Division of Nephrology

About

Welcome to the San Francisco Veteran’s Affairs division of Nephrology! We are a group of eleven nephrologists, all with joint academic appointments at the University of California, San Francisco.

We are all deeply committed to providing the best possible nephrology care to Veterans and their families. We also have diverse academic interests including clinical research, basic science research and education.

To view our overall Division website, please go here: UCSF NeprhologY Website

Patient Care

The Nephrology (Kidney) Section at the San Francisco VA Health Care System (SFVAHCS) offers outstanding comprehensive, personalized care to veterans with kidney disease, hypertension and electrolyte disorders.

Our specialists, are UCSF-affiliated faculty, provide expertise in the diagnosis and treatment of a variety of conditions that lead to chronic kidney disease including:

Hypertension
Acute Kidney Injury
Glomerular Disease
Vascular Disorders
Heart Failure
Tubulo-Interstitial Disease
Autoimmune Disorders
Drug Toxicity
Electrolyte Disorders
Urinary Obstruction and Recurrent kidney

Our team works closely with other specialty services at the SFVAHCS, including nutrition, endocrinology, rheumatology, cardiology, oncology, urology, vascular surgery and radiology to provide coordinated care plans for each patient and to offer specialized services, including kidney transplant care.

SFVAHCS Nephrology Clinics

The SFVA Nephrology Section provides services within the VISN21 network that extend from the San Francisco Bay area to the California-Oregon border and are in partnerships with other networks. We offer care through in-person clinics as well as e-consults and telehealth services.

General Renal Clinic

The clinic is staffed by nephrologists with expertise in various kidney disease conditions, including early to late stage chronic kidney disease, hypertension, kidney disease from a variety of causes, electrolyte disorders, and kidney stones.

When: Thursdays, 8 AM to 12 PM

Where: San Francisco VA Medical Center, Building 203, Ground Floor Module 1

Renal Transitions Clinic

The Renal Transitions Clinic provides care to patients with very advanced chronic kidney disease to support shared decision-making surrounding kidney replacement therapy. The clinic offers patient education on dialysis modality and offers an integrated approach to dialysis initiation working with vascular surgery and interventional radiology, to coordinate the patient’s advanced chronic kidney disease care. The clinic also offers palliative nephrology care. The clinic approaches patient care comprehensively with nephrology, nutrition, social work and kidney transplant evaluation programs working together to guide patients nearing end-stage kidney disease. The clinic also works with additional services as needed, such as

When: Wednesday 10:30AM to 4PM

Where: San Francisco VA Medical Center, Building 200, GB 17

Kidney Transplant Clinic

The Kidney Transplant Evaluation Clinic guides patients through pre-transplant needs including anticipation and coordination of additional services and provides comprehensive post-transplant care.

We have an outstanding, close working relationship with our nearest VA kidney transplant center in Portland, Oregon, as well as with the University of California, San Francisco (UCSF) Kidney Transplant Program .

When: By appointment with transplant evaluation team

Where: San Francisco VA Medical Center, Building 200, GB17 or Building 203, Ground Floor Module 1

Dialysis Services

San Francisco VA Hemodialysis Service

The SFVA Medical Center provides outpatient hemodialysis to patients with end-stage kidney disease. The dialysis unit is staffed by dedicated, well-trained dialysis nurses and technicians. A team of nephrologists, dialysis staff, nutritionist and social work provide multidisciplinary coordinated care to comprehensively address the hemodialysis patient’s needs. We work closely with vascular surgery and interventional radiology to establish and maintain the patient’s vascular access for dialysis. In addition, the dialysis unit provides continuous renal replacement therapy for acutely ill patients admitted to the SFVA Intensive Care Unit.

Where: San Francisco VA Medical Center, Building 200, 3rd Floor

Contact: 415-221-4810, extension 22034

Home Peritoneal Dialysis Service

The SFVA Medical Center provides home peritoneal dialysis to patients with end-stage kidney disease, including patient and caregiver training for home peritoneal dialysis. Eligible individuals for the program work with a team of nephrologists, peritoneal dialysis specialty trained nursing staff, nutritionist and social work to provide multidisciplinary coordinated care to comprehensively address the peritoneal dialysis patient’s needs. Individuals are typically followed in our Renal Transitions Clinic [EMM8] until the need for dialysis arises. The team works very closely with surgery and interventional radiology for catheter placement. Comprehensive peritoneal dialysis training includes one week of intensive one-on-one training.

When: Wednesday am and pm clinic, training by appointment

Where: San Francisco VA Medical Center, Building 200, GB17

Additional Access to Nephrology Care

We offer the same outstanding outpatient clinical service at our community-based outpatient clinics (CBOCs). The Nephrology Section is also proud to participate in the Veterans Health Administration Telehealth Services through the provision of monthly video teleconference appointments. We offer electronic consultation and video teleconference (VTEL) for eligible veterans who live remotely from San Francisco. We provide electronic consultation (e-consult) for providers who may need aid in patient management but may not necessarily require a full patient visit. These e-consults may be placed via the computerized patient record system (CPRS). In addition, outpatient face-to-face clinical service will be provided at the Eureka and Santa Rosa clinics. Referrals for these consultation programs may be made by your primary care provider. The following is a list of community-based clinics eligible for both e-consult and VTEL consultation.

Eureka
Santa Rosa
Clearlake
Ukiah
San Bruno (e-consult)

Faculty

Education

The San Francisco VA (SFVA) is one of three primary teaching sites for the University of California, San Francisco (UCSF) Nephrology Fellowship. Each month, two fellows rotate on our clinical rotation services.

One fellow works closely with the inpatient consult attending to care for patients requiring inpatient nephrology consultation. The other fellow is responsible for supervising the care of outpatients that receive renal replacement therapy from our dialysis unit. UCSF fellows and UCSF internal medicine residents also provide care to veterans in our renal clinic under our supervision.

Every member of our faculty is dedicated to education. Several of us have completed rigorous advanced training in medical education, scholarship and leadership through the UCSF Teaching Scholars Program. Selected faculty have also competed successfully for funding both for education related activities including education innovations and mentorship.

Learn more about the Nephrology fellowship here: Nephrology Fellowship

Research

SFVA Nephrology faculty members are leaders in the field of kidney disease research.

Our faculty members serve in editorial roles in top journals and are members of working groups for major ongoing studies. Dr. Lovett is a member of the prestigious American Society for Clinical Investigation. Our work is supported by many competitive grants from both the National Institutes of Health and other sources.

The San Francisco VA also houses the Kidney Health Research Collaborative (KHRC) which is joint investment by SFVA and UCSF. The KHRC is an innovation hub dedicated to improving kidney health worldwide through research and mentorship. Our faculty serve in key roles at the KHRC including Dr. Peralta who is Executive Director and Co-founder of the KHRC, and Dr. Estrella and Dr. Johansen who are both Core Investigators.

Our senior faculty are committed to maintaining a culture of supportive mentorship and have each mentored many successful trainees and junior faculty members. Dr Johansen is also the recipient of a highly competitive mentoring grant (NIH K24). Members of our faculty (Drs Lovett and Johansen) have chaired the UCSF Nephrology T32 committee for the last 12 years. We are deeply proud of our senior fellows and junior faculty and their success in both dissemination of their work and in obtaining competitive funding awards.

Faculty who devote a substantial portion of their time to research include Cynthia Delgado, Ruth Dubin, Michelle Estrella, Vasantha Jotwani, David Lovett and Carmen Peralta.

Helpful Links

Kidney Health Research Collaborative KHRC door

UCSF Nephrology Fellowship

TED style talk about research mentorship in academic medicine by Carmen Peralta, SFVA Nephrology faculty member and Executive Director of the KHRC

Meet Our Chief: Michelle Estrella, MD

Dr. Estrella

We are pleased to announce that Michelle Estrella, MD has accepted the position of Chief of the Division of Nephrology at the San Francisco VA Health Care System (SFVAHCS). Dr. Estrella is Associate Professor of Medicine at UCSF, Executive Director of the Kidney Health Research Collaborative, and a member of the SFVAHCS nephrology division. She has served as interim division chief since July 2019

Michelle was born in the Philippines and immigrated to Nacogdoches, Texas at the age of eight. She received her undergraduate degree from Centenary College of Louisiana and her MD from the University of Texas Health Science Center in Houston. She then moved from Texas to Johns Hopkins University, where she completed her internal medicine residency and nephrology fellowship and earned a master’s degree in clinical investigation at the Bloomberg School of Public Health. In 2006, Michelle joined the Johns Hopkins faculty, where she remained for a decade. In 2016, she was recruited by Dr. Michael Shlipak to UCSF and the SFVAHCS to join our faculty, based in the Kidney Health Research Collaborative and the VA’s nephrology division.

Michelle is an outstanding clinical investigator with a strong portfolio of published scholarship. Her research has focused on identifying markers of kidney injury that will lead to earlier detection and disease management in HIV-infected and uninfected populations. She also studies the clinical implications of genetic risk factors for kidney disease, novel kidney diagnostic strategies for patients with acute heart failure, and quality of care for patients with chronic kidney disease. She has published 115 original articles and has been funded by various NIH agencies (National Institute of Diabetes and Digestive and Kidney Disease, National Institute of Aging, and National Institute of Allergy and Infectious Disease), as well as the National Kidney Foundation, VA HSR&D, and the Department of Health and Human Services. She also has mentored numerous nephrology fellows and post-doctoral students, many of whom are now in faculty positions.

We are grateful to Dr. David Lovett, who retired as SFVA nephrology division chief in July 2020. David served as division chief for 24 years and a member of the UCSF faculty for 33 years. He enjoyed an extraordinary research career focused primarily on the role of matrix metalloproteinases in renal and cardiac disease. His mentorship of scores of nephrology trainees, research fellows, and junior faculty has influenced a generation of clinical investigators and clinical nephrologists worldwide. He also provided immense service to UCSF, most recently as Chair of the Senate Committee for Academic Personnel, and to his professional organizations.

HD Unit staff and Medical Center Director

Hemodialysis Unit receives highest praise from Joint Commission and Medical Center Director, Bonnie Graham

To all of the staff,

One of the best dialysis units they have ever seen. That’s what surveyors from The Joint Commission expressed to me about our Hemodialysis Unit after our recent Joint Commission survey. I was so thrilled to hear that. It was also fascinating for me to hear the JC surveyors say this since they have seen hundreds of dialysis units at both private and VA facilities all over the country.

Congratulations and thank you to Dr. Cynthia Delgado, Oksook Kim, Sharon Offril, Dr. David Lovett, and the entire Hemodialysis Unit team. You should all be very proud of your accomplishment. The hemodialysis team has done such a fantastic job at creating a sense of community and teamwork. When I visited the unit, employees told me they felt respected by their supervisors and coworkers and enjoyed working on a team that accepts one another’s differences. They said what made their jobs easier is that they all work with one goal in mind—helping our Veterans.

Dr. Delgado wrote to me, “we did not achieve our success without the support of Engineering, Clinical Informatics, OI&T and EMS. Members from these departments were instrumental in efficiently addressing issues prior to our inspection. Oftentimes, these issues required repeated visits and I do want to thank the folks who often work behind the scenes and may not necessarily get our thanks.” Thank you to all the services that were instrumental in this accomplishment.

Beginning on June 6, our Veterans will have more choices to seek their care in the community. With exceptional teams like the Hemodialysis Unit in so many other areas at the SFVAHCS, I am confident Veterans will continue to choose us for their health care needs. The dedication I see in our employees every single day at the SFVAHCS is what differentiates us from private hospitals. Why should Veterans choose VA? This team is another example.

Thank you for being part of the reason why Bay Area Veterans choose and trust the San Francisco VA Health Care System for their health care.

Sincerely,

Bonnie