Nephrology elective experience during medical residency: a national survey of US nephrology fellowship training program directors.

Interest in nephrology careers continues to decline in the United States. The reasons for this declining interest are not fully understood but it is plausible that inadequate exposure to the full spectrum of what a career in nephrology encompasses may be part of the explanation. Inpatient-based nephrology electives have been a common venue for residents to gain exposure to nephrology but little is known regarding the details of such electives and how often they include outpatient experiences. We carried out a national survey of nephrology fellowship training program directors to obtain data on the content of nephrology elective experiences as well as their ideas on how to promote interest in the field. The survey revealed the majority of elective experiences to be either exclusively or heavily inpatient based, with only a small percentage having a substantial outpatient component, particularly in outpatient dialysis or transplantation. Training program directors felt that providing greater outpatient experiences to residents during elective rotations would be an effective means to promote interest in nephrology, along with structured faculty mentoring. Our findings suggest that current approaches to the nephrology elective experience are heavily inpatient-based and might benefit from incorporating much more of the rich spectrum of activities a career in nephrology entails. Hopefully such efforts can create and enhance interest in careers in nephrology and potentially begin a sustained reversal of an unfortunate and serious decline in interest.

Pregnancy management of diabetic renal transplant patients.

Advances in medical care and options for medications for diabetic kidney transplant recipients have allowed for successful pregnancies to be carried to full term. End-stage renal disease leads to impaired fertility. Fertility is restored 1 to 6 months after a successful kidney transplant. Poor glycemic control near the conception period leads to a higher incidence of major fetal malformations and spontaneous abortion. Preconception counseling about risks of medications, control of comorbid conditions, stability of allograft function, and potential risks to mother, fetus, and allograft has to be done. Close and careful monitoring of mother, fetus, and allograft is important in ensuring a good outcome.