www.edrep.org

Anatomy and physiology

Urinary abnormalities

Investigations

Urinary tract obstruction

Intrinsic renal diseases

• Glomerular diseases 
• Interstitial diseases
• Reflux and pyelonephritis
  

Age and physiological states

Systemic disorders and the kidney

Renovascular disease

Hypertension

Acute renal failure

Chronic renal failure and ESRD

Renal replacement therapy

• Dialysis
• Transplantation

Kidney stones

Continence and incontinence 

UTI

Prostate and bladder

Malignancies

Fluid and electrolyte abnormalities

Drugs and the kidney

Basic anatomy of the urinary tract including vascular supply

• Recognise normal glomeruli and tubules histologically

Basic mechanisms of glomerular filtration,tubular resorption and secretion,and handling of
solute and water by the kidneys

• Detail of some specific transporters and the consequences to them of malfunction and
  drug therapy

Mechanisms of bladder filling and emptying and maintenance of continence

Haematuria and proteinuria - pathophysiology of each

Basis and sensitivity of stick tests for haematuria and proteinuria

• Pathways of tubular protein metabolism
• differences between glomerular and tubular
  proteinuria

Important causes of haematuria

Significance of positive results of screening tests

• Significance of associated signs of renal disease and of red cell morphology/casts
• Possible mechanisms for microalbuminuria,and its significance beyond renal disease

Appropriate management of haematuria and proteinuria

Polyuria - possible mechanisms with examples

Mechanism of urine concentration; effects of ADH

• Some detail of diabetes insipidus;mechanisms,consequences.

Mechanisms and consequences of osmotic diuresis

Oliguria - major possible physiological and pathological explanations and how they can be distinguished clinically

• Features (incompletely)distinguishing compensatory oliguria from established acute renal failure ('ATN ')

Imaging

Basic principles and capabilities of major imaging modalities: ultrasound, CT, pyelography, arteriography, MRI

Risks of non-invasive imaging techniques

Risks of intravenous and intra-arterial procedures

• Background, prophylaxis, alternatives

Other investigations

Estimation of renal function

Capabilities and use of cystoscopy

• ureteroscopy also

Presentation, (lack of) signs, possible locations and etiologies

Diagnostic and therapeutic approaches to obstruction at different levels

Glomerular diseases

Glomerulonephritis ­ range of clinical presentations; generic features

• Cell types (3),mechanisms of injury.
• Basis of differences between inflammatory and non-inflammatory glomerulopathies.

Nephrotic syndrome ­ presentation, diagnosis, major complications, principles of management

• Short details of 5 important causes,primary and secondary - minimal change disease, FSGS, Membranous, diabetes mellitus, amyloidosis (but also remembering subacute inflammatory, including SLE)

IgA nephropathy as the most common example of inflammatory glomerulonephritis;its range of
presentations and outcomes.

• Some further details of the incidence,management,outcome of IgA nephropathy.
• Prognostic factors in IgA disease (most also true for other glomerular diseases)

Other glomerulonephritis

• Post-streptococcal nephritis as the archetypal 'nephritic ' illness.

Crescentic nephritis (RPGN): presentation, importance, occurrence in systemic diseases

• Short details of major systemic causes;especially small vessel vasculitis but also SLE
  (see 'systemic diseases and the kidney ')

Diabetic nephropathy: presentation and prevention

• Some detail on incidence,association,prevention,management

Inherited diseases: Alport syndrome (primary features only)

• Benign familial haematuria ' ­ in concept only

Tubulointerstitial diseases 

Presentation and characteristic urinary and other features

• Principal manifestations that may characterise tubular disorders (eg concentrating
  ability,salt-losing,acidosis,aminoaciduria)

Polycystic kidney disease ­ presentation and major features of ADPKD

• That there are other causes of renal cysts, ± examples
• a little detail of ADPKD genetics, complications, prognosis, management

Acute tubulointerstitial nephritis : important features of causation, presentation, and treatment of
allergic AIN

• Some alternative causes or mechanisms of damage (infection,toxins,immune)

Chronic TIN ­ outline knowledge of two important causes: Myeloma and Reflux nephropathy (q.v.)

Vesicoureteric reflux, reflux nephropathy, and chronic pyelonephritis: their nature and
interrelationships

• Little detail on each. Some evidence to support assertions about relationships.

Age ­ Age-associated changes in renal function

Pregnancy: physiological changes and their effects on common tests (BP, blood tests).

Recognition and immediate management of pre-eclampsia and eclampsia.Risk factors for pre-
eclampsia

• The multiple presentations of pre-eclampsia and related diseases.
• Minimal knowledge of effect of pregnancy on pre-existing hypertension and renal
  disease.

Haematological

Sickle cell anaemia ­ awareness that it may affect the kidney

• How (very briefly)

HUS/TTP ­ presenting features and complications

• Basic understanding of pathogenesis,management and outcome of E.coli-associated
  HUS

Infection

Outline knowledge that chronic or subacute infections may cause secondary glomerulonephritis (other than by post-infectious glomerulonephritis).

• Bacterial endocarditis and the kidney
• Reactive amyloidosis.

Inflammatory and autoimmune disorders

The ways in which systemic inflammatory diseases can affect the kidney

• Some knowledge of important causes: Small vessel vasculitis, SLE, Infection

Malignancy

Myeloma ­ its effects on the kidney via hypercalcaemia and cast nephropathy

• Further understanding of myeloma kidney
• Understanding of nature of some other B cell dyscrasias (eg MGUS,amyloidosis, cryoglobulinaemia) - see Haematology

Other tumours:via hypercalcaemia or other mechanisms

• Membranous nephropathy most commonly implicated

Metabolic

Diabetes mellitus (see glomerular disorders)

Arterial disease

Renal artery stenosis: principle causes,diagnosis,effects of ACE inhibition

• Best treatments ­ and uncertainty of

Atheroemboli ­ as a possible consequence of investigations and otherwise.Major features.

• Major risk factors,treatment

Hypertension

Relationship to renal disease

• Possible mechanisms
• That the effect of the kidney in hypertension is frequently paramount.

Risk factors for decline in GFR

• Uncertainty that much renal failure is due to hypertension in the absence of pre-existing renal disease

Malignant hypertension: consequences, treatment, importance of seeking cause

• Possible causes

Important categories and causes of acute renal failure

Management and natural history of acute tubular necrosis (ATN)

• Simple pathophysiology of prerenal oliguria and ATN

Causes of rapid loss of renal function - likely diseases,how to recognise them,implications for management: Obstruction; Vascular; Intrinsic: RPGN, ATN, Toxic

• Indications for referral/renal replacement therapy

Major consequences of CRF

How to suspect and identify CRF

• Outline understanding of:anaemia,bone disease,non-specific effects
• Effects and practicalities of Epo administration
• Basic approach to prevention and treatment of osteodystrophy

Progression of renal impairment regardless of cause of initial injury

• Preventive therapies and their effectiveness
• Role of dietary management

Patients with end stage renal failure managed by renal replacement therapy are increasingly commonly encountered. Although this used to be regarded as entirely the province of specialists, all doctors now need to be familiar with the outline of these conditions and of the therapeutic, sociological and ethical questions raised.

Dialysis

Basic principles and a sketchy outline of the practice of each of the major modalities, their chief advantages and disadvantages - PD/ HD/ haemofiltration

• Major causes of morbidity and mortality in the ESRF population
• Requirements for dialysis by each modality

Transplantation 

The various origins of donor organs

• Principles and practicalities of brainstem death

Practicalities of renal transplantation (when, where, how)

• Effects on quality of life and lifespan

Pancreatic transplantation (outline and hazards of)

• Advantages and disadvantages
• Effects on quality of life and lifespan

Consequences of longterm immunosuppression

• Basic mechanisms of action of major drugs
• A little detail of the mechanisms behind susceptibility to infections,cancer