Jehan Bahrainwala, MD, FASN
Clinical Assistant Professor, Medicine - Nephrology
Bio
Dr. Bahrainwala is a board-certified, fellowship-trained nephrologist with the Stanford Medicine Kidney Clinic at Boswell. She is a part of the AHA-Certified Stanford Hypertension Center. One of her main clinical areas of focus is the diagnosis and treatment of resistant hypertension and secondary hypertension. She also has a clinical interest in caring for patients who are pregnant or planning pregnancy with hypertension and kidney disease. In addition to hypertension, she also cares for patients with all types of kidney diseases. Her extensive experience includes caring for patients with electrolyte abnormalities, kidney stones, chronic kidney disease and end stage kidney disease.
Dr. Bahrainwala is skilled at creating connections with her patients. She treats the whole person rather than the condition. She also strongly believes in patient education and involving them in the medical decision-making process. She integrates their goals of care and other aspects of advanced care planning into treatment planning. She is also interested in the conservative care of elderly patients with advanced kidney disease. She has formal communication skills training in discussing serious illnesses with patients through Vital Talk.
In addition to being a clinician, she is committed to and involved in the medical education of trainees at all levels including medical students, residents and fellows. She is a fellow and a member of the American Society of Nephrology. Additionally, she is a member of the National Kidney Foundation and the American Heart Association. She is double board certified in internal medicine and nephrology.
Clinical Focus
- Nephrology
- Hypertension
- Resistant Hypertension
- Chronic Kidney Disease
- Electrolyte Disorders
Administrative Appointments
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Director of Wellbeing (Division of Nephrology), Department of Medicine (2024 - Present)
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Associate Director for Nephrology Education, Stanford Division of Nephrology, Department of Medicine (2023 - Present)
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Education Lead, AHA-Certified Stanford Hypertension Center (2024 - Present)
Honors & Awards
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Penn Pearls: Award for Excellence in Clinical Teaching, Perelman School of Medicine, University of Pennsylvania (2016)
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Fellow, American Society of Nephrology (2023)
Boards, Advisory Committees, Professional Organizations
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Member, American Society of Nephrology (ASN) (2014 - Present)
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Member, National Kidney Foundation (NKF) (2014 - Present)
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Member, American Heart Association (AHA) (2024 - Present)
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Member, VitalTalk (2023 - Present)
Professional Education
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Board Certification: American Board of Internal Medicine, Nephrology (2016)
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Fellowship: Penn Medicine Nephrology Fellowship (2016) PA
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Board Certification: American Board of Internal Medicine, Internal Medicine (2014)
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Residency: Hospital of the University of Pennsylvania Dept of Internal Medicine (2014) PA
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Medical Education: Medical College of Wisconsin (2011) WI
All Publications
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NEPHROTIC SYNDROME AND HEPATITIS IN SECONDARY SYPHILIS
W B SAUNDERS CO-ELSEVIER INC. 2024: S64
View details for Web of Science ID 001282605100214
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Development and Validation of a Formative Assessment Tool for Nephrology Fellows' Clinical Reasoning.
Clinical journal of the American Society of Nephrology : CJASN
2023
Abstract
Diagnostic errors are commonly driven by failures in clinical reasoning. Deficits in clinical reasoning are common among graduate medical learners, including nephrology fellows. We created and validated an instrument to assess clinical reasoning in a national cohort of nephrology fellows and established performance thresholds for remedial coaching.Experts in nephrology education and clinical reasoning remediation designed an instrument to measure clinical reasoning through a written patient-encounter note from a web-based, simulated acute kidney injury (AKI) consult. The instrument measured clinical reasoning in three domains (Problem Representation, Differential Diagnosis with Justification, Diagnostic Plan with Justification). Inter-rater reliability was established in a pilot cohort (n = 7 raters) of first-year nephrology fellows using a two-way random effects agreement intraclass correlation coefficient model. The instrument was then administered to a larger cohort of first-year fellows to establish performance standards for coaching using the Hofstee method (n = 6 raters).In the pilot cohort, there were 15 fellows from 4 training program, and in the study cohort, 61 fellows from 20 training programs. The intraclass correlation coefficients for Problem Representation, Differential Diagnosis, and Diagnostic Plan were 0.90, 0.70, and 0.50. Passing thresholds (% total points) in Problem Representation, Differential Diagnosis, and Diagnostic Plan were 59%, 57%, and 62%. Fifty-nine percent (n=36) met the threshold for remedial coaching in at least one domain.We provide validity evidence for a simulated AKI consult for formative assessment of clinical reasoning in nephrology fellows. The majority of fellows met criteria for coaching in at least one of three reasoning domains, demonstrating a need for learner assessment and instruction in clinical reasoning.
View details for DOI 10.2215/CJN.0000000000000315
View details for PubMedID 37851423
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New-Onset Proteinuria in a Patient With Schwannoma
AMERICAN JOURNAL OF KIDNEY DISEASES
2021; 78 (3): A12-A15
View details for DOI 10.1053/j.ajkd.2021.03.031
View details for Web of Science ID 000686900900001
View details for PubMedID 34420678
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Use of Dietary Supplements in Living Kidney Donors: A Critical Review
AMERICAN JOURNAL OF KIDNEY DISEASES
2020; 76 (6): 851-860
Abstract
Dietary supplement use is high among US adults, with the intention by users to promote overall health and wellness. Kidney donors, who are selected based on their overall good health and wellness, can have high utilization rates of dietary supplements. We provide a framework for the evaluation of living kidney donors and use of dietary supplements. In this review, dietary supplements will include any orally administered dietary or complementary nutritional products, but excluding micronutrients (vitamins and minerals), food, and cannabis. Use of dietary supplements can influence metabolic parameters that mask future risk for chronic illness such as diabetes and hypertension. Dietary supplements can also alter bleeding risk, anesthesia and analgesic efficacy, and safety in a perioperative period. Finally, postdonation monitoring of kidney function and risk for supplement-related nephrotoxicity should be part of a kidney donor educational process. For practitioners evaluating a potential kidney donor, we provide a list of the most commonly used herbal supplements and the effects on evaluation in a predonation, perioperative donation, and postoperative donation phase. Finally, we provide recommendations for best practices for integration into a comprehensive care plan for kidney donors during all stages of evaluation. We recommend avoidance of dietary supplements in a kidney donor population, although there is a paucity of data that identifies true harm. Rather, associations, known mechanisms of action, and common sense suggest that we avoid use in this population.
View details for DOI 10.1053/j.ajkd.2020.03.030
View details for Web of Science ID 000591680400013
View details for PubMedID 32659245
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Preoperative Risk Assessment and Management in Adults Receiving Maintenance Dialysis and Those With Earlier Stages of CKD
AMERICAN JOURNAL OF KIDNEY DISEASES
2020; 75 (2): 245-255
Abstract
With an increasingly aging population and improved mortality in individuals with end-stage kidney disease, more surgeries are being performed on patients with all stages of chronic kidney disease (CKD). This high-risk population carries unique risk factors that have been associated with increased adverse perioperative outcomes, including acute kidney injury, cardiovascular events, and mortality. In this article, we review the literature describing absolute risks associated with common surgeries performed in patients with CKD and patients receiving maintenance dialysis. We also review perioperative optimization with special risk assessment including evaluation of cardiovascular and bleeding risk evaluation, hypertension management, and timing of dialysis. Predictive model scores are reviewed as a method to stratify risk for acute kidney injury, major adverse cardiac events, or other serious complications with elective surgeries. A multidisciplinary approach with individualized counseling is necessary to counsel the patient with advanced CKD or patients treated with maintenance dialysis considering elective surgery.
View details for DOI 10.1053/j.ajkd.2019.07.008
View details for Web of Science ID 000508617000014
View details for PubMedID 31601429
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Bilateral Renal Infarctions During the Use of Sumatriptan
KIDNEY INTERNATIONAL REPORTS
2018; 3 (5): 1233-1236
View details for DOI 10.1016/j.ekir.2018.05.003
View details for Web of Science ID 000443612900029
View details for PubMedID 30197992
View details for PubMedCentralID PMC6127403
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Use of Radiocontrast Agents in CKD and ESRD
SEMINARS IN DIALYSIS
2017; 30 (4): 290-304
Abstract
Contrast exposure in a population with chronic kidney disease (CKD) requires additional consideration given the risk of contrast-induced nephropathy (CIN) after exposure to iodinated contrast as well as systemic injury with exposure to gadolinium-based contrast agents (GBCA). Strategies to avoid CIN, and manage patients after exposure, including extracorporeal removal of contrast media, may differ among an advanced CKD population as compared to a general population. There is strong evidence to support the use of isotonic volume expansion and the lowest dose of low-osmolar or iso-osmolar contrast media possible to decrease CIN. The current literature on other newer prophylactic strategies such as statins, remote ischemic preconditioning, discontinuation of renin angiotensin aldosterone system (RAAS) blockade, and RenalGuard is limited thus these strategies cannot currently be recommended as routine prophylaxis for CIN. The use of extracorporeal removal of contrast agents as prophylaxis to reduce CIN has been the subject of multiple studies; however, data do not support a beneficial effect in reduction in CIN. Immediate removal of contrast by dialysis in a maintenance dialysis population is also not recommended, unless an individual's cardiopulmonary status is dependent on strict volume management. In patients with reduced renal function, GCBA exposure increases the risk of NSF. In patients with AKI, CKD stage 3 or greater (eGFR <30 ml/minute/1.73 m2 ), or patients on dialysis, we do not recommend the use of GBCA and alternative imaging modalities should be considered. If patients absolutely need magnetic resonance imaging with GBCA, we recommend the use of the lowest dose possible of the newer macrocylic, ionic agents (gadoterate meglumine) as well as immediate postprocedural HD in patients already on HD or peritoneal dialysis or with stage 5 CKD and with a functioning dialysis access already in place.
View details for DOI 10.1111/sdi.12593
View details for Web of Science ID 000407109400002
View details for PubMedID 28382626
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Atypical Antiglomerular Basement Membrane Disease With IgG1-kappa Staining
KIDNEY INTERNATIONAL REPORTS
2017; 2 (1): 80-83
View details for DOI 10.1016/j.ekir.2016.08.014
View details for Web of Science ID 000405958900011
View details for PubMedID 29142944
View details for PubMedCentralID PMC5678821
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Diagnosis of Iron-Deficiency Anemia in Chronic Kidney Disease
SEMINARS IN NEPHROLOGY
2016; 36 (2): 94-98
Abstract
Anemia is a common and clinically important consequence of chronic kidney disease (CKD). It is most commonly a result of decreased erythropoietin production by the kidneys and/or iron deficiency. Deciding on the appropriate treatment for anemia associated with CKD with iron replacement and erythropoietic-stimulating agents requires an ability to accurately diagnose iron-deficiency anemia. However, the diagnosis of iron-deficiency anemia in CKD patients is complicated by the relatively poor predictive ability of easily obtained routine serum iron indices (eg, ferritin and transferrin saturation) and more invasive gold standard measures of iron deficiency (eg, bone marrow iron stores) or erythropoietic response to supplemental iron. In this review, we discuss the diagnostic utility of currently used serum iron indices and emerging alternative markers of iron stores.
View details for DOI 10.1016/j.semnephrol.2016.02.002
View details for Web of Science ID 000378018100003
View details for PubMedID 27236129