Presentations
- Antenatal diagnosis
- Decreased urine output
- Growth failure
- Haematuria
- Hypertension
- Incontinence
- KDIGO – GFR stages G1–G5
- Nephritic syndrome
- Nephrotic syndrome
- Oedema
- Polyuria
- Uraemia
Conditions
-
CKD sequalae with complications:
- acidosis
- anaemia
- β2‐microglobulin amyloidosis
- cardiovascular disease
- CKD mineral bone disorder (MBD) including:
- calcium/phosphate/PTH and vitamin D control
- electrolyte disturbances, including hyperkalaemia and hypocalcaemia
- hypertension
- increased risk of infections
- infectious complications iron stores, erythropoietin, preparation for transplant
- physiology, and use of, hypoxia inhibitor stabilisers and hepcidin
- Diabetic kidney disease
- Environmental chronic kidney disease of unknown aetiology (CKDu)
- Glomerulonephritis
- Hyperuricaemia and gout
-
Nephropathy:
- hypertensive
- obstructive
- vascular/renovascular
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, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Extraosseous and vascular calcification:
- calciphylaxis
- medial vessel calcification
- other extraosseous and vascular calcification, including visceral organs
- Inherited and genetic kidney disease (see KG8)
- Kidney failure protein energy wasting
- Kidney hypertension
- Kidney manifestations of systemic and chronic disease, hepato-renal, and cardio-renal
- Metabolic acidosis
- Mineral and bone disorder:
- kidney osteodystrophy (and related pathophysiology):
- adynamic bone disease
- mixed uremic osteodystrophy
- osteitis fibrosis
- osteomalacia
- other kidney osteodystrophy, including low bone mass (osteoporosis)
- Renal artery stenosis complications
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, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Allergic/interstitial kidney disease
- Bone–kidney axis and its physiology, including:
- fetuin
- fibroblast growth factor 23 (FGF23)
- klotho
- parathyroid hormone (PTH)
- Calcium and phosphate and vitamin D balance
- Chronic kidney disease of unknown aetiology (CKDu), including Balkan nephropathy
- Classification and description of CKD – KDIGO stages G1–G5
- Kidney endocrine functions:
- erythropoietin (EPO)
- vasopressin
- vitamin D3
- Measurement of kidney function and estimation of glomerular filtration rate (eGFR) using creatinine clearance
- Nephrotoxins including drugs, contrast, and envenomation
- Pathophysiology of diabetic nephropathy, its predisposing factors, and available screening methods
- Pathophysiology of kidney anaemia, and the haematological and biochemical methods to diagnose, assess, and monitor treatment for kidney anaemia
- Pathophysiology of kidney mineral and bone disease (MBD) including:
- adynamic mineral and bone disease
- hyper parathyroid-associated mineral and bone disease
- osteomalacia
- Physiology of electrolyte and acid base disturbances
- Progression and progressive disease predictors (senescence versus disease and predicting progression)
- The common nephrotoxins causing:
- AKI – drugs, contrast
- CKD – environmental, drugs, herbs, e.g. Balkan nephropathy
Imaging
- CT scan and MRI
- Kidney angiogram
- Kidney tract ultrasound
- Nuclear medicine testing
- Pyelography
Laboratory studies
- 24-hour urine electrolyte collection
- Arterial blood gases (ABGs)
- Bone studies
- Creatinine clearance
- Electrolytes
- Full blood count (FBC)
- Glomerular filtration rate (eGFR)
- Haematuria (urine microscopy and phase contrast microscopy)
- Kidney function
- Other labs appropriate to underlying disease – nephrotic state TFTs, lipids
- Proteinuria
- PTH
- Urinalysis
- Urine microscopy and dipstick analysis
- Vitamins D and A
Procedures
- Renal artery angioplasty and stenting
- Kidney biopsy
- CARI guidelines identifying the components relevant to patients and their family and/or carers in supporting non-dialysis patients:
- continuity of care
- multidisciplinary management with allied health staff, particularly social work and dietetics
- symptom control
- Pregnancy in patients with CKD: » perinatal and postnatal support
- pregnancy outcomes
- risk and incidence of AKI
- Post significant AKI screening
- Prevalence and aetiology of kidney disease in Aboriginal and Torres Strait Islander and Māori peoples
- Strategies to improve diagnosis and prognosis by opportunistic and at-risk screening and early intervention
- Impacts and considerations for patients with CKD
- Common pathological, pharmacological, and sexual health impacts
- Dermatological complications, such as pruritis
- Factors that affect progression of kidney failure
- Fatigue, xerostomia, depression, constipation, insomnia, nausea, vomiting, dyspnoea, and pain
- Management of patients with CKD in palliative care
- Nephrotoxicity of environmental and occupational agents, including lead, organic solvents, cadmium, and mercury
- Nutritional issues facing kidney patients and special dietary regimes prescribed, such as low protein diet in CKD
- Referral for vascular access where appropriate
- Transplant preparation
- Vein preservation
- Pharmacology and treatment
- Anti-hypertensive agents
- Cardiovascular risk factor management
- Causes of resistance to erythropoietic stimulating agent (ESA) therapy and its investigation
- CKD mineral and bone disorder (MBD) pharmacology management, including:
- calcimimetic drugs
- parathyroidectomy to manage the condition
- phosphate binders
- vitamin D preparation
- Continued immunosuppression therapy for proliferative glomerulonephritis and vasculitis immunosuppressive agents and regimes
- Diabetic management
- Drug interactions
- ESAs and their complications
- Ethical considerations for treatment equity in different populations
- Hypertensive medications
- Immunosuppressive agents
- Kidney disease and anaemia – erythropoietin and Fe, including hypoxia-inducible factor (HIF) stabilisers and hepcidin
- Oral and parenteral iron therapy and its complications
- Patient response to treatment for kidney mineral and bone disease
- Pharmacology of major drug classes used to treat kidney disease
- Proteinuria reducing drugs
- The interrelationship between drug dosing to GFR and age using Cockcroft–Gault equation (CG) or eGFR equation to identify the toxicity of certain agents in CKD
- Therapeutic drug level monitoring
PCH
- Growth, and the role of nutrition and growth hormone in paediatrics
- Outcomes of kidney failure in infants and children diagnosed at an early age
- The principles of bioethics and ethics support available
- Transition of kidney patients to adult care
