All candidates are matched into the general nephrology track. During the first year of training, fellows may opt
into an interventional radiology or critical care track.
Clinical Nephrology Track
This track is designed for individuals interested in pursuing a career in clinical nephrology in private, academic or federal settings. This track is also appropriate for those interested in a career as a clinician educator. The clinical training is centered within four training sites: University Hospital, South Texas Veterans Health Care System, San Antonio Military Medical Center and the UHS Free-Standing Dialysis Units.
Outpatient activity is at the Texas Diabetes Institute and at the VA clinics. Transplant experience is at the University Hospital setting and between 80-100 renal transplants are performed each year. In addition to the core rotations at these sites, elective rotations are offered to provide exposure to relevant complementary specialties and skills including vascular surgery, interventional nephrology, critical care, and ultrasound.
Fellows also have the opportunity to research at the basic, translational and clinical levels. During the first year, research symposiums are organized to enable fellows to identify faculty research mentors. Up to four months during the second year of training are dedicated to a successful research experience.
Cardiovascular disease (CVD) continues to be the greatest cause of mortality and a major cause of morbidity in patients with chronic kidney disease (CKD), on maintenance dialysis and after kidney transplantation. Yet, the role of nephrologist in the screening, diagnosis, and management of wide spectrum of CVD in kidney diseases remain peripheral.
Furthermore, presence of kidney disease introduces a significant layer of complexity in the management of patients with CVD, e.g., CKD patients have higher risk of stroke with co-existent atrial fibrillation but have higher risk of bleed with preventative anticoagulants at the same time; frequent electrolyte shifts during dialysis can precipitate arrhythmic sudden death in patients with congestive heart failure. Therefore, cross-training in these two specialties is essential to treat these complex patients.
The cardiorenal training track with in the nephrology fellowship is a concerted effort to bridge the knowledge and skills between fields of cardiology and nephrology. The goal of the track is to foster the development of a cardionephrologist who is competent managing complex cardiorenal interactions and is a critical member of the multidisciplinary patient care team.
The fellow opting for this track will spend the elective months and/or research months within variety of cardiology disciplines such as CCU, heart station learning non-invasive imaging, heart failure program, cath lab and general cardiology consult, working with cardiology colleagues with focus on patients with heart and kidney ailments. Fellows opting for research will join the faculty with cardiorenal expertise in their ongoing projects or develop new projects. The majority of these elective and research months will be offered during first year of fellowship to the fellow interested in applying for future cardiology fellowship to have a strong cardiology application by the beginning of the second year.
After completing 2 year- nephrology fellowship -cardiorenal track, fellows will be eligible for nephrology board certification. However, this track does not full fill any of the requirements of future cardiology fellowship or board certification.
Renal physiology and pathophysiology play a large role in critically ill patients. Critical care nephrologists are uniquely positioned to deliver the best care to these patients and have become an important and invaluable asset to the ICU team. Individuals who wish to practice intensive care medicine built upon a foundation of nephrology can decide to opt for this track at any point of their nephrology fellowship.
This track consists of two years of clinical nephrology training followed by one-year training in Critical Care in the Division of Pulmonary Diseases and Critical Care Medicine. The Pulmonary and Critical Care Fellowship at UT Health San Antonio is highly competitive and consists of faculty educators who are award-winning leaders in education and have been recognized both nationally and internationally in this respect.
Many of our faculty educators are also on the boards of national and international clinical guidelines providing trainees with up-to-date training. Following completion of this track, graduates are eligible for certification in both Nephrology and Critical Care Medicine by the American Board of Internal Medicine.
There is a growing need for clinicians with the perspective of a clinical nephrologist and the skills of a proceduralist. The fellows interested in pursuing a career in interventional nephrology will commit for this track by the middle of the first year. This training will be provided over 5-6 months during the second year at the San Antonio Kidney Disease Center Vascular Access Center which is accredited by American Society of Diagnostic and Interventional Nephrology (ASDIN). During this training, the fellows will perform set number of procedures under the supervision of ASDIN accredited faculty to become eligible for ASDIN certification. Demonstration of pertinent scholarly activity is also expected.
Each second-year fellow is provided with 4 months to work with a research mentor. The mentor is identified during the fellow’s first year. There are ample opportunities for research at the basic, translational and clinical levels. The division takes pride in its rich contribution to the research in diabetes, acute kidney injury, aging, cardio-renal disease, fibrosis and genetic basis of kidney disease.
We are also major contributors and active in the NIH funded Kidney Precision Medicine Project, which is the future of kidney disease. We participate in multiple NIH consortia, individual and large multi-PI grants, and industry-sponsored clinical trials. An optional third year is available to the interested fellows in pursuing their research projects and applying for career development grants.