Nephrology
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 kidney disease
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
-
Autoimmune GN (lupus, vasculitis, anti-GBM)
-
Alport’s syndrome
-
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 kidney disease
Monitoring and management of complications of CKD
-
Growth failure
-
Anaemia
-
Metabolic bone disease
-
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
-
Establish vascular access for renal replacement therapy or HD