test. Calculate:
 correct sodium for glucose
 FENa (Fractional Excretion of Na)
E. Glomerular Diseases
1) Causes, presentation, management and complications of:
 Acute glomerulonephritis
 Chronic glomerulonephritis
 Nephrotic syndrome
2) Order appropriate tests and interpret results of
 Kidney function test
 Urine analysis
 Quantification of proteinuria
 Vasculitis work up
 Renal biopsy
F. Hypertension
1) Causes, presentation, management and complications of:
 Hypertensive crisis
 Secondary hypertension including renal artery stenosis
2) Order appropriate tests and interpret results of:
 Renal sonogram
 MRA renal vessels
 Renal catecholamines, metanephrine, VMA
 IVP (when applicable)
G. Inherited Diseases
 Polycystic kidneys
H. Kidney Disease in Systemic Illness
1) Understand the pathophysiology of disease, management and preventive strategies
for:
 Diabetic mellitus
 Hypertension
 Other systemic diseases
I.
Neoplasia (see also Oncology)
1) Presentation, and management of
 Renal cell carcinoma
2) Order appropriate tests and interpret results of:
 Renal sonogram
 CT scan of abdomen
 Radionuclide scan
J. Nephrolithiasis
1) Causes, presentation and management of:
 Diagnosis of renal stone disease
 Management of acute renal colic
 Obstructive uropathy
2) Order appropriate tests and interpret results of:
 24-hour urine excretion of calcium, oxalate, citrate, uric acid, and protein
 Urinary calculus analysis
K. Renal Disease in Pregnancy
L. Urinary Tract Infection
 Cystitis
 Pyelonephritis
M. Urologic Disorders
 Bladder outlet obstruction
 Hematuria
 Nephrolithiasis
 Neoplasia
 Erectile dysfunction
VI.
Recommended Readings
Residents are expected to pursue directed reading of standard texts and journal articles
pertinent to the clinical problems they encounter. On a case-by-case basis residents should
refer to:
 Up To Date
 MDConsult
 Harrison’s Principles of Internal Medicine
The residents are also encouraged to complete a reading of the Nephrology section of the
MKSAP and Medstudy. They may also refer to the following reading list:
A. General and Glomerular Disease
1. Cattran, DC, et.al. A Controlled trial of cyclosporine in patients with progressive
membranous nephropathy. Kidney International 1995; 47: 1130-1135.
2. Falk RJ, Jennette JC. ANCA Small-Vessel Vasculitis. JASN 1997; 8(2): 314-322.
3. Galla, John. IgA Nephropathy. Kidney International 1995; 47: 377-387.
4. Hricik DE, Chung-Park M, Sedor JR. Medical Progress: glomerulonephritis. N Eng J
Med 1998; 339: 888-899.
5. Jindal, Kailash. Management of Idiopathic Crescentic and Diffuse Proliferative
Glomerulonephritis: Evidence Based Recommendations. Kidney International 1999;
55 (Supp 70): S33-S40.
6. Levin, Adeera. Management of Membranoproliferative Glomerulonephritis: Evidence
Based Recommendations. Kidney International 1999; 55 (Supp 70): S41-S46.
7. Levy, Andrew S. Measurement of renal function in chronic renal disease. Kidney
International 1990; 38: 167-184.
8. Muirhead, Norman. Management of Idiopathic Membranous Nephropathy: Evidencebased recommendations. Kidney International 1999; 55 (Supp 70): S47-S55.
9. ONeill, W. Charles. Sonographic Evaluation of Renal Failure. Am J Kidney Dis 2000;
35:6: 1021-1038.
10. Orth SR and Eberhard R. Medical Progress: The Nephrotic Syndrome. N Engl J Med
1998; 338: 1202-1201.
11. Pollock C, et.al. Dysmorphysm of urinary red blood cells-Value in diagnosis. Kidney
International 1989; 36:1045-1049.
12. Remuzzi, Giuseppe; Bertani, Tullio. Mechanisms of Disease: Pathophysiology of
Progressive Nephropathies. N Engl J Med 1998; 339: 1448-1456.
13. Russo D, et.al. Additive Antiproteinuric Effect of Converting Enzyme Inhibitor and
Losartan in Normotensive Patients with IgA Nephropathy. Am Journal Kid Dis 1999;
33:851-856.
B. Systemic Disease with Renal Manifestations
1. Cameron, JS. Lupus Nephritis. JASN 1999; 10(2).
2. DeFronzo RA, et.al. Renal Function in Patients with Multiple Myeloma. Medicine
1978; 57(2):151-166.
3. Donohoe, John. Scleroderma and the Kidney. Kidney International 1992; 41: 462477.
4. Gault MH, Barrett BJ. Analgesic Nephropathy. Am J Kidney Dis 1998; 32(3):351360.
5. Gertz Morie and Kyle, Robert. Primary Systemic Amyloidosis-A Diagnostic Primer.
Mayo Clin Proc 1989; 64:1505-1519.
6. Hou, Susan. Pregnancy in Chronic Renal Insufficiency and End-Stage Renal
Disease. Am J Kidney Dis 1999; 33(2): 235-252.
7. Johnson WJ, et.al. Treatment of Renal Failure Associated with Multiple Myeloma:
Plasmapheresis, Hemodialysis, and Chemotherapy. Arch Int Med 1990; 150: 863869.
8. Johnson, RJ, et.al. Renal Manifestations of Hepatitis C Virus Infection. Kidney
International 1994; 46: 1255-1263.
9. Klotman, Paul. HIV-associated Nephropathy. Kidney International 1999; 56: 11611176.
10. Roberts LR and Kamath S. Ascites and Hepatorenal Syndrome: Pathophysiology
and Management. Mayo Clinic Proceedings 1996; 71: 874-881.
11. Perneger TV, et.al. Risk of Kidney Failure Associated with the Use of
Acetaminophen, Aspirin and Nonsteroidal Antiinflammatory Drugs. N Engl J Med
1994; 331(25): 1675-1679.
12. Schwartz, Melvin, et.al. Role of Pathology Indices in the Management of Severe
Lupus Glomerulonephritis. Kidney International 1992; 42: 743-748.
C. Diabetes and Renal Disease
1. Brancatti FL, et.al. Risk of End-stage Renal Disease in Diabetes Mellitus: A
Prospective Cohort Study of Men Screened for MRFIT. JAMA 1997; 278: 20692074.
2. Lewis EJ. et.al. Inhibition of Diabetic Nephropathy. The Effect of AngiotensinConverting-Enzyme N Engl J Med 1993; 329: 1456-62.
3. The Diabetes Control and Complications Trial Research Group. The effect of
intensive treatment of diabetes on the development and progression of long-term
complications in insulin dependent diabetes mellitus. N Engl J Med 1993; 329: 977986.
D. Acid-Base and Electrolyte Disorders
1. Adrogue HJ and Madias NE. Medical Progress: Management of Life-Threatening
Acid-Base Disorders: First of Two Parts. N Engl J Med 1998; 338:26-34.
2. Adrogue HJ and Madias NE. Medical Progress: Management of Life-Threatening
Acid-Base Disorders: Second of Two Parts. N Engl J Med 1998; 338:107-111.
3. Battle DC, et.al. The Use of Urinary Anion Gap in the Diagnosis of Hyperchloremic
Metabolic Acidosis. N Engl J Med 1988; 318: 594-9.
4. Brown, RS. Extrarenal potassium homeostasis. Kidney International 1986; 30: 116127.
5. Chesney RW and Jones DP. Renal Tubular Syndromes. Current Nephrology 1996:
1-31.
6. DeFronzo RA and Their SO. Pathophysiologic Approach to Hyponatremia. Arch Int
Med 1980; 140:897-902.
7. Gennari FJ. Current Concepts: Hypokalemia. N Engl J Med 1998; 339: 451-458.
8. Hamm LL. Renal Handling of Citrate. Kidney International 1990; 38: 728-735.
9. Harrington JT and Cohen JJ. Clinical Disorders of Urine Concentration and Dilution.
Arch Int Med 1973;131:810-825.
10. Narins RG and Emmett M. Simple and Mixed Acid Base Disorders: A Practical
Approach. Medicine 1980; 59 (3): 161-187.
11. Oster JR and Epstein M. Acid-Base Aspects of Ketoacidosis. Am J Nephrol 1984; 4:
137-151.
12. Rimmer JM, Gennari FJ. Metabolic Alkalosis. J Intensive Care Med 1987;2:137-150.
13. Rose, BD. New approach to disturbances in the plasma sodium concentration. AJM
1986; 81:1023-1040.
14. Sherman RA and Eisinger RP. The Use (and Misuse) of Urinary Sodium and
Chloride Measurements. JAMA 1982; 247:3121-4.
15. Swartz RD, et.al. Correction of Postoperative Metabolic Alkalosis and Renal Failure
by Hemodialysis. Annals of Internal Medicine 1977; 86:52-55.
E. Acute Renal Failure: Pathophysiologv and Treatment
1. Anderson RJ, et.al. Nonoliguric Acute Renal Failure. N Engl J Med 1977; 296: 11341138.
2. Belenfant X, Meyrier A, and Jacquot C. Supportive Treatment improves Survival In
Multivisceral Cholesterol Crystal Embolism. Am J Kidney Dis 1999; 33:840-850.
3. Conger JD. Interventions in Acute Renal Failure: What Are the Data? Am J Kidney
Dis 1995; 26:565-576.
4. Klahr S and Miller SB. Acute Oliguria. N Engl J Med 1998; 338:671-675.
5. Miller TR, et al. Urinary Diagnostic indices in Acute Renal Failure: A Prospective
Study Ann Int Med 1978; 89:47-50.
6. Nolan CR and Anderson RJ. Hospital-Acquired Acute Renal Failure. J AM Soc
Nephrol 1998; 9:710-8.
7. Thadhani R, Pascual M, Binventre JV. Medical Progress: Acute Renal Failure. N
Engl J Med 1996; 334:1448-1460.
8. Solomon R et al. Effects of Saline, Mannitol, and Furosemide on Acute Decreases in
Renal Function Induced by Radiocontrast Agents. N Engl J Med 1994; 331:1416-20.
9. Swartz RD, Messana JM, Orzol S, Port FK. Comparing Continuous Hemofiltration
with Hemodialysis in Patients with Severe Acute Renal Failure. Am J Kidney Dis
1999; 34:424-432.
F. Chronic Renal Failure and Progression
1. Burgess, Ellen. Conservative treatment to slow deterioration of renal function:
Evidence-based recommendations. Kidney International 1999; 55 (Supp 70): S17S25.
2. Epstein, FH. Pregnancy and Renal Disease. New Engl J Med 1996; 335: 277-278.
3. Giatras I et al. Effect of Angiotensin-Converting Enzyme Inhibitors of the Progression
of Non-diabetic Renal Disease: A Meta-Analysis of Randomized Trials. Annals of Int
Med 1997; 127:337-345.
4. Hou, Susan. Pregnancy in chronic renal insufficiency and end-stage renal disease.
Am J Kidney Dis 1999; 33(02): 235-252.
5. Jungers, Paul et al. Pregnancy in Renal Disease. Kidney International 1997; 52:871885.
6. Klahr, S et al, The Effects of Dietary Protein Restriction and Blood Pressure Control
on the Progression of Chronic Renal Disease. New Engl J Med 1994; 330(13): 877884.
7. Maschio, Giuseppe, et al. Effect of the Angiotensin-Converting-Enzyme Inhibitor
Benazepril on the Progression of Chronic Renal Insufficiency. N Engl J Med 1996;
334:939-45.
G. ESRD and Renal Replacement Therapy: General, Outcomes, Vascular Access,
Complications
1. Beathard GA. Management of Bacteremia Associated with Tunneled-Cuffed
Hemodialysis Catheters. J Am Soc Nephrol 1999; 10:1045-1049.
2. Beathard GA. Thrombolysis Versus Surgery for the Treatment of Thrombosed
Dialysis Access Grafts. J Am Soc Nephrol 1995; 6:1619-1624.
3. Besarab A, et al. The Effects of Normal as Compared with Low Hematocrit Values in
Patients with Cardiac Disease Who are Receiving Hemodialysis and Epoetin. N Engl
J Med 1998; 339:584-590.
4. Eschbach JW, et al. Correction of the Anemia of End-Stage Renal Disease with
Recombinant Human Erthropoietin. N Engl J Med 1987; 316:73-78.
5. Felsenfeld AJ. Considerations for the Treatment for Secondary Hyperparathyroidism
in Renal Failure. J Am Soc Nephrol 1997; 8:993-1004.
6. Herzog CA, Ma JZ, and Collins AJ. Poor Long-Term Survival After Acute Myocardial
Infarction Among Patients on Long-term Hemodialysis. N Engl J Med 1998; 339:799805.
7. Hollett MD, et al. Complications of Continuous Ambulatory Peritoneal Dialysis:
Evaluation with CT Peritoneography. AJR 1992; 159:983-989.
8. Ifudu O. Care of Patients Undergoing Hemodialysis. N Engl J Med 1998; 339:10541062.
9. Llach F. Hyperphosphatemia in End-stage Renal Disease Patients:
Pathophysiological Consequences. Kidney International 1999; 56 (supp 73): S31S37).
10. Macdougall IC, et al. A Randomized Controlled Study of Iron Supplementation In
Patients Treated with Erythropoietin. Kidney International 1996; 50: 1694-1699.
11. Marcus RG, Messana JM, Swartz RD. Peritoneal Dialysis in End-stage Renal
Disease Patients with Preexisting Chronic Liver Disease. Am J Med 1992; 93:35-40.
12. Pastan S and Bailey J. Dialysis Therapy. N Engl J Med 1998; 338: 1428-1437.
13. Popovich RP, et al. Continuous Ambulatory Peritoneal Dialysis. Ann Int Med 1978;
88:449-456.
14. Port FK. Morbidity and Mortality in Dialysis Patients. Kidney International 1994;
46:1728-1737.
15. Slatopolsky E, Brown A, Dusso A. Pathogenesis of Secondary Hyperparathyroidism.
Kidney Inter 1999; 56(supp 73): S14-S19.
16. Swartz RD, et al. Successful Use of Cuffed Central Venous Hemodialysis Catheters
Inserted Percutaneously. J Am Soc Nephrol 1994; 4:1719-1725.
17. Swartz RD. Chronic Peritoneal Dialysis: Mechanical and Infectious Complications.
Nephron 1985; 40:29-37.
18. U.S. Renal Data System 1999 Annual Report. Incidence and Prevalence of ESRD.
Am Jour of Kidney Dis 1999; 34(2 Suppl 1): S40-50.
19. Valji K. et al. Hand Ischemia in Patients with Hemodialysis Access Grafts:
Angiographic Diagnosis and Treatment. Radiology 1995; 196: 697-701.
20. Wolfe RA, et al. A Critical Examination of Trends in Outcomes over the Last Decade.
Am J Kidney Dis 1998; 32 (supp 4): S9-S15.
H. Transplant
1. Anonymous. VII: Renal Transplantation: Access and Outcomes. Am J Kidney Dis
1999; Supp 1: S95-S101.
2.
Fishman JA and Rubin RH. Infection in Organ Transplant Recipients. N Engl J Med
1998; 338: 1741-1751.
3. Terasaki Pl, et al. High Survival Rates of Kidney Transplants from Spousal and
Living Unrelated Donors. N Engl J Med 1995; 333:333-6.
4. Veenstra DL, et al. Incidence and Long-term Cost of Steroid-Related Side Effects
after Renal Transplantation. Am J Kidney Dis 1999; 33:829-839.
I.
Hyponatremia/Hypernatremia
1. Adrogue HJ. Madias NE. Hyponatremia. New England Journal of Medicine.
342(21):1581-9, 2000 May 25.
2. Adrogue HJ. Madias NE. Hypernatremia. New England Journal of Medicine.
342(20):1493-9, 2000 May 18.
PRINCE GEORGE’S HOSPITAL CENTER
INTERNAL MEDICINE RESIDENCY PROGRAM
NEPHROLOGY LOGSHEET
RESIDENT NAME______________________________________________
PGY LEVEL_______________
ROTATION MONTH_____________
* Slide must be personally reviewed by resident under direct supervision of attending physician.
Any renal biopsy, on any patient, during the month MUST be reviewed(no minimum # requirement)
Electrolyte
LABORATORY
Urine Analysis*
Renal Biopsy
Imbalance( Na, K,
ABG
DATA
Ca, Phos)
MR#
Interpretation of
result by resident
(diagnosis/
management plan)
Comment by
supervising attending
(correct/not, missed
findings etc)
SIGNATURE of
Supevising
attending & DATE
MR#
Interpretation of
result by resident
(diagnosis/
management plan)
Comment by
supervising attending
(correct/not, missed
findings etc)
SIGNATURE of
Supevising
attending & DATE
MR#
Interpretation of
result by resident
(diagnosis/
management plan)
Comment by
supervising attending
(correct/not, missed
findings etc)
SIGNATURE of
Supevising
attending & DATE
RESIDENT NAME:____________________________________________
LABORATORY
DATA
MR#
Interpretation of
result by resident
(diagnosis/
management plan)
Comment by
supervising attending
(correct/not, missed
findings etc)
SIGNATURE of
Supevising
attending & DATE
MR#
Interpretation of
result by resident
(diagnosis/
management plan)
Comment by
supervising attending
(correct/not, missed
findings etc)
SIGNATURE of
Supevising
attending & DATE
MR#
Interpretation of
result by resident
(diagnosis/
management plan)
Comment by
supervising attending
(correct/not, missed
findings etc)
SIGNATURE of
Supevising
attending & DATE
Urine Analysis*
Renal Biopsy
Electrolyte Imbalance(
Na, K, Ca, Phos)
ABG
PRINCE GEORGE’S HOSPITAL CENTER
INTERNAL MEDICINE RESIDENCY PROGRAM
DIALYSIS ATTENDANCE SHEET
RESIDENT NAME______________________________________________
PGY LEVEL_______________
DATE
ROTATION MONTH_____________
COMMENTS (IF ANY) BY ATTENDING
SIGNATURE OF
ATTENDING
__________________________________