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College of Medicine MD Curriculum

Nephrology Elective – Riverside Methodist Hospital

Title of Clerkship: Nephrology Elective – Riverside Methodist Hospital 

Elective Year(s): Fourth Year Elective

Department: Internal Medicine

Type of Elective: Clinical

Clerkship Site: Riverside Methodists Hospital

Course Number: MEDI 802

Blocks Available: All

Number of Students/Block: 3 (combined total on both 2 and 4-week nephrology electives)

Faculty: Ramesh Annadurai, M.D. and other various faculty

Elective Description/Requirements: This elective consists of a mixture of acting internship inpatient consultation, and outpatient experiences. The student will have primary and/or consultative responsibility for patients who have a variety of acid-base and electrolyte disorders and problems in clinical nephrology and renal transplantation. The principal method of learning will be problem-based case analysis on inpatient/consultative rounds. The student will be directed to do in depth reading regarding his patients and selected topics. In addition, ad hoc seminars on relevant topics will be scheduled for the members of the Nephrology Service.

Length of Clerkship: 4 weeks

Educational Course Objectives and Links to EPOs:

  1. Perceive problems in ill-structured clinical cases. Formulate Hypothesis(es) Based on Problems: (EPOs: PC-6, PC-7)
    1. Test hypothesis(es) on a logical basis
    2. Proposes therapeutic plan based on above analysis.
    3. Re-evaluate hypothesis on basic of test results and/or response to treatment.
    4. Search out basic science and clinical literature relevant to problem at hand.
    5. Self-evaluate and become a self-directed learner.
  2. Formulate Hypothesis(es) Based on Skills: (EPOs: PC-1)
    1. Perform a careful analysis of urine sediment in the context of a clinical problem.
    2. Write a concise consultation note clearly identifying the most likely diagnosis and therapeutic recommendations
  3. Formulate Hypothesis(es) Based on Behaviors/Attitudes: (EPOs: PC-1)
    1. Perform a considerate examination and evaluation of the patient.
    2. Explain to the patient and family members where appropriate the nature of the patient’s condition and the patient’s choices including: risks, benefits, and alternatives
  4. Formulate Hypothesis(es) Based on Cognitive Objectives: (EPOs: MK-1, MK-4, MK-7, PC-6, PC-7)
    1. Hyponatremia/Hypernatremia/Body Fluids
      1. Describe the body control of sodium and water balance.
      2. Explain the ways sodium and water balance is independent and the ways they are dependent.
      3. Characterize from clinical information the patient’s total body sodium (effective extra- cellular fluid volume) status. 
      4. Distinguish true hypotonicity form pseudohyponatremia.
      5. Order diagnostic tests and interpret to determine pathogenesis of hyponatremia. 
      6. Prescribe fluids appropriate to clinical information.
      7. Estimate water deficit from clinical information and prescribe fluids.
      8. Evaluate edematous patient for pathogenesis and prescribe appropriate treatment.
    2. Potassium Balance/Hypokalemia/Hyperkalemia 
      1. Describe body balance of potassium.
      2. From clinical information determine differential diagnosis for hypokalemic state. Propose diagnostic tests to confirm diagnosis and recommend treatment.
      3. Distinguish pseudohyperkalemia from hyperkalemia, describe tests required to confirm impression.
      4. From clinical information determine the differential diagnosis of hyperkalemic state, propose tests to confirm pathogenesis and prescribe treatment.
      5. Describe the emergency treatment of hyperkalemia, mechanisms of action, relative speed and efficacy.
    3. Simple Acid-Base Disorders
      1. Describe buffering system of the body and explain why bicarbonate is a good butter to maintain pH at 7.4 in vivo but a poor butter in vitro at the pH.
      2. Describe the body balance of H+, HCO3-, and CO2 for the body and describe the generation, elimination and measurement of these substances.  Explain the differences between total CO1, pCO2, HCO3-.
      3. Identify the 4 simple acid-base disturbances from clinical information.
      4. Describe compensatory mechanisms for each simple disturbance. Explain why the Henderson-Hasselbalch
      5. Equation (ionization constant) does not predict the compensation expected. e. List 5 causes for each simple acid-base disturbance.
      6. Explain the difference between acidemia and acidosis.
      7. Explain how perpetuating factors make it difficult for the body to homeostatically correct metabolic alkalosis in the face of volume depletion.
      8. Describe the treatment of each of the primary acid-base disturbances. Calculate the dosages of bicarbonate for metabolic acidosis.
    4. Complex (Mixed) Acid-Base Disorders
      1. Explain the difference between simple and complex (or mixed) acid-base disturbances.
      2. Explain what predicted compensations.
      3. Explain why compensation never obliterates the primary acid-base disturbances.
      4. Identify mixed (or complex) acid-base disturbances from clinical material with the aid of confidence bands for simple disturbances.
      5. Propose treatment for mixed acid-base disturbances based on an understanding of the pathophysiology.
    5. Acute Renal Failure
      1. Differential Diagnosis 
      2. Treatment
    6. Chronic Renal Failure
      1. Search for reversible causes
      2. Management
    7. Dietary
    8. Dialysis options
    9. Renal transplantation
    10. Interstitial nephritis
    11. Cystic diseases of the kidney
    12. Hypertension
    13. Evaluation and treatment of other common clinical disorders
      1. Proteinuria
      2. Obstructive Uropathy
      3. Urinary Tract Infections

Professionalism: UT/COM students will meet or exceed the institutional standards for professionalism as stated in the current Educational Program Objectives and the current Educational Course Objectives for the Sponsoring Department.

Instructional Methods:

  1. Small group - clinical skills
  2. Interpretation of lab data
  3. Diagnostic tests - use/interpretation
  4. Lecture/media
  5. Independent study
  6. Outpatient rounds
  7. Inpatient rounds

Evaluation Methods:

  1. Attendance
  2. Case presentation
  3. Case write-up
  4. Faculty/resident evaluation
  5. Narrative

Prerequisites: Successful completion of required Internal Medicine Clerkship

Clerkship Director: Mani Askari, M.D.

Clerkship Coordinator: Dawn Jagodzinski; Mackenzie McNair
Phone Number: 419-383-5022
Email: Dawn.jagodzinski@utoledo.edu

Special Requirements: None

ECC Approved
June 2023

Last Updated: 11/21/23