Introduction

Welcome

History

Important papers

2008

2007

2006

2005

2004

2003

More..

The Department

Faculty

Residents

Research scholars

Statistics

Teaching activities and materials

Seminars

Case discussions

Journal Clubs

Useful resources

For physicians

For patients

Other links

Welcome

Welcome to the PGIMER Nephrology department's website.

Here you can find information about the place that started world's first structured nephrology training program.  So far about 125 students have qualified for the DM degree of the Department. A number of the big nephrology programs of the country have been started by PGI alumni. They continue to bring laurels to their alma mater by excelling in their fields.

The Training Program

The training program became the first Asian nephrology program outside of Japan to be featured in the Trainee Forum section of the journal Hemodialysis International.

In 1969, Postgraduate Institute of Medical Education and Research (PGIMER) became the first center in India to start a nephrology training program. Selection for fellowship training leading to the award of postdoctoral (DM) degree is through a nationwide entrance examination. In this 3-year course, fellows spend one year looking after patients in the nephrology inpatient service, one year in dialysis, 3 months in transplant services, 3 months providing consultations to patients admitted in other specialties and 6 months in laboratories learning about basic and applied research techniques.

PGIMER is the largest tertiary care hospital in north India, and receives patients with all types of renal diseases. On an average, 110 new ESRD patients and 50-60 cases with ARF are seen every month.

Teaching activities include renal grand rounds and case presentation by trainees to department faculty, fortnightly journal clubs where trainees discuss important new research publications, and seminars in which topics related to renal physiology or new advances are reviewed. Joint sessions are held fortnightly with pathologists to review kidney biopsies, and another one with radiologists to discuss and teach interpretation of radiology, once a month with the department of nuclear medicine and with Urologists every 2 weeks.  Nephrology trainees also participate in teaching activities common to all medical specialties and are required to teach Internal Medicine residents during their nephrology rotation. All trainees are required to conduct at least one research project under the direct supervision of faculty and must submit a dissertation to be eligible to appear for the final examination.

Trainees are taught procedural skills including kidney biopsies, central venous catheterization to establish temporary access for dialysis and placement of acute peritoneal dialysis (PD) catheter. An ultrasound machine is available in the department, and residents learn to study renal anatomy and perform native and allograft kidney biopsies under real time guidance in the unit without help from radiologists. On an average, each trainee performs approximately 120 kidney biopsies, 170 central venous access procedure and places 275 PD catheters.

A resident is available on the hospital premises round the clock to provide consultations to other medical, surgical and obstetrics units and for providing follow-up for dialysis and transplant patients. About 20 fresh consult requests are received daily. There is no separate pediatric nephrology unit and trainees gain valuable experience by providing service to neonates and children admitted in Pediatric services.

Outpatient Services:

Four half-day outpatient clinics are held every week; one exclusively for kidney transplant recipients. These are on Mondays, Wednesdays and Saturdays (Renal Clinic) and Thursday (Renal Transplant Clinic). The nephrology department also runs the general medical outpatient and emergency service every Saturday.

Students pursuing the postgraduate (MD) course in Internal Medicine rotate through nephrology unit during which they learn basic principles of nephrology, assist Renal fellows in management and diagnosis of patients with kidney disease and participate in the teaching activities of the department.

Dialysis:

Both outpatient and inpatient dialysis is available. Available treatment modalities including hemodialysis, CRRT (continuous venovenous hemofiltration and hemodiafiltration), plasmapheresis, and acute and chronic PD. Trainees start CRRT and acute PD procedures and write down prescriptions, which are followed by nurses of the intensive care units. Patients are switched between different modalities depending upon their clinical condition. Being a referral center, there is a huge load of patients with ARF and those with dialysis-related complications. Acute PD is utilized to tide over an emergency if a slot for HD is not immediately available; about 3-4 such procedures are performed by trainees every day. ARF patients are dialyzed for as long as required, but ESRD patients on maintenance HD are referred to peripheral dialysis units after the complications have been sorted out and clinical condition has been stabilized. Emergency HD can be performed by the trainee round the clock.

Fellows lead morning rounds in the dialysis unit along with a member of the faculty, dialysis nurses and technicians, and do the afternoon rounds by themselves. A faculty member is always available for consultations. All problems related to dialysis patients are discussed in a weekly meeting with faculty, technicians and nurses. They also follow the chronic dialysis patients when they are hospitalized and coordinate care with the inpatient nephrology fellow.

Kidney Transplantation

Our center performs about 120-140 kidney transplants every year, almost all from living donors. Recipients and donors are worked up by trainees during their dialysis posting. Fellows are intimately involved in immediate post-transplant care including deciding and modifying immunosuppressive protocol along with nephrology and transplant surgery faculty. Long-term follow up is conducted through weekly clinics, and those requiring closer attention are admitted.

After successful completion of the course, candidate is eligible for appointment as Lecturer or Assistant Professor in medical colleges. A large number joins private sector hospitals and 25-30% go abroad and provide skilled nephrology services throughout North America, Europe, Australia and the Middle East.

© Vivekanand Jha, 2007-2008. Last updated 24-01-2008