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:
- 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:
- 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
