Renal Pathology Fellowship

Faculty

Behzad Najafian, MD

Professor | Director, Renal Pathology Fellowship Program | Director, Electron Microscopy Laboratory

Shreeram Akilesh, MD, PhD

Associate Professor | Medical Director, Immunofluorescence Laboratory | Director, Digital Spatial Profiling Core Facility

Charles E. Alpers, MD

Professor | Nelson Fausto-Ann De Lancey Endowed Professor

Kelly Smith, MD, PhD

Professor | Director, Renal Pathology Service | Director, NWBioSpecimen | Director, Digital Spatial Profiling Core Facility

Description

The Renal Pathology Fellowship at the University of Washington is a fellowship jointly supported by the University of Washington Medical Center and the Department of Pathology. The purpose of this fellowship is to provide an intensive experience in diagnostic renal pathology, with broad experience in the techniques of evaluation of specimens by light microscopy, immunofluorescence microscopy, electron microscopy, immunohistochemistry, and other adjunctive techniques relevant to the clinical diagnosis of renal biopsy material. The fellow will join with the pathology faculty in all aspects of the routine diagnostic work-up of all renal biopsies accessioned by this hospital, including immunofluorescence microscopy studies and full work-up and analysis by electron microscopy.  In the course of such studies, the fellow will also gain experience in the management and supervision of hospital laboratories that perform each of these functions. It is expected that at the end of one year, the fellow would have sufficient diagnostic experience to be able to function independently as a diagnostic renal pathologist in an academic medical center. Currently, we receive ~1,500 renal biopsies a year, ~1/3 of which are from transplants and the rest are from native kidneys.  Our program accepts one fellow per year.

Program Goals and Objectives

Typical Schedule

All biopsies received in the morning are processed the same day and those received in the afternoon are processed the day after the specimens are received. Immunofluorescence and light microscopy slides are reviewed in the afternoon and the preliminary diagnoses are communicated with the clinicians immediately after reviewing the slides. The fellow previews the slides initially and constructs a preliminary diagnosis followed by a joint review with the attending. The electron microscopy images become available in three business days, after which a final report is generated. We have three regular conferences where we present biopsies for clinical and educational purposes. These include weekly clinical-pathological renal biopsy conference at UWMC, monthly renal biopsy conference at Renal Grand Round at Northwest Kidney Center and monthly HLA/Renal pathology journal club at UWMC. In addition, the fellow is expected to attend the monthly pediatric renal biopsy conference at Seattle Children Hospital. As the fellow progresses in his/her training assumes more responsibilities in handling biopsies, communication with physicians and presenting at local conferences. Fellows are encouraged and supported to attend the Renal Pathology course "Renal biopsy in medical diseases of the kidney" at Columbia University and USCAP meeting. There are many other educational opportunities offered at the University of Washington that fellows can benefit from based on their time and interest.

Typical Schedule

Educational Resources

Renal Pathology Clinical Service, including recorded seminars

Nephrology Grand Rounds – Kidney Biopsy Conference

Renal Pathology Twitter

Research Opportunities

The long-range goal of this fellowship is to train academic renal pathologists, and therefore an important component of the fellowship is engagement in clinical and/or basic research. Clinical research studies are incorporated into the daily diagnostic work of the fellow, and are based on the material accessioned by the renal pathology service. More basic research will utilize projects ongoing in research laboratories. It is anticipated that involvement in these latter studies would involve one or more additional years of research training beyond that provided in the diagnostic portion of the renal pathology fellowship. Interested fellows are encouraged to apply or arrange for such opportunities early on since typically available funded positions are limited and competitive.

Dr. Alpers has an extensive record of morphologic studies that utilize human renal biopsies to validate in human diseases the insights gained from studies of animal models in his laboratory. Examples of this include studies on platelet-derived growth factors (PDGF) and their receptors, vascular endothelial growth factor (VEGF), osteopontin, cell cycle regulatory proteins, and matrix proteins in diabetic nephropathy. He has been the Principal Investigator of an NIH funded Mouse Metabolic Phenotyping Center Core that was a participant in the NIH funded Animal Models of Diabetic Complications Consortium, a position which has afforded him considerable insight and experience in evaluating diabetic nephropathy and diabetic complications involving the kidney and other organs. He has been a leader in characterizing the BTBR ob/ob mouse model of diabetic nephropathy and other diabetic complications. He has established a role for podocyte regeneration in the regression of diabetic nephropathy that can be induced in this model and then translated these findings into comparable studies in humans using renal biopsies accessioned at the University of Washington. His long record of translational studies of expression of specific genes and proteins in diseased and developing kidney tissues has enabled him to participate as a pathologist leader in the NIH funded Kidney Precision Medicine Project  (KPMP) which seeks to blend a variety of cutting-edge transcriptomic, proteomic, and metabolomic technologies with digital pathology using research renal biopsies obtained from patients with acute and chronic kidney disease. The goal of the KPMP is to develop molecularly informed diagnostics applicable to clinical renal biopsies and identify new therapeutic targets for the treatment of kidney disease.  

Dr. Nicosia’s research has focused on mechanisms of angiogenesis and the development of methods to study the angiogenic response to injury and pathologic stimuli. As a practicing pathologist, Dr. Nicosia has a special interest in medical renal disease and the diagnostic evaluation of kidney biopsies with light, immunofluorescence, and electron microscopy techniques. Dr. Nicosia’s research publications can be viewed on PubMed here.

Dr. Smith has research program focused on immunity and inflammation, and the implementation of new technologies to help understand the mechanisms of kidney diseases. With others at the University of Washington, we have used proteomic technologies to identify DNAJB9 as a putative autoantigen in fibrillary glomerulonephritis.  Ongoing efforts are directed at defining the function of this molecule in kidney disease, and using proteomics to better understand and diagnose kidney diseases.  Fellows will be encouraged to participate in these studies and other translational projects and clinical studies conducted by us and other members of the University of Washington community.

Dr. Najafian's lab is currently engaged in comprehensive studies of diabetic nephropathy and Fabry nephropathy, using unbiased quantitative electron microscopy, machine learning, podocyturia assay, and molecular biology techniques. Dr. Najafian is a principal investigator of NIH-funded Lysosomal Disease Network (LDN). One or two funded fellowship/post-doc positions may be available through LDN or other sponsors. More details about Najafian’s lab can be found at https://dlmp.uw.edu/research-labs/najafian.

Dr. Akilesh’s laboratory uses epigenomics, spatial transcriptomics and integrative multi-omic analysis to understand the structure and function of the kidney in health and disease. More details about Akilesh’s lab can be found at here.

The graduates of our program primarily go on to positions in academic medicine combining clinical practice in diagnostic renal pathology and basic kidney and translational research. 

  • M. Barry Stokes, MD - Columbia University Medical Center, New York, NY
  • Kelly Smith, MD, PhD - University of Washington, Seattle, WA
  • Nedjema Sustento-Reodica, MD - Northwestern University, Evanston, IL
  • Jolanta Kowalewska, MD - University of Washington, Seattle, WA
  • Anthony Chang, MD - University of Chicago Hospitals, Chicago, IL
  • Erika Bracamonte, MD - Arizona Health Sciences Center, Tuscon, AZ
  • Alexander Kats, MD - Children's Mercy Hospital, Kansas City, MO
  • Xiaotong "Tony" Wang, MD - Northshore University Hospital, Long Island, NY
  • Ryuji Ohashi, MD, PhD - Weill Cornell Medical College, New York, NY
  • Fernando Palma-Diaz, MD - Univeristy of California, Los Angeles, CA
  • Kotaro Sasakim MD - Hokkaido University School of Medicine, Hakodate, Japan
  • Shreeram Akilesh, MD, PhD - University of Washington, Seattle, WA
  • Dao-Fu Dai, MD, PhD - Nephropath, Little Rock, AR
  • Mercury Lin, MD - Cedar Sinai Medical Center, Los Angeles, CA
  • Mirna Toukatly, MD – Pacific Pathology Partners, Seattle, WA
  • Nicole Andeen, MD – Oregon Health and Science University, Portland, OR
  • Maziar Riazy, MD, PhD – University of British Columbia, Canada
  • Tiffany Shao, MD – University of Calgary, Canada
  • Selvaraj Muthusamy, MD, PhD – VCU School of Medicine, Richmond, VA

Requirements

Applicants are expected to have completed the training required for certification in Anatomic Pathology or Anatomic Pathology/Clinical Pathology  by the American Board of Pathology. This requirement may be waived by the Program Director in exceptional cases.

Program Aims

  • Train fellows to become independent Renal Pathologists with excellent diagnostic ability.
  • Help trainees develop their own career path and provide the substrate for them to build a foundation of expertise and achieve this goal.
  • Set example of life-long learning and critical thinking. 
  • Provide opportunities for scholarly activities during fellowship.

Stipend & Benefits

Appointment is for 1 clinical year with 1-2 years optional research training. Stipend and benefits are based on the schedule for residents at an equivalent level. Fellows are encouraged to apply for extramural funding if additional years of research training is desired.

For More Information

Dr. Bezhad Najafian
Department of Laboratory Medicine & Pathology
University of Washington
Box 356100
Seattle, WA 98195-6100

Application & Instructions for Pathology Fellowships
We do not accept the APC Standard Application Form

If you have questions or problems, please contact our Academic Programs Coordinator.