Nephrology

Draft proposed by Dr Simon To, Dr Sabrina Tsao, Dr NC Fong
Reviewed by Dr Stephen Chan, Dr Annie Fok

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.

Download Syllabus (28 November 2023)
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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 and 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 and 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 and 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 and 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 and 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 kidney disease

Monitoring and management of complications of CKD

  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
Establish vascular access for renal replacement therapy or HD.

 

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