About the Program

The Pediatric Nephrology fellowship at The University of Iowa is a three-year program that provides training in all aspects of clinical pediatric nephrology and gives fellows tailored opportunities for participation in clinical, translational, or basic science research. Our fellowship program is integrated into the global fellowship training program in the Stead Family Department of Pediatrics and offers broad educational opportunities across the campus. In addition, we have a pediatric nephrology fellows lecture series which covers all the pediatric nephrology content specifications of the ABP to prepare our fellows for success in both the pediatric nephrology board exam and in clinical practice.

We offer unique opportunities in rare renal disease education with a dedicated clinical program with an international referral base. This is supported by the University of Iowa Institute for Human Genetics and is a cross disciplinary program. Our faculty have varied clinical and research interests from basic science to clinical quality improvement, to neurocognitive outcomes in CKD, and more.

Schedule

Below is a typical 3-year Pediatric Nephrology Fellowship schedule. In addition to the rotations listed below, fellows participate in an outpatient continuity clinic, where they follow their own patients longitudinally. All attending nephrologists participate in staffing the continuity clinic.

Year 1

Inpatient Services*: 16 weeks
Dialysis Outpatient Unit: 8 weeks
Outpatient General Nephrology: 8 weeks
Pathology: 4 weeks
Urology: 4 weeks
Research: 4 weeks

Year 2

Research: 28 weeks (7, 4-week blocks)
Dialysis Outpatient: 4 weeks
Pheresis/Blood Bank: 4 weeks
Inpatient: 8 weeks

Year 3

Research: 28 weeks (7, 4-week blocks)
Transplant (adult/surgical rotation): 4 weeks
Inpatient: 8 weeks
Dialysis Outpatient: 4 weeks

*Inpatient service time is typically divided into month-long blocks

Clinical Rotations

The Division of Pediatric Nephrology divides its rotational service into month-long blocks. 

Our inpatient Pediatric Nephrology Service, which is staffed by pediatric residents, is quite active with over 170 admissions per year.  In addition, we see over 130 consults from various other inpatient services including the neonatal and pediatric intensive care units.  We conduct over 2,000 outpatient clinic visits annually.  We have an extensive referral base not only within the State of Iowa, but also from southern Minnesota, southwestern Wisconsin, western Illinois, eastern Nebraska, and northern Missouri.  Patients come from across the USA and internationally to receive care in our Rare Renal Disease Clinic (Carla Nester, M.D.), which specializes in the care of patients with atypical hemolytic uremic syndrome and C3 glomerulopathy.

We have an independent pediatric dialysis unit which provides peritoneal dialysis and hemodialysis to pediatric patients.  The unit is fully staffed with dietician and social work support to meet the complex needs of our pediatric patients.  Our pediatric dialysis nurses are skilled at fistula development and access. Fellows are expected to co-manage dialysis patients with staff and rotate in the dialysis unit during fellowship training.

Our division is fully accredited as a pediatric kidney transplant center.  Fellows are expected to actively participate in the management of kidney transplant recipients and can rotate with the adult and surgical transplant teams during their second/third years of fellowships.  We also enjoy an excellent, friendly relationship with our transplant surgery division.

Fellows perform or are directly involved in a diverse number of procedures.  All procedures are supervised by faculty.  These include:

  • Percutaneous kidney biopsy (native and transplant)
    • The assistance of pediatric anesthesia is available for kidney biopsies.  In high risk or critically ill patients, general anesthesia is utilized.  We perform more than 30 kidney biopsies per year on pediatric patients.
  • Acute and chronic dialysis therapies (hemodialysis and peritoneal dialysis)
  • Continuous renal replacement therapy (CRRT) as standalone therapy and in line with extracorporeal membrane oxygenation (ECMO)

Education and Conferences

Pediatric Nephrology Fellows Lecture Series

This twice-monthly lecture series is designed to cover the full content specifications of the Pediatric Nephrology sub-board of the American Board of Pediatrics every 2 years in a rotating schedule. The lectures are mostly given by the attending pediatric nephrologists, but the series also includes guest lectures from pharmacy, urology, dialysis nurse management, hospital administration, and dialysis water management. Fellows present selected topics 3-4 times per year.  Lectures are designed to be interactive, and the small group format encourages fellows to ask clarifying questions to maximize their learning. 

Pediatric Nephrology Division Meetings

These weekly meetings include case discussions and division updates.  The current inpatient cases are discussed as well as outpatient cases as needed. 

Pediatric Fellows Core Curriculum Seminars

Weekly departmental fellow seminars provide opportunities to enhance professional development, explore research options, and advance teaching skills.  Our fellows interact with other pediatric faculty and fellows during these conferences.  They have a chance to present their research to the pediatric department, get feedback, and learn how to evaluate their peers' research projects.

Pediatric Dialysis Patient Care Conference and Quality Assurance/Performance Improvement (QAPI)

These meetings involve discussions on dialysis outpatient care.  We review each dialysis patient with discussion of laboratory results as well as concerns that the primary physician may have regarding growth/nutrition, social well-being, or ability to refer to transplant.  This session includes teaching about pathophysiology, management of dialysis problems, and discussion with specialized team members including dialysis nurses, dietician, and social work.

Pediatric Transplant Surgery Conference

This monthly conference gives the fellows the opportunity to interact with the pediatric transplant team.  Pediatric patients who are pending kidney transplant are discussed during these meetings.

Pathology Meetings

Ad-hoc meetings with the renal pathologist are set via videoconference to review slides remotely, allowing fellows and faculty to see the slides with the helpful guidance of the pathologist.

Combined Adult and Pediatric Nephrology Fellows Seminars

Dialysis "Practicals"

These review sessions allow fellows to see the equipment, learn the technical aspects, and evaluate actual patient studies.  Clinical cases conferences are chosen from pertinent patient scenarios with interesting or difficult diagnoses or a diagnostic and therapeutic dilemma.

Journal Club

Topics are chosen to discuss state of the art or cutting-edge articles.  Case based discussion sessions are run by faculty and are aimed at assessing the fellows' knowledge base and thought process in article interpretation and review.

Fellows' Pathology Conference 

Staff renal pathologists provide teaching seminars for adult/pediatric fellows to review cases and pertinent pathology.  Fellows can practice use of the microscope and discuss basic to advanced pathology in a conversational setting.

Adult/Pediatric Pathology Conference

Staff renal pathologists chose interesting cases to be presented at a joint adult/pediatric pathology conference and discuss the clinical and pathological correlates of the case.  The referring physician (staff or fellow) is asked to present the case.

Board Review

These seminars include a variety of teaching sessions on a rotating basis.  Fellows discuss core curriculum based on KSAP (American Society of Nephrology).

Research Opportunities

Our division actively publishes in both the basic science and clinical research realms. All fellows in our program are required to complete a basic science or clinical research project. There are a numerous opportunities for research in any field of interest across all subspecialties both within and outside of our own division. Research within our division includes the work of Dr. Carla Nester, Dr. Lyndsay Harshman, Dr. Jason MisuracDr. Kathy Lee-Son,vand Mary Lee Neuberger, APN

Fellows also have the opportunity to find research mentors outside the division. For example, previous fellows had mentors in Internal Medicine Endocrinology and Adult Psychiatry/Neurology.

You can find a list of our publications here.PDF iconNephrology_Division_Publications_2016-2018.pdf

Our faculty and staff participate in numerous national pediatric nephrology collaboratives, which also provide opportunities for fellow engagement, involvement, and research:

Improving Renal Outcomes Collaborative (IROC): IROC is a national collaborative including 32 pediatric kidney transplant centers. IROC’s mission is “to partner with patients with kidney disease and their caregivers to achieve health, longevity and quality of life equivalent to the general population, by harnessing the inherent motivation and expertise of all stake holders to improve care, spawn innovation and conduct research that improves health and outcomes.”

  • Lyndsay Harshman 
    • Local IROC PI
    • IROC Research committee member
  • Jason Misurac 
    • Local IROC co-PI
    • IROC Quality Improvement/Information Technology committee leader
    • IROC Research committee member

Nephrotoxic Injury Negated by Just-in-Time Action (NINJA): NINJA is a multi-center collaborative of 15 children’s hospitals. Their mission is to “eliminate all preventable cases of nephrotoxic medication associated AKI in hospitalized children.” Their vision is that “children should only get the nephrotoxic medications they need for the duration they need them.” 

  • Jason Misurac 
    • Local NINJA PI
    • NINJA Nephrotoxic Medication Subcommittee Leader

Neonatal Kidney Collaborative: The mission of the NKC is to improve the health of newborns with or at risk for kidney disease through multidisciplinary collaborative research, advocacy, and education.  www.babykidney.org

  • Jennifer Jetton
    • Steering committee member
    • Education committee co-chair

CKiD: Chronic Kidney Disease in Children Study: The CKiD Study is a NIH-funded, multicenter, prospective cohort study of children aged 6 months to 16 years with mild to moderate kidney function impairment.

  • Lyndsay Harshman
    • Local PI

Cure Glomerulonephropathy: (CureGN) is a multicenter five-year+ cohort study of glomerular disease patients funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes for Health (NIH).

  • Carla Nester
    • Local PI

SCOPE: The Standardized Care to Improve Outcomes in Pediatric End-stage Renal Disease (SCOPE) collaborative prevents infections in pediatric peritoneal dialysis and hemodialysis patients using large-scale collaboration to identify and spread effective interventions across pediatric care settings.

  • Kathy Lee-Son
    • Local PI

Pediatric Nephrology Research Consortium (PNRC): The PNRC started in 2004 as the Midwest Pediatric Nephrology Consortium with a mission to develop and execute multi-center clinical and translational studies related to pediatric kidney diseases. With over 200 members, it continues to be an active continent-wide platform for collaborative research by investigators dedicated to developing the evidence for the best standards of care for children with kidney disorders. 

  • Jason Misurac
    • Member
    • Website Committee Leader 

FAQ

Will I receive excellent clinical training at the University of Iowa?

Yes! Our active inpatient service, dialysis unit, and transplant program allow fellows to learn through experience and personalized one-on-one teaching. The fellows’ continuity clinic teaches fellows to manage their own patients. And our didactic lecture series ensures that all American Board of Pediatrics Pediatric Nephrology content specifications are covered on a 2-year rotating schedule. Fellows find that there is excellent balance between service expectations, protected research time, and learning. Our fellows graduate confident in their ability to care for patients across the full spectrum of pediatric nephrology.

What is the general outcome of your fellows?

All graduated fellows have passed the pediatric nephrology subspecialty board examination on their first attempt. All have obtained positions in pediatric nephrology at academic medical centers.  

How will I identify a research mentor and project?

The University of Iowa is a very strong research institution with basic, translational, and clinical research. Research mentors may be found within the division of pediatric nephrology but may come from another department depending on the fellow’s research interests. During the first few months of fellowship, fellows are encouraged to meet with several clinical and basic science investigators who have ongoing projects that match their own interests. The fellowship program director and associate program director will help facilitate these meetings. Should a fellow enter the program with a strong background in research or an identified project, a mentor with similar interests may be identified before the fellowship starts. A strong mentor-fellow relationship is imperative to success in research.

Will I have protected time to perform a research project and meet board eligibility requirements?

Yes. Research blocks are protected time. It is requested that fellows attend their outpatient continuity clinic and educational conferences. All other activities during research blocks should be dedicated to research, which allows our fellows to complete their research projects, meeting board eligibility requirements.

What is the call schedule?

Call is dependent on the rotations - during all three years fellows are expected to cover 2 weekends per month. During the inpatient rotations, nephrology fellows share call with the attending physicians every other night. 

Is a Masters Degree available to interested fellows?

Yes. A Masters in Medical Education is offered by the University of Iowa Carver College of Medicine

The University of Iowa Masters of Science in Clinical Investigation is designed for clinicians interested in pursuing careers in clinical research and is offered by the University of Iowa Department of Epidemiology in cooperation with the Institute for Clinical and Translational Science

Tuition discounts and tuition assistance are available. Schedule accommodations will be made to allow interested fellows to pursue a Masters Degree.  

Where is Iowa City?

Iowa City is 220 miles (3-4 hours) directly west of Chicago on Interstate 80. It's also within a 4-5 hour drive to Minneapolis, Omaha, Kansas City and St. Louis. It has the cultural, educational, social, and political opportunities of a bigger city with the ambiance of a Midwestern town. It’s clean, safe, it has a great city bus system (with bike racks!), wonderful parks, sports, schools and even sailing. Nothing is farther than a 15 min drive, and there are many affordable and safe housing options near the hospital. Those who have lived here and left, frequently return because what they were looking for was in their own back yard. 

How ethnically diverse are the patients?

Like a lot of university towns, Iowa City has a large international community. Growing cultural diversity is another reason Iowa City is an interesting and exciting place to live. Diversity is embraced and celebrated with city and university events, festivals, clubs and programs. The University works hard to recruit and retain minorities with its affirmative action policies. About 13% of Iowa citizens are non-white as are almost 13% of the patients seen in our clinic.

What is it like to live in Iowa City?

Iowa City and the surrounding areas of North Liberty and Coralville are great places to live! Who doesn't love a commute time of less than 20 minutes? Explore what Iowa City has to offer through our Discover Iowa page.

Are there any job opportunities for my spouse/significant other?

The Iowa City area boasts many employment options with businesses large and small, including the University of Iowa, one of the state’s largest employers.  

Do you have a freestanding children's hospital?

Yes. The University of Iowa Stead Family Children’s Hospital is a freestanding state-of-the-art pediatric hospital opened in 2017.

Honors/Recognition

University of Iowa Stead Family Children’s Hospital is the only children’s hospital in Iowa nationally ranked for pediatric care by U.S. News and World Report. Read June 15, 2021 press release.

  • 25 in Neonatology
  • 35 in Pediatric Orthopedics
  • 41 in Pediatric Diabetes and Endocrinology
  • 27 in Pediatric Nephrology
  • 50 in Pediatric Neurology and Neurosurgery

The 13th annual Best Children’s Hospitals rankings recognize the top 50 pediatric facilities across the U.S. in 10 pediatric specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology and gastrointestinal surgery, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology and lung surgery, and urology. 

UI Stead Family Children’s Hospital and the UI Stead Family Department of Pediatrics are recognized nationally for a number of achievements.

Pediatric researchers at the University of Iowa have a long history of breakthrough discoveries in both the clinical and laboratory setting. Meet members of our research team: