Nephrology curriculum standards
Knowledge guide
LG 24: Urological issues and onco-nephrology
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will describe the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.
Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management.
Presentations
- Kidney cell cancer
- Kidney stone disease
- Urothelial cancer
Conditions
- Congenital abnormalities of the kidney and urinary tract:
- congenital abnormalities of the urinary tract
- kidney dysplasia
- posterior urethral valves
- ureteropelvic junction obstruction
- urinary tract obstruction vesicoureteral reflux and reflux nephropathy
- Nephrolithiasis, including:
- calcium stones cystine stones
- drug stones
- oxalate
- struvite stones
- uric acid stones
- Onco-nephrology conditions:
- AKI and acute tubular injury (ATI), including chemotherapy nephrotoxicity
- clear cell carcinoma
- immune checkpoint inhibitor kidney disease
- paraneoplastic glomerular diseases
- tumour lysis syndrome
- water and electrolyte disturbances
- Paraprotein-related kidney disease:
- plasma cell dyscrasias, including myeloma kidney, amyloid and immunotactoid glomerulopathy
- Post-kidney obstruction:
- bladder, bladder outlet, and benign prostatic hyperplasia
- bleeding/clot
- malignancy
- prostate cancer
- retroperitoneal fibrosis
- retroperitoneal infiltrative disease
- stones and crystals
- ureteral stenosis
- Urothelial cancer:
- kidney mass
- squamous cell carcinomas (SCC)
- transitional cell carcinomas (TCC)
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a relevant clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life
Manage
- provide evidence-based management For less common or more complex presentations and conditions the trainee must also seek expert opinions
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management appropriate screening and where possible, preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Associated conditions and complications of nephrolithiasis:
- kidney failure
- medullary nephrocalcinosis
- medullary sponge kidney
- osteopenia and osteoporosis
- Kidney disease after stem cell transplant
- Radiation nephropathy
- Rare forms of nephrolithiasis
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a relevant clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life
Manage
- provide evidence-based management For less common or more complex presentations and conditions the trainee must also seek expert opinions
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management appropriate screening and where possible, preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Epidemiology of kidney stones:
- diet and medication as risk factors
- prevalence, sex, and geography stone recurrence
- systemic diseases
- Mechanisms of stone formation:
- calcium stones
- causes of nephrolithiasis:
- autosomal dominant hypocalcaemia
- distal RTA, vitamin D intoxication
- hyperoxaluria
- hyperthyroidism
- hyperuricosuria
- hypocitraturia
- rare genetic disorders – Dent disease
- cystinuria
- infection stones
- inhibitors
- modes and sites of stone growth
- promoters
- saturation and crystallization
- urinary risk factors for nephrolithiasis:
- hypercalciuria
- low urine volume
AIM
- Primary hyperparathyroidism
- Sarcoidosis
- Onco-nephrology:
- pathogenesis of kidney cell cancer and urothelial cancer, including transitional cell carcinomas (TCC) and squamous cell carcinomas (SCC) in the bladder, kidney, pelvis, and ureters
- pathophysiology of cancer chemotherapy nephrotoxicity, in particular:
- checkpoint inhibitors
- concomitant drugs often used, such as aminoglycosides
- gemcitabine
- methotrexate
- platinum salts
- tyrosine kinase inhibitors
- pathophysiology underlying water and electrolyte disturbances in cancer
- UTI pathophysiology
- Haematuria:
- assessment of kidney function and imaging
- cystoscopy
- urine cytology
- Immune system tests:
- serum electrophoresis light and heavy chain
- Metabolic evaluation of calcium nephrolithiasis:
- 24-hour urine studies – calcium, oxalate, citrate, uric acid, sodium, urea nitrogen or ammonia, volume
- serum studies – metabolic panel, calcium, phosphate, magnesium, PTH, vitamin D metabolites
- Mid-stream urine (MSU) microscopy and culture
- Possible kidney mass:
- CT scans
- ultrasound
- Predisposition to kidney stones calculi:
- blood tests
- imaging
- stone analysis
- urine solute excretion analysis
- Radiological studies:
- dimercaptosuccinic acid (DMSA)
- micturating cystourethrogram (MCU)
- Advantages and disadvantages of screening for prostate cancer
- Kidney tumours:
- common benign and malignant tumours of the kidney and the significance of the histological grading and staging used
- Prevention of calcium nephrolithiasis:
- normal excretion of solute and the protective mechanisms against stone formation
- pharmacological and non-pharmacological preventions
- predisposing metabolic, dietary, and environmental factors
- systematic high fluid intake
- Patient factors, such as age and gender, that influence:
- bacteriuria, including asymptomatic
- complicated urinary tract infections (UTIs)
- simple UTIs
- recurrent infection (relapse versus reinfection)
- UTI:
- conditions mimicking UTI, and their additional diagnostic and management considerations
- difficult to control infection, including:
- complicated UTI
- dysfunctional voiding
- postmenopausal women
- pregnant patients
- structural abnormalities of the urinary tract
- upper and lower UTIs in different age groups
- host defence mechanisms
- predisposing structural abnormalities
- rationale for prophylactic and suppressive antimicrobial therapy, potential benefits, and complications
TCC/SCC
- Association between urothelial tumours and toxins
- Ongoing surveillance once urothelial tumours have been diagnosed or risk factors identified
- Referral to urology for further investigation
- Surveillance required for TCC in patients at high risk
PCH
- Acute presentation of urinary tract obstruction, and the long-term consequences
- Antenatal and postnatal features and management of hydronephrosis
- Antenatal counselling for CAKUT and antenatally diagnosed genetic kidney disease
- Causes of obstructive uropathy, including posterior urethral valves
- Clinical signs and symptoms of UTI in different ages in children, and methods to obtain urine samples
- Imaging strategies for UTI in childhood
- Pathophysiology of the neurogenic bladder
- Physiology of normal micturition and acquisition of bladder control
- Radiological studies:
- MAG3 for obstruction
- Recurrent UTIs in childhood, including:
- assessment of bladder function
- indications for surgical intervention
- upper tract involvement
- Role of urodynamics in the investigation of disturbed micturition
- Types of reconstructive procedures undertaken in children with bladder abnormalities, and their relevance to future kidney transplantation
- Wilms tumor and other rare paediatric kidney tumours