Nephrology

Playing in a Tunnel
Draft proposed by Dr Eric KW Lee
Reviewed by Dr Winnie Tse

Essential Skills

Domain 1 Professional Values & Behaviour

Domain 2 Communication

Domain 3 Procedural skills

Domain 4 Patient Management

Domain 6 Leadership and Teamworking

Additional desirable skills are listed in each proposal. These recommended skills are to be acquired as opportunity arises

Basic Training

Embryology and anatomy of genito-urinary tract development

Understand the development and anatomy of the urinary tract.

Fluid, electrolyte and acid-base balance

Understand physiology of fluid, electrolyte, and acid-base control by kidney

Recognise the presentations, investigate and manage abnormalities

Urinary Tract Infection

Presentations of UTI in different age groups

Differentiation between upper and lower urinary tract infection

Proper collection of urine sample, pros and cons of different methods

Definition and treatment of UTI

Follow up investigations

VUR grading and indications for antibiotic prophylaxis and surgical intervention

Proteinuria & Nephrotic syndrome

Definition of proteinuria (normal, significant, nephrotic)

Presentation & etiologies (primary & secondary) of nephrotic syndrome

Investigations and acute management of nephrotic syndrome

Complications of nephrotic syndrome and treatment side effects

Understand the procedure and the risk of renal biopsy

Haematuria & Nephritic syndrome

Pathophysiology and causes of microscopic and macroscopic haematuria

Definition of nephritic syndrome, its presentation and causes

Investigations of haematuria

Treatment of nephritic syndrome and recognition of its complications

Congenital abnormality of Kidney & Urinary Tract

Hydronephrosis

Definition

Aetiologies(congenital/ acquired)

Investigations and management of different severity and causes of hydronephrosis, including posterior urethral valve, PUJO

Cystic kidney disease

Understand the clinical course and outcome of Solitary renal cyst

Multicystic dysplastic kidney disease (MCDK)
Autosomal recessive polycystic kidney disease (ARPKD)
Autosomal dominant polycystic kidney disease (ADPKD)

Hypertension

Technique in measuring BP in different age groups

Definition of hypertension; recognition of white coat hypertension

Etiologies of primary and secondary hypertension and investigations

Principles of hypertension management

Management of hypertensive emergency 

Acute Renal Failure

Definition and cause of ARF (pre-renal, renal and post-renal ARF)

Investigations including indications of renal biopsy

Assessment and management of fluid status, hypertension, electrolyte and acid-base disturbance in AKI.

Presentation and causes of haemolytic-uraemic syndrome (HUS)

Chronic Renal Failure

Definition and causes of CKD.

The basis and use of estimated glomerular filtration rate (eGFR) in CKD.

Staging CKD with eGFR

Understand complications of CKD (anemia, metabolic bone disease, acid-base & electrolyte disturbance, growth failure)

Renal Calculi

Presentation

Causes and investigations

Voiding problem

Pathophysiology, presentation, investigation and management of primary nocturnal enuresis

Presentation and investigations of other voiding dysfunction

 

Renal tubular disorders

Physiology of renal tubules in electrolyte and acid-base homeostasis

Presentation of tubular disorders including different types of renal tubular acidosis

Presentation and causes of diabetes insipidus; diagnosis and treatment of nephrogenic DI

 

Desirable skills 

1. Use of frequency-volume chart

2. Calculation of eGFR with different formulas

Higher Training

Proteinuria & Nephrotic syndrome

Definition of steroid sensitive, steroid resistant, frequent relapser, remission, relapse of nephrotic syndrome

Workup for steroid resistant/ frequent-relapsing NS (include renal biopsy, genetics study)

Treatment modalities of steroid resistant NS/ frequent-relapsing NS

Haematuria & Nephritic syndrome

Management of post-streptococcal glomerulonephritis

Understand the management plan for different glomerulonephritis presenting with haematuria

  1. Autoimmune GN (lupus, vasculitis, anti-GBM)

  2. Alport’s syndrome

  3. IgA nephropathy

Treatment modalities of different glomerulonephritis

 

UTI with VUR, reflux nephropathy

Management and monitoring complications of reflux nephropathy including the use of radio-isotope imaging

 

Hypertension

Application of Ambulatory Blood Pressure Monitoring

Definition of white coat hypertension, masked hypertension, ambulatory hypertension

Management of hypertension including hypertensive emergency

Evaluation of complications and end-organ damage with hypertension

Voiding problem

Presentation, investigation and management of neurogenic bladder

Understand multidisciplinary care by Paed urologist, Neurosurgeon, Paed neurologist, orthopedics surgeon in management of spina bifida

Understand the use of urodynamic study

Congenital Abnormality of Kidney and Urinary Tract

Investigations of cystic kidney disease

Management plan for MCDK, ADPKD, ARPKD

 

Acute renal failure

Understand principles & indication of renal replacement therapy

Understand selection of appropriate RRT in different clinical conditions

 

Chronic renal failure

Monitoring and management of complications of CRF

  1. Growth failure

  2. Anaemia

  3. Metabolic bone disease

  4. Acid-base & electrolyte disturbance

Understand principles of peritoneal dialysis and haemodialysis

Understand role of renal transplantation

 

Renal calculi

Understand the various management of renal calculi  

Desirable skills 

  1. Establish vascular access for renal replacement therapy or HD