Division of Nephrology

The Nephrology Division at Thomas Jefferson University provides a comprehensive two year fellowship training experience, directed by Rakesh Gulati, MD, the James F. Burke, Jr MD, Nephrology Fellowship Program Director and Omar Maarouf, MD, Assistant Fellowship Director. Our overall goal is to furnish a highly structured clinical and research experience for trainees to develop the skills necessary to pursue successful careers in clinical nephrology and/or scientific investigation. This goal is to be accomplished under the auspices of the University, whose general mission it is to:

• Provide state-of–the-art, compassionate and cost-effective healthcare services
• Teach future healthcare professionals
• Lead research, develop and introduce improved methods of healthcare delivery to benefit everyone

Why Choose Jefferson Renal?

Our program is celebrating the 40th anniversary since it inception and is comprised of a two-year renal fellowship that features rigorous clinical training, clinical research and a teaching experience with focus on empathy and respectful delivery of care to our patients with kidney disease. There are options for pursuing a year specializing in transplantation, critical care, onco-nephrology and enrolling in master's programs at the Jefferson school for population health.

Starting sub-specialty training can feel like a daunting endeavor, for this reason, all in-coming fellows undergo a two-week orientation with hands-on experience from their senior fellows on various inpatient wards to help integrate to our system, understand the workflow including the use of our electronic medical record, EPIC. During this prepraratory period, new fellows will be exposed to a series of didactic and practical interactive sessions to review the basics of renal care, including how to address renal emergencies, write hemodialysis and peritoneal dialysis orders, review immunosuppression protocols at TJUH and to understand essential clinical concepts of kidney transplantation

Clinical Training

The Fellowship training experience of the nephrology division at Thomas Jefferson University offers an exceptional practical and clinical training in every aspect of nephrology, making our graduating fellows ready for an all-encompassing career whether in academia or private practice. The fellowship provides an interwining clinical and academic experience that grants a broad knowledge of kidney disease with a focus on skills to integrate various equally important principles: interpersonal skills, professionalism, empathetic care and lifelong learning.

Jefferson Heatlh

Thomas Jefferson University Hospital is the flagship of Jefferson Health, which encompasses more that 10 hospitals in the Philadelphia metropolitan area and southern New Jersey.  In the heart of Philadelphia's historic area, Thomas Jefferson University Hospital is a 937 licensed-bed hospital that is home to Sidney Kimmel Medical College and teaching hospital for Thomas Jefferson University. Thomas Jefferson University Hospital and its affiliated hospitals serve a diverse patient population that spans across the tristate area of southeastern Pennsylvania.  From bread-and-butter diabetes and hypertension to the rarest of presentation, fellows at Thomas Jefferson University Hospital will see it all. Our renal services are divided into consultation, ICU, dialysis and transplation services.  Servicing as the referral hub of the most-challending cases for its sister hospitals, our fellows are exposed to multitude of pathology featuring SLE and various other autoimmune glomerular diseases, extensive onco-nephrology with a robust bone marrow transplant unit.  Our fellows will treat complex renal transplant cases with a robust solid organ transplant program including heart, liver, pancreas and soon, lung transplants. Thomas Jefferson University Hospital is home to the world's first successful bypass surgery and is a world-renowned cardiac and heart failure center providing our fellows with exposure to extremely ill patients with renel failure on ventricular assistive devices, Impella heart pumps, ECMO and various other life-sustaining devices of the heart and lung.

Fellowship Rotations

Year One

There are four hospital rotations during the first year: floor consult, ICU consult, ESRD, transplant. Each fellow spends two weeks on each rotation for a total of three months on each of the four rotations. One attending and one fellow staff each rotation, except consult service where one attending will be covering the consult floor and ICU services with its corresponding fellow.  The goals and objectives of the rotation or learning experience will be discussed by the faculty and fellow at the start of each rotation. Each fellow will have direct supervision by faculty in all patient care activities. Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Fellows will provide effective and timely communication with Transplant Surgery/ICU Teams/Hepatology/Heart Failure Service/House Staff as warranted by clinical situations.  Despite the rigors of busy patient lists, our fellows have many opportunities to develop and hone their teaching skills, including formal teaching of medical students, residents, NP students, attending opportunities on teaching services alongside dedicated academic clinician-educator faculty.

1. Inpatient Dialysis – The fellow will oversee managing all dialysis patients on the ESRD service and will manage the renal/dialysis care of all other chronic dialysis patients admitted to other medical/surgical services.
2. Inpatient Transplant – The renal fellow will participate in all aspects of the transplant patients care. The fellow will oversee managing all transplant patients admitted to the primary nephrology service and will actively provide consultative care to all newly transplanted patients on the surgical service. The fellow will also perform transplant biopsies with the attending supervising.
3. Inpatient Consultation – The fellow, along with medical residents and medical students assigned to this service, will provide consultative services for patients with acute renal failure, chronic renal failure, glomerular and interstitial diseases, fluid and electrolyte abnormalities, acid-bases disturbances, hypertension and for patients in the bone marrow transplant unit.
4. Inpatient ICU Consultation - The fellow will provide acute renal care to various intensive care units. the fellow will build a robust experience in renal replacement therapy in the form of continous renal replacement therapy or bedside intermittent hemodialysis.  Fellows are exposed to extreme pathology including end-stage heart failure with use of ventricular assist devices and ECMO Fellow will also treat patients  with end-stage liver failure with a liver-assist device combined with renal replacement therapy - MARS: Molecular Adsorbent Recirculating System.

Continuity Clinic

Year One

The first-year fellow is assigned to an attending's outpatient clinic. Starting in early September of their first year, the fellow will work one-on-one with the attending in the outpatient office half a day per week.  Fellows are expected to see two to three patients per session.

Year Two

During the second year, fellows will see more outpatients in two assigned general nephrology clinics to sharpen their outpatient kidney care skills in addition to rotating in various kidney transplant clinic disciplines.  This experience will prepare our fellows to address all aspects of kidney disease and kidney transplantation in ambulatory care setting.  This year also included in-center hemodialysis training at the Walnut Towers dialysis center, which is just a one block walk from our main hospital campus.  The outpatient renal replacement experience also includes exposure to home modalities with a monthly visit to our home hemodialysis clinic and bi-weekly visit to our peritoneal dialysis clinic.  Our fellows will graduate as experts in home hemodialysis modalities.

The second year fellows will be responsible for covering clinical rotations when the first-year fellows take ABIM exams, vacations, emergency leave or are otherwise not working

For more information, please contact Rakesh.Gulati@jefferson.edu or Omar.Maarouf@jefferson.edu

Transplant Fellowship

The Transplant Nephrology Fellowship at Thomas Jefferson University is accredited by the American Society of Transplantation and directed by Maitreyee Gupta, MD, Transplant Nephrology Fellowship Director.  It is designed to provide one year of advanced training and expertise in the field of kidney transplantation, to trainees who have completed ACGME general nephrology training requirements.  We accept one fellow every year into our program.  

The Thomas Jefferson University Kidney/Pancreas Transplant Program is an integrated service of transplant professionals - nephrologists, surgeons, physicians-scientists, advanced practitioners, nurses, pharmacists, other transplant sub-specialists, coordinators and support staff.  The program focuses on developing fellows' clinical skills and leadership qualities in managing complex transplant patients and leading teams.  It fulfills the requirements established by United Network of Organ Sharing (UNOS) for individuals to stand as the approved transplant physician for any kidney transplant program.

The Transplant Fellowship experience includes both in-patient (6 month) and out-patient (6 month) management of transplant recipients as the primary transplant caregiver.  The trainees will learn to lead medical management with regards to immunosuppression, rejections, diagnose and treat infections specific to kidney transplant recipients and use of molecular biomarkers for surveillance. They will become apt at managing anti-infective prophylasis, diabetes, hypertension, anemia, dialysis for delayed graft function and weaning off immunosuppression when needed.  Training includes direct observation of at least three kidney transplants and procurements.  It also includes understanding indications for transplant biopsies, performing and interpreting them.

Transplant candidate evaluations are done by a multidisciplinary team which reports to transplant evlauation committee.  All new transplants are cared for in one nursing unit dedicated to solid organ transplantation.  All new recipients are discharged closely in dedicated clinics by transplant nephrologists and surgeons.  Long-term transplant recipients hospitalization are admitted to medicine service and nephrologists lead as consultants.  Twice weekly pre-transplant recipient evaluations, participation in weekly multidisciplinary recipient selection and waitlist management committee, donor evaluation and presentation at multidisciplinary donor selection committee, are built program essentials to give rigorous in-debth transplant training experience.  Quality Assurance and Performance Improvement (QAPI), is increasingly becoming a requirement for healthcare providers and participation in monthly QAPI meeting, Case-based error reduction conferences are designed to train our fellow to be future health care leaders.

The elective experience includes at least one week of transplant Infectious Disease service and two weeks in HLA laboratory.  They also participate in CKD clinics for non-kidney solid organ transplant recipients.  The conferences include weekly renal division conferences and grand rounds, weekly multidisciplanary patient selection committe and transplant journal clubs.  Trainees will be expected to participate in clinical research projects and present/publish and resultant data.  Every year the American Society of Nephrology conducts an extensive 3-day Fellow Symposium in September and our fellows are encouraged to leverage this for networking and expending their knowledge base.  Direct mentorship and career development guidance for the experienced faculty ensures support for accelerated person and professional growth.

All transplant clinics and in-patient rounding that trainees attend are in close vacinity of 1-2 block with Center-City Jefferson Hospital.  This is a high-volume transplant center in Philadelphia including simultaneous kidney-panceas transplant, liver-kidney transplant and simultaneous heart-kidney transplantation, with excellent outcomes.

For more information, please contact Maitreyee.Gupta@jefferson.edu.

Research Experience

During the second year, fellows participate in either a basic science or clinical research project. Research is expected to consume approximately 40% of the second year fellow’s time. Fellows are to present their data every four months during the year during a basic science/research conference. Fellows are expected to write at least one abstract or other scholarly project (case report, literature review, etc.) during their second year.  Presentation at scientific meetings is encouraged. We Also Mandate our fellow to take on a Quality Improvement initiative in our division which drastically improves their experience toward efficient and empathic care.