Core Adult Internal Medicine Disciplines

Nephrology

Topics

• Fluid, electrolyte and acid-base homeostasis:
  
  • Recognition of under- and over-hydration; causes consequences and treatment.
    
  • Electrolyte disorders associated with altered sodium, potassium, acid-base and water homeostasis. Appropriate treatment of these disorders.
  • Biochemical tests of renal functions; urinalysis and urine microscopy; serological testing; appropriate use of renal imaging techniques.
    
  • The differential diagnosis and management of proteinuria, haematuria, oliguria, polyuria.
    
  • ndications and requirements for, and complications of, renal biopsy.
    
  • Knowledge of the typical renal biopsy appearance of common renal disorders.
• Renal disease:
  
  • Glomerulonephritis: primary and secondary, the immunopathogenisis of the major glomerulopathies (with and without association with systemic disease), treatment options including role and complications of immunosuppression.
    
  • Nephrotic and nephritic syndromes: aetiology, complications and management.
    
  • Diabetic nephropathy: incidence, stages, microalbuminuria, management - early and late.
    
  • Analgesic nephropathy: aetiology, incidence, clinical manifestations, and treatment.
    
  • Hypertensive renal disease and renovascular disease: incidence, natural history, diagnosis, and management (including pharmacological and nonpharmacological treatment of hypertension).
    
  • Inherited renal disease, e.g. polycystic kidney disease, Alport's disease: genetics, diagnosis/screening, and complications.
    
  • Reflux nephropathy: aetiology, clinical manifestations, and therapy.
    
  • Tubulo-interstitial diseases of the kidney (including acute and chronic interstitial nephritis): aetiology, clinical manifestations, and therapy.
    
  • Urinary infections, nephrolithiasis and obstructive nephropathy:
  • Urinary tract infections: clinical manifestations, microbiology, diagnosis, investigation, management (including pyelonephritis, cystitis, prostatitis, and recurrent urinary tract infections).
    
  • Renal stone disease: incidence, aetiology, clinical manifestations, prevention, drug therapy, urological principles.
    
  • Obstructive nephropathy: diagnosis and management including indications for emergency nephrostomy; knowledge and understanding of acute urinary retention.
• Acute and chronic renal failure:
  
  • Definition, differentiation between 'pre-renal', 'renal' and 'post-renal' causes of acute renal failure; knowledge of common causes of acute and chronic renal failure; knowledge of symptoms and signs of uraemia; assessment of severity; nondialytic therapy including principles of managing calcium phosphate balance.
    
  • Effect of common drugs on renal function and principles of dose modification of drugs in renal failure.
• Dialysis:
  
  • Understanding modalities available in acute and chronic renal failure; indications for acute and chronic renal replacement therapy; recognising problems with dialysis patients, e.g. nutritional support. This includes choosing between CAPD and haemodialysis (HD).
    
  • Long-term complications of CAPD and HD: dialysis amyloid; loss of peritoneal membrane function; indications for and implications of surgical parathyroidectomy.
    
  • Principles of Tenckhoff catheter insertion, complications: peritonitis, and exit-site infections. AV-fistula, infected dialysis cannulae.
• Renal transplantation:
  
  • Choosing/screening potential recipients, donors.
    
  • Immunosuppresive regimens, side effects (short- and long-term).
    
  • Basic principles of diagnosis and management of cellular and vascular rejection.
    
  • Common post-transplantation problems: CMV infections, treatment, prophylaxis, UTI, pyelonephritis, lymphocoele.
    
  • Investigations of late graft dysfunction.

Practical Skills for all Trainees

• Urine microscopy.

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