Nephrology Curriculum - الزمالة المصرية للكلي

Nephrology
curriculum
Preface
T he Egyptian Fellowship Board and the Nephrology Scientific Council worked

collaboratively and closely to make this curriculum available for trainees’ guid-
ance and support.
Postgraduate medical education world wide are now governed by sets of academic
standards that describe the qualities and abilities of graduates. In addition, there are
standards for the training processes , trainers’ selection and methods of assessment.
standards ensure transparency and clarify expectations.
The Egyptian fellowship board has already defined and published its standards for
the general and professional competencies expected from our graduates in different
specialties upon successful completion of training. These expectations are clearly
reflected in the nephrology curriculum.
The curriculum describes what trainees will know and be able to do upon com-
pletion of training. In additions, methods of teaching and learning needed to deliver
the curriculum are outlined. The curriculum also describes in details, expectations
from trainees during their rotations in “The training rules and regulations section”.
Methods of assessment and examination regulations are also available in the last
section of the curriculum.
All topics covered during practical and theoretical study are outlined. This will
help trainees to guide their readings and their choice of learning activities. In addi-
tion, all required clinical cases and procedures are listed together with expected per-
formance at various stages of training
To help our trainers, supervisors and maximize benefits, we provided a guide for
required lectures at various rotations and years. Mandatory courses are also men-
tioned and the Egyptian Fellowship Board will work closely with nephrology scien-
tific council to ensure proper organization and implementation of these courses.
We hope that all our trainees, trainers and educational supervisors will follow
the guides provided in the curriculum and cooperate with The Egyptian Fellowship
Board and Nephrology Scientific Council to implement the curriculum in the best
ways.
Esmat Ahmed Sheba

Secretary General
The Higher Committee of Medical Specialties
Acknowledgement
The nephrology curriculum has been created through collaboration between the Ne-
phrology scientific council and the Egyptian fellowship curriculum committee. The
Egyptian Fellowship Board would like to acknowledge the significant efforts and the
substantial contribution of
 Professor Dr Hany Hafez , Professor of nephrology , Cairo University and
Head of the nephrology scientific council
 Dr Hafez Bazaraa, Associate Professor of pediatric nephrology, Cairo
University, Medical Education Expert and member of the fellowship cur-
riculum committee
The fellowship curriculum committee and the nephrology scientific council
consulted international and national curricula in nephrology. The external ref-
erences for the development of this curriculum are:
1. The Joint Committee on Higher Medical Training Nephrology curriculum

approved by Postgraduate Medical Education and Training Board UK
2007
2. Previous Egyptian Fellowship nephrology curriculum
3. Egyptian Fellowship Guidelines for curriculum development
Nephrology Egyptian Fellowship Board
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CONTENTS………………….
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Structure & regulations of Nephrology Training……...…….….….………........................9
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Description of Rotations..........................................................................................................10
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Trainees duties and obligations …………..…………………………………………………12
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Rationale Statement ................................................................................................................15
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Aims & Intended Learning Outcomes (ILOs)……………………………….……..….…...16
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List of major topics…..........................……………………………………………………….19
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Topics description..........………………………………………………………....…………...20
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…………………… A. Basic Science..………………………………………………………………..20
…………………..B. Assessment of The Renal Patient .……………………………………............21
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…………………..C. Hematuria & Proteinuria …………………………………………..….….…..22
…………………… D. Renal Diseases ………………………………………………………..….......23
…………………..E. Systemic Conditions and The Kidney .............................…………………….26
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…………………..F. Renal Functional Impairment ...........................……………………………....30
…………………… G. Fluid, Electrolyte, & Acid-Base Disorders ........……………………………..33
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H. Renal Replacement Therapy ....…………………………………………...….35
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Training methods description .................……………………………………………...…..46
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Learning & reference materials …...………………………………………………….…...47
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List of lectures .............................……………………………………………………….…..48
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Overall list of clinical cases ......…………………………………………………….……....53
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Renal replacement therapy competencies ...…………………………………….………..56
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List of procedures ...……………………………………………………………….………..56
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Interpretation of diagnostic studies......................................................................................57
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Methods of assessment …………………………………………………………..………....58
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………………….. The Structure and Regulation of Nephrology Training
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………………….. The Egyptian Fellowship Board requires two years of supervised training
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………………….. program that must be conducted in accredited hospitals before sitting for the
…………………… final examination. The board will announce a list of accredited hospitals yearly.
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…………………… Entry to nephrology training requires any of the following qualifications
…………………..  Diploma in General Medicine with evidence of recent training or practice in
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………………….. recognized internal medicine hospitals
……………………  Master in General Medicine with evidence of recent training or practice in
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…………………… recognized internal medicine hospitals
…………………..  M.D. in General Medicine with evidence of current practice in general inter-
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………………….. nal medicine services recognized by the MOHP
……………………  M.R.C.P. with evidence of current practice in general internal medicine ser-
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…………………… vices recognized by the MOHP
…………………..  At least two years of training in Egyptian fellowship of general internal
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………………….. medicine with successful completion of the first part exam
…………………… During the entire training program, the candidate must be dedicated full time
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…………………… and must be fully responsible for patient care under supervision.
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Description of nephrology rotations
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………………….. First Year Second Year
…………………… Clinical Nephrology I Clinical Nephrology II
………………….. (4 months) with field study (3 months)
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………………….. Ultrasonography and bi- Nephrology Critical Care
…………………… opsy (2 months)
………………….. (1 month)
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………………….. Dialysis I Dialysis II
…………………… (3 months) (3 months)
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…………………… Transplantation I Transplantation II
………………….. (3 months) (3 months)
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……………………. CLINICAL NEPHROLOGY I
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……………………. The purpose of this rotation is to provide clinical experience in the assessment &
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management of patients with common renal diseases. The field study project
……………………. will take place during this rotation.
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……………………. CLINICAL NEPHROLOGY II
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……………………. The purpose of this rotation is to provide further clinical experience in the as-
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……………………. sessment and management of patients with renal diseases. Tubulointerstitial dis-
……………………. orders, congenital anomalies, less common systemic conditions with renal affec-
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tion, water-electrolyte-acid base disorders and conservative management of renal
……………………. functional impairment are the main targets of this rotation.
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……………………. ULTRASONOGRAPHY AND BIOPSY
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……………………. The purpose of this rotation is to introduce trainees to practice routine ultrasono-
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……………………. graphic examination of the kidneys & urinary tract & ultrasound guided renal
……………………. biopsy. It is, however, expected that trainees will continue to practice these skills
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throughout the program to achieve the required competencies. The required out-
……………………. comes of training related to kidney biopsy are listed in page .
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……………………. NEPHROLOGY CRITICAL CARE
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……………………. The purpose of this rotation is to enable trainees to experience the practice of
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……………………. nephrology in the acute care setting and as a part of multidisciplinary manage-
……………………. ment of intensive care patients. Training contents include:
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…………………….  Advanced life support, stabilization of emergencies & multisystem
……………………. support
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…………………….  Acute conditions & emergencies complicating/ associated with renal
……………………. disease
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 Fluid-electrolyte-acid base disturbances
…………………….  Acute kidney injury
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…………………….  Nutritional management in acute renal failure and multisystem failure
…………………….  Acute renal replacement therapy and plasmapheresis
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…………………….  Interpretation of chest X rays, ECG, echocardiography and brain CT
……………………. scans as needed for patient management
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DIALYSIS I
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…………………… This rotation would cover the management of chronic hemodialysis
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………………….. DIALYSIS II
…………………… During this rotation, the management of dialysis modalities other than chronic
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…………………… hemodialysis will be targeted. Training contents include:
…………………..  Hemodialysis and vascular access complications
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…………………..  Acute hemodialysis and plasmapheresis (integrated with critical care
…………………… rotation)
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……………………  Acute peritoneal dialysis (integrated with critical care rotation)
…………………..  Chronic peritoneal dialysis
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…………………..  Pediatric dialysis
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………………….. TRANSPLANTATION I
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………………….. The purpose of this rotation is to provide basic training in the management of
…………………… typical uncomplicated renal transplantation during preparation, operative,
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…………………… postoperative and follow up stages.
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TRANSPLANTATION II
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………………….. During this rotation, training would include difficult and complicated cases
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………………….. and management of failing grafts.
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………………….. Important notice
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………………….. Trainees must pass successfully all the seven foundation courses before
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………………….. being promoted to the second year of training. Full information about
…………………… foundation courses is available at the EF website & administration office.
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……………………. TRAINEES DUTIES AND OBLIGATIONS
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……………………. 1. Trainees must attend at least 75% of lectures in nephrology subjects.
……………………. They should pass successfully through the first nephrology fellowship
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……………………. exam before being promoted to the second year of training.
……………………. 2. They should be actively involved and fully responsible for patient care
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……………………. including sharing in making decisions about diagnosis and management
……………………. under supervision of the consultants.
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……………………. 3. They must attend 75% of weekly meetings including clinical rounds,
……………………. tutorials and journal clubs
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……………………. 4. Their performance will be monitored and evaluated by trainers and a
……………………. report made about their performance on monthly basis to the Egyptian
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Fellowship Board.
……………………. 5. All trainees will work as residents in the training specialty & they must
……………………. fulfill all residents jobs defined by supervisors and trainers
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……………………. 6. They should be responsible under supervision for outpatient and in
……………………. patients' routine work.
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……………………. 7. They must take supervised shifts according to the hospitals requirements
……………………. and regulation.
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……………………. SPECIFIC REQUIREMENTS AND OBLIGATIONS
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……………………. 1- Obligations towards the admitted patients
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……………………. A. The trainees will be responsible for supervised admission of patients from
……………………. the outpatient department or emergency.
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……………………. B. They will share in the completion of the following documents under
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……………………. a. Complete history and physical examination form.
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……………………. b. Investigation requests, (laboratory, radiology, pathology, etc.).
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……………………. c. Reporting results of the investigations
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d. The plan of management after consultation and approval from
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……………………. e. Daily progress notes.
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……………………. f. Order and medication sheets
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………………….. g. Order the necessary diagnostic procedures
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………………….. h. Discussion of the case with the trainer and consultants
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………………….. i. Discharge summaries.
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………………….. j. Sick leaves and medical reports
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………………….. C. The trainee should inform the senior staff of any high-risk patient admission.
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………………….. 2- Obligations in the outpatient Clinics:
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……………………The trainees should attend the nephrology outpatient clinics & clinics related to the
………………….. rotation in different subspecialties as requested by trainers & supervisory staff. They
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………………….. should participate in different patients' interviews and share in management under
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………………….. 3- Mandatory Clinical and Academic Activities
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……………………The trainees should attend and participate in the mandatory academic and clinical
………………….. activities of the department. Attendance and participation should not be less than
……………………75% of the total number of activities within any training rotation / period including.
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……………………  Daily morning patients' rounds and meetings
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……………………  Clinical round presentation, at least once weekly to cover various topics,
………………….. problems or research
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…………………..  Journal club meeting.
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…………………..  Interdepartmental meetings/ morbidity and mortality meetings
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…………………..  Grand staff rounds
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………………….. 4. The Log Book
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………………….. The trainees must keep & update the Log Book where they record all activities &
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………………….. skills performed & learned during the training program. The activities should be
……………………dated & categorized to whether been performed by the trainee him/herself or as an
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assistant or participant. The trainer should counter sign each activity registered in
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………………….. the Logbook. The Trainer and educational supervisor must sign the completed Log
……………………Book. The educational supervisor must sign important activities and check the log-
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……………………book for completion at least every rotation.
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……………………. 5. The Research project
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……………………. The trainee shall undertake one research project during the first year of the
……………………. training program under the guidance & supervision of their educational
……………………. supervisor. Such project or mini thesis should be presented to the scientific
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……………………. council and accepted before the trainee sits for the first part nephrology
……………………. exam.
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……………………. Before the completion of the training program, the trainee should have
……………………. completed satisfactorily the Rotations described in the structure of the
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……………………. program, performed him/herself, and assisted in the various requested
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……………………. procedures.
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……………………. GENERAL RULES AND REGULATION
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……………………. Holidays and on call duties
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……………………. According to Ministry of Health and Population regulation
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……………………. INTERRUPTION OF TRAINING
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……………………. It is not permissible to interrupt such a structural training program except in
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major unavoidable circumstances. Such circumstances should be convincing
……………………. & approved by the Secretary General. The Interruption once approved
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……………………. should not be for more than one year. Interruption of the training program
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for more than one year shall result in dismissal from the program and cancel-
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……………………. lation of the preceding training period.
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………………….. Rationale Statement
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…………………… The nephrology training program is concerned with the preparation of trainees
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…………………… for pursuing their role in the provision of comprehensive health care services
………………….. in the field of nephrology. In addition to adequate knowledge and understand-
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ing of the specialty, the program aims to develop nephrologists who are com-
…………………… petent in skills necessary for patient management, decision making & safe per-
………………….. formance of procedures that are integral to field (e.g. kidney biopsies, renal
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………………….. replacement therapy).
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………………….. Nephrologists are often involved in multidisciplinary management of patients
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………………….. in various settings. Other than Nephrology and dialysis units, these include
…………………… critical care and primary health care settings. The program aims to enable
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trainees to work with other team members in various settings and stresses the
………………….. role of nephrologists in emergency and critical care.
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…………………… The curriculum describes the knowledge, skills and attitudes expected of a
………………….. nephrologist upon completion of specialist training. It also outlines how these
…………………… outcomes are to be achieved and assessed.
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………………….. The scientific committee has referred to the Specialty Training Curriculum for
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Renal Medicine (UK) developed by the Specialist Advisory Committee (SAC)
…………………… in Renal Medicine for the Joint Committee on Higher Medical Training.
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AIMS AND
……………………. INTENDED LEARNING OUTCOMES
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……………………. I. Aims
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 To provide trainees with the necessary knowledge and understanding of renal
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……………………. conditions and diseases as well as related basic medical science
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…………………….  To enable trainees to assess, diagnose, manage and monitor treatment of vari-
……………………. ous renal disorders and related multisystem disorders in acute and chronic
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settings
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…………………….  To enable trainees to manage acute & chronic renal replacement therapy
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…………………….  To develop the attitudes and behaviors expected in good practice of ne-
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……………………. phrology and integrate these in trainees’ practice
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……………………. II. Intended Learning Outcomes
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……………………. I. Knowledge
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……………………. At the end of the program, trainees should be able to:
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……………………. 1. Demonstrate adequate knowledge of basic medical science relevant to
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proper understanding of renal & urinary tract functioning, diseases, their
……………………. investigations and therapeutic lines
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……………………. 2. Describe the epidemiology, causes, pathophysiology, natural history &
……………………. complications of different renal and urinary tract presentations and diseases
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……………………. 3. Explain the clinical manifestations and diagnosis of different renal and uri-
……………………. nary tract presentations and diseases
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……………………. 4. Describe appropriate management (medical, surgical, renal replacement &
……………………. novel therapies) of different renal diseases, including acute & long term
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……………………. management and follow up when required
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…………………… 5. Outline the methods that can be used for promoting health & preventing
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disease relevant to the field of nephrology
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…………………… 6. Explain the principles, requirements & complications of different dialysis
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…………………… modalities and illustrate the differences between such modalities
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…………………… 7. Describe the principles, value, requirements, preparation, perioperative
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…………………… and long term management of renal transplantation
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………………….. II. Professional Skills & Intellectual skills
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………………….. 8. Take appropriate history and conduct proper clinical examination of
…………………… patients with different renal disorders, including accurate assessment of
………………….. anthropometric measurements, blood pressure and fluid status
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…………………… 9. Select, use & interpret appropriate investigations needed for assessment,
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diagnosis & follow up of patients with different renal disorders. These
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………………….. include laboratory, imaging and pathological investigations
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…………………… 10. Use data from clinical assessment and investigation results to diagnose
………………….. and develop management plans for patients with different renal & urinary
…………………… tract disorders
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………………….. 11. Monitor disease course, response to therapy & development of complica-
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tions & modify patient management accordingly
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………………….. 12. Use adequate methods for prevention, diagnosis and management of
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………………….. infectious conditions in renal patients
…………………… 13. Perform competently the technical procedures necessary for management
………………….. of renal patients (advanced life support, routine medical procedures, ultra-
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………………….. sonography, ultrasound guided kidney biopsy, insertion of temporary di-
…………………… alysis catheters, renal graft perfusion)
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………………….. 14. Apply and interpret standard guidelines and classifications in the diag-
…………………… nosis, classification & management of renal patients (e.g. hypertension,
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…………………… hyperlipidemia, CKD stages, SLE nephropathy, etc)
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…………………… 15. Plan for & conduct community and primary care based screening sur-
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…………………… veys for conditions which may present prospects for preventive and/ or
………………….. early intervention (e.g. microscopic hematuria, asymptomatic proteinuria,
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hypertension)
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……………………. 16. Recognize & manage patients presenting with Acute Kidney Injury, fluid –
……………………. electrolyte – acid-base disturbance or acute conditions complicating renal
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diseases (e.g. acute coronary syndrome, hypertensive emergencies, serious
……………………. infections, etc) in different acute care settings, including intensive care
……………………. units.
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……………………. 17. Manage the patient with Chronic Kidney Disease (CKD) to ensure that ap-
……………………. propriate measures are taken to limit disease progression, ameliorate the
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……………………. consequences and plan for renal replacement
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18. Manage acute and chronic dialysis and its complications
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……………………. 19. Prepare and manage the renal transplant recipient before, during and after
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……………………. transplantation
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……………………. 20. Identify and manage patients with chronic kidney disease who require end
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……………………. of life palliative care
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……………………. III. Attitudes and behaviors
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……………………. 21. Demonstrate respect and consideration for patients and their interests
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……………………. 22. Communicate effectively with patients regarding the different aspects of
……………………. patient care (e.g. natural history, management options and their implica-
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tions, potential complications, long-term management & lifestyle modifica-
……………………. tions, inherited and familial disorders, breaking bad news)
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……………………. 23. Integrate relevant ethical and legal requirements in the management of pa-
……………………. tients
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……………………. 24. Use the best available scientific evidence to inform decisions on patient
……………………. management and integrate this with clinical experiences and patients values
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and preferences
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……………………. 25. Recognize the role of other physicians, nurses and paramedics in the mul-
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……………………. tidisciplinary management of renal patients and work closely with them
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……………………. 26. Demonstrate appropriate professional attitudes, self-confidence and recog-
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……………………. nition of personal limitations
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………………….. LIST OF MAJOR TOPICS
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A. Basic science
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…………………… B. Assessment of the renal patient
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………………….. C. Hematuria and proteinuria
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…………………… D. Renal diseases
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E. Systemic conditions and the kidney
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………………….. F. Renal functional impairment
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F1. Acute kidney injury
…………………… F2. Chronic kidney disease
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………………….. G. Fluid, electrolyte and acid-base disorders
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H. Renal replacement therapy (RRT)
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………………….. H1. General principles of RRT
…………………… H2. Hemodialysis
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H3. Acute hemodialysis and plasmapheresis
………………….. H4. Peritoneal dialysis
…………………… H5. Renal transplantation
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…………………… H6. End of life care
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TOPICS DESCRIPTION
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……………………. A. Basic science
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……………………. MAIN OBJECTIVE
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……………………. The trainee would have the knowledge of basic medical sciences relevant to
……………………. proper understanding of renal and urinary tract functioning, diseases, their
……………………. investigations and therapeutic lines
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……………………. Trainees should demonstrate adequate knowledge and understanding of
……………………. the following, as needed for appropriate practice in nephrology specialty
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…………………….  Development of the kidneys and urinary tract
…………………….  Anatomy of native and transplant kidneys, urinary tract, central venous
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……………………. system in the upper thorax and neck and femoral veins
…………………….  Histological structure of the kidney
…………………….
…………………….  Concepts and principles of renal pathology at the gross, microscopic and
……………………. ultrastructural levels
…………………….
…………………….  Physiology of the kidneys and urinary tract
…………………….  Physiology of water, electrolytes, bone minerals & acid-base homeosta-
…………………….
……………………. sis
…………………….  Infectious problems to which renal and immunocompromised patients
…………………….
……………………. are prone
…………………….  Health care associated infections related to nephrology and renal
…………………….
…………………….
replacement therapy (vascular access infections, blood borne viral
……………………. infections, peritonitis, catheter associated UTI)
…………………….
 Principles of infection control applicable to nephrology and dialysis
…………………….
…………………….  Mode of action, adverse effects, and indications for the use of
……………………. antimicrobial agents in renal patients
…………………….
…………………….  Immunological mechanisms of renal disease and graft rejection
…………………….
 Theoretical and practical application of blood grouping, HLA matching
…………………….
……………………. and donor – recipient cross matching
…………………….  Mode of action, interactions and adverse effects of immunosuppressive
…………………….
……………………. agents
…………………….
…………………….
20
……………………  Prescribing drugs for renal patients, including drug handling and dose
…………………..
…………………… modifications in patients with acute or chronic renal impairment or
………………….. renal replacement therapy
……………………
…………………..
 Effects of drugs on renal function
……………………
…………………..
…………………… B. ASSESSMENT OF THE RENAL PATIENT
…………………..
……………………
………………….. MAIN OBJECTIVE
……………………
…………………..
…………………… The trainee would be able to assess patients with various renal and urinary
………………….. tract presentations and diseases through history taking, clinical examination
…………………… and appropriate investigations
…………………..
…………………… INTENDED LEARNING OUTCOMES
…………………..
……………………
…………………..  Take appropriate history for patients with different renal disorders
……………………  Conduct proper clinical examination of patients with different renal
…………………..
…………………… disorders, including accurate assessment of anthropometric measure-
………………….. ments, blood pressure and fluid status
……………………
…………………..
 Use appropriate communication skills when interviewing & counseling
…………………… patients
…………………..
 Explain the principles of, and interpret, the following diagnostic tests:
……………………
………………….. 1. Laboratory assessment of renal function
…………………… 2. Urine analysis
…………………..
…………………… 3. Common biochemical, hematological and microbiological tests
………………….. 4. Immunological tests
…………………… 5. Renal pathology reports
…………………..
…………………… 6. Renal and urinary tract ultrasonography
………………….. 7. Plain X rays, excretory urography, antegrade pyelography, ascend-
……………………
ing and voiding cystourethrography
…………………..
…………………… 8. CT and MR scan (including CT and MR angiography and MR uro-
………………….. graphy)
……………………
………………….. 9. Renal isotopic scan
…………………… 10. Urodynamic studies
…………………..
…………………… TEACHING/ LEARNING METHODS
…………………..
……………………  Lectures
…………………..
……………………  Clinical Ultrasonography and Biopsy rotation
…………………..  Application of patient assessment in all training rotations
……………………
…………………..
……………………
…………………..
21
…………………….
……………………. C. HEMATURIA AND PROTEINURIA
…………………….
……………………. -
…………………….
…………………….
……………………. The trainee will be able to carry out specialist assessment and treatment of
…………………….
patients with proteinuria and hematuria (including asymptomatic proteinuria
…………………….
……………………. and microscopic hematuria)
…………………….
…………………….
…………………….
……………………. Knowledge
…………………….
…………………….  Define the causes and pathophysiology of proteinuria (including asympto-
……………………. matic proteinuria) and hematuria (gross and microscopic)
…………………….
…………………….
…………………….  Differentiate between physiological and pathological causes of asympto-
…………………….
……………………. matic proteinuria
…………………….
…………………….
…………………….
 Describe the methods of investigation of the patient with asymptomatic
……………………. proteinuria, microalbuminuria and microscopic hematuria
…………………….
…………………….
…………………….  Identify the indications of referral to the urologist and outline the urologi-
……………………. cal interventions requested in cases of hematuria
…………………….
…………………….
…………………….  Describe the management (including the need for follow up) and long term
…………………….
prognosis of asymptomatic proteinuria and microscopic hematuria
…………………….
…………………….
……………………. Intellectual and Professional Skills
…………………….
…………………….
…………………….  Take a relevant history and perform a thorough examination
…………………….
…………………….  Undertake the appropriate investigation (to include the differentiation
……………………. between pathological and physiological causes of proteinuria, use of phase
…………………….
contrast microscopy for hematuria, recognition of patients needing urologi-
…………………….
……………………. cal assessment and imaging for hematuria)
…………………….  Explain the indications for renal biopsy
…………………….
…………………….  Plan and conduct a limited field study in the primary care setting for
……………………. screening of microscopic hematuria, asymptomatic proteinuria and screen-
…………………….
……………………. ing high risk groups for microalbuminuria
…………………….
……………………. Attitudes and Behaviors
…………………….
…………………….  Appreciate the role of primary care in the initial screening and involve-
ment in future management
22
…………………… Teaching Learning Methods

…………………..
…………………… -Lectures
………………….. -Clinical Nephrology rotations
……………………
………………….. -Field study
…………………… -Self learning activities
…………………..
……………………
………………….. D. RENAL DISEASES
……………………
……………………
…………………..
…………………… The trainee will be able to carry out specialist assessment and treatment of
………………….. patients with various renal and urinary tract disorders.
……………………
………………….. INTENDED LEARNING OUTCOMES
……………………
………………….. Knowledge
……………………
…………………..
For all conditions that are listed in the training contents, trainees should be
……………………
………………….. able to:
……………………  Define etiology, pathophysiology, natural history and prognosis
…………………..
……………………  Describe pathological & clinical features, including clinical spectrum of
………………….. disease and complications
……………………
…………………..  Describe the methods of investigation
……………………  Explain the general and specific methods of management, including
…………………..
…………………… novel therapies and measures to prevent or limit renal damage
…………………..  Define the indications for intervention/ surgery/ referral to other special-
……………………
………………….. ists when relevant and outline the interventional/ surgical methods com-
…………………… monly used
…………………..
……………………  Explain the use of screening methods (where relevant, e.g. PKD) and
………………….. their limitations
……………………
…………………..
…………………… Intellectual and Professional Skills
…………………..
……………………
…………………..  Take an accurate clinical history
……………………
…………………..
 Perform a reliable and accurate clinical examination of the patient
……………………  Plan for appropriate use of laboratory investigations, imaging studies &
…………………..
…………………… kidney biopsy and interpret results
…………………..
……………………  Plan appropriate treatment, including (where appropriate) long term
…………………..
treatment/ follow up, prevention of recurrence, management of complica-
……………………
………………….. tions and preservation of renal function
……………………
…………………..
23

…………………….
…………………….
…………………….  Counsel patients and families regarding inherited and familial conditions
……………………. and deal with related concerns and anxieties
…………………….
…………………….  Discuss the relevant treatment options and their relative merits
…………………….
…………………….  Recognize the role of urologists, radiologists & pathologists in the man-
…………………….
……………………. agement of certain diseases and work in collaboration with them
…………………….
…………………….
……………………. Training contents
…………………….
…………………….
-Glomerulopathies
…………………….
…………………….  Clinicopathological syndromes, Nephrotic Syndrome, Nephritic syn-
…………………….
……………………. drome.
…………………….
 Primary & secondary glomerulopathies, Minimal change nephropa-
…………………….
……………………. thy, focal segmental glomerulosclerosis, membranous nephropathy,
…………………….
……………………. membranoproliferative glomerulonephritis, Congenital nephrosis,
……………………. IgA nephropathy/ HSP, Goodpasture’s syndrome, acute post-
…………………….
……………………. infectious glomerulonephritis, Hereditary nephritis.
…………………….
…………………….  Rapidly progressive glomerulonephritis
…………………….
…………………….  Chronic glomerulonephritis
……………………. Vascular disorders
…………………….
…………………….  Renovascular disease
…………………….
…………………….  Arterial and venous thrombosis
…………………….
…………………….  Thrombotic microangiopathies
…………………….
…………………….  Renal vasculitis
……………………. Tubulo-interstitial diseases
…………………….
…………………….  Tubular disorders: primary & secondary tubular disorders, renal tu-
…………………….
……………………. bular acidosis, nephrogenic diabetes insipidus, tubular disorders of
…………………….
electrolyte and mineral reabsorption
…………………….
…………………….  Acute interstitial nephritis
…………………….
…………………….  Hyperoxaluria
…………………….
…………………….  Chronic Tubulo-interstitial diseases
…………………….
…………………….  Renal papillary necrosis
…………………….
…………………….
…………………….
24
…………………… Congenital renal anomalies

…………………..  Aplasia, hypoplasia, dysplasia
……………………
…………………..  Polycystic Kidney Disease
……………………
…………………..  Nephronophthisis/ Medullary cystic disease/ Medullary sponge kid-
……………………
………………….. ney
…………………… Urinary tract disorders
…………………..
……………………  Urinary tract infections
…………………..
……………………  Stone diseases
…………………..
……………………  Obstructive uropathies
…………………..
……………………  Neurogenic bladder and voiding disorders
…………………..
……………………
 Vesico-ureteric reflux and reflux nephropathy
………………….. Renal and urinary tract neoplasia
……………………
…………………..
…………………..
…………………..
…………………… -Clinical Nephrology rotations
…………………..
-Independent reading
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
25
…………………….
……………………. E. SYSTEMIC CONDITIONS AND THE KIDNEY
…………………….
…………………….
……………………. E1. Renal disorders in pregnancy
…………………….
…………………….
…………………….
MAIN OBJECTIVE
…………………….
…………………….
…………………….
patients with renal disorders, including renal transplant patients, who
…………………….
……………………. Become pregnant.
…………………….
…………………….
……………………. The trainee will be able to carry out specialist assessment of patients who
……………………. develop renal disorders during pregnancy
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….  Describe how pregnancy may affect renal function in normal patients &
……………………. in those with preexisting renal disease, including those on renal replace-
…………………….
……………………. ment therapy
…………………….
…………………….
 List the adverse effects of drug treatment on both patient and fetus
…………………….
…………………….
…………………….  List which renal disorders may be inherited & explain the inheritance of
…………………….
……………………. renal disorders
…………………….
…………………….
…………………….  Describe how to prepare the patient with a pre-existing renal disorder
……………………. (including renal transplant) for pregnancy with particular emphasis on
…………………….
minimizing the risk to patient and fetus
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….  Manage hypertension in pregnancy, including the safe use of antihyper-
……………………. tensive drugs
…………………….
…………………….
…………………….  Manage the renal consequences of preeclampsia as well as acute renal
…………………….
……………………. failure in pregnancy and the puerperium
26
…………………… Attitudes and Behaviors

…………………..
……………………  Work closely with obstetricians in the management of renal conditions in preg-
………………….. nancy
……………………
…………………..
……………………  Recognize the need for genetic counseling in inherited kidney disorders
…………………..
…………………… E2. Hypertension and hyperlipidemias
…………………..
……………………
……………………
…………………..The trainee will be able to carry out assessment and treatment of patients
……………………
…………………..with hypertension and/ or hyperlipidemia, with particular respect to renal disease
……………………
…………………..
…………………… INTENDED LEARNING OUTCOMES
…………………..
……………………
……………………
…………………..
……………………  Define hypertension, hyperlipidemia and dyslipidemia and describe their rele-
………………….. vance to renal disease
……………………  Describe the possible mechanisms causing primary (essential) hypertension
…………………..
……………………
………………….. List the causes of secondary hypertension, the methods of investigation and treat-
…………………… ment and their limitations
…………………..
……………………
………………….. Describe the complications of hypertension
……………………
…………………..
……………………  Discuss the treatment of hypertension/ hyperlipidemia according to nationally
………………….. accepted guidelines
……………………
 Describe the mechanisms of action and potential side effects of anti-hypertensive
…………………..
…………………… agents with particular reference to renal disease
…………………..
……………………  Describe the dietary and drug treatment of hyperlipidemia
…………………..
……………………
………………….. Intellectual and Professional Skills
……………………
…………………..
……………………  Take a relevant history and perform a thorough examination to diagnose patient
………………….. who may have hypertension/ hyperlipidemia
……………………
…………………..
……………………  Investigate appropriately patients for hypertension/ lipid disorders
…………………..
……………………  Demonstrate the use of home & ambulatory BP measurement to accurately as-
…………………..
…………………… sess blood pressure.
…………………..
27
…………………….
…………………….
…………………….  Recognize the role of primary care in the management of hypertension
…………………….
…………………….
…………………….  Recognize importance of patient centered care & education to change
…………………….
lifestyle, achieve compliance and BP treatment targets
…………………….
…………………….
…………………….  Involve dietitians and other health care professionals in the management
…………………….
……………………. of hyperlipidemias
…………………….
…………………….
……………………. E3. Systemic diseases and therapies affecting the kidneys
…………………….
…………………….
…………………….
……………………. patients having various systemic conditions with renal involvement
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
……………………. For all conditions that are listed in the training contents, trainees should be
……………………. able to:
…………………….
…………………….
 Define diseases which may affect the kidneys, their etiology and patho-
……………………. genesis
…………………….
…………………….
…………………….  Outline the clinical picture and diagnostic tests for diseases which may
……………………. affect the kidneys
…………………….
…………………….
…………………….  Discuss the risk factors, pathology, disease spectrum, natural history and
…………………….
…………………….
methods of diagnosis of renal involvement in systemic conditions
…………………….
…………………….
 Describe the methods for prevention & screening for renal involvement
…………………….
……………………. (when appropriate) as well as the indications of referral to specialist re-
……………………. nal clinics
…………………….
…………………….
…………………….  Describe the methods of treatment (including acute conditions, preven-
…………………….
…………………….
tion of disease progression and long term management, as appropriate)
…………………….
…………………….  Explain the different effects of drugs and chemicals on the kidneys,
…………………….
……………………. their pathogenesis, characteristic features, consequences and methods of
prevention, diagnosis and management, as appropriate
28
……………………Intellectual and Professional

…………………..
……………………
…………………..  Take appropriate history and conduct proper clinical examination
……………………
…………………..
……………………  Plan appropriate investigations needed for assessment, diagnosis
………………….. and follow up
……………………
…………………..
……………………  Diagnose and classify renal involvement
…………………..
……………………
…………………..  Manage treatment, monitor its effectiveness, make necessary modifica-
……………………
………………….. tions and arrange long term management, as appropriate
……………………
…………………..
……………………Attitudes and Behaviors
…………………..
……………………
…………………..
……………………  Recognize the role of other specialties and paramedical personnel and
………………….. work with them in the management of patients
……………………
………………….. TRAINING CONTENTS
……………………
…………………..
……………………
-Diabetic nephropathy
…………………..
…………………… -SLE and other collagen diseases
…………………..
…………………… -Liver disease
…………………..
-Specific infections (e.g. Bilharziasis, Malaria)
……………………
………………….. -Congestive heart failure
……………………
………………….. -Sickle cell nephropathy
…………………… -Dysproteinemias
…………………..
…………………… -Amyloidosis
…………………..
…………………… -Metabolic errors (e.g. Fabry)
………………….. -Cancer and its treatment
……………………
………………….. -Chemicals and drugs
……………………
…………………..
…………………… TEACHING/ LEARNING METHODS
…………………..
……………………
…………………..-Lectures
…………………… -Clinical nephrology rotations
…………………..
……………………
-Field study
…………………..-Independent reading
……………………
…………………..
29
…………………….
……………………. F. RENAL FUNCTIONAL IMPAIRMENT
…………………….
…………………….
…………………….
……………………. F1. ACUTE KIDNEY INJURY
…………………….
…………………….
…………………….
……………………. patients with acute kidney injury (AKI, acute renal failure)
…………………….
…………………….
…………………….
INTENDED LEARNING OUTCOMES
…………………….
…………………….
…………………….
…………………….
…………………….  List the causes of acute kidney injury (acute renal failure)
…………………….
…………………….
…………………….  Describe the risk of AKI after the use of contrast media and an-
……………………. giographic procedures and how this can be avoided
…………………….
…………………….
…………………….  Describe different methods of investigating the severity and causes of
……………………. acute kidney injury
…………………….
…………………….
…………………….  Describe the methods to correct fluid and biochemical abnormalities
……………………. and strategies to treat reversible causes of acute kidney injury
…………………….
…………………….
…………………….  Explain the indications of dialysis in cases of acute renal failure
…………………….
…………………….
…………………….
…………………….  Take an accurate clinical history in the assessment of acute renal failure
…………………….
…………………….
including drug history, surgical history, family, social & environmental
……………………. history
…………………….
…………………….
…………………….
 Perform a reliable and accurate clinical examination of the patient, in-
……………………. cluding assessment of the patient’s fluid balance
…………………….
…………………….
 Interpret different investigations ( Biochemistry, Hematology, Microbi-
…………………….
……………………. ology, ultrasound scanning, CT/MRI, Immunology, renal biopsy)
…………………….
…………………….
 Institute correct management (includes renal replacement therapy &
…………………….
……………………. measures to treat the underlying cause) for patients with AKI, including
……………………. those with multisystem failure
…………………….
30

…………………..
……………………
 Appreciate the role of intensivists & cooperate with them in the management
…………………..
…………………… of patients with AKI and multisystem disease or multiorgan failure
…………………..
……………………
…………………..  Recognize the role of nurses in the management of AKI
……………………
…………………..
……………………  Recognize the role of the radiologist, urologist, surgeon, histopathologist and
………………….. microbiologist
……………………
…………………..
…………………..
……………………
………………….. -Lectures
………………….. -Nephrology critical care rotation
……………………
………………….. -Independent reading
……………………
…………………..
…………………… F2. CHRONIC KIDNEY DISEASE
…………………..
……………………
…………………..
…………………… MAIN OBJECTIVE
…………………..
…………………… The trainee would be able to carry out specialist assessment and management of
…………………..
…………………… the patient with Chronic Kidney Disease (CKD) to ensure that appropriate meas-
………………….. ures are taken to limit disease progression, ameliorate the consequences and plan
……………………
for renal replacement
…………………..
……………………
……………………
…………………..
…………………… Knowledge
…………………..
……………………
…………………..  List the causes of chronic kidney disease and outline their relative incidence
…………………… in different age groups
…………………..
……………………
…………………..  Describe the classification (stages) of chronic kidney disease and the
……………………
…………………..
investigations used to assess the degree of renal impairment and its causes
……………………
…………………..
 Define the natural history and prognosis of chronic kidney disease from
……………………
………………….. different causes
……………………
…………………..
……………………  Describe the underlying factors & pathophysiology of different manifestations
………………….. and consequences of chronic renal functional impairment (listed in the train-
ing contents).
31
…………………….  Explain the effects of renal replacement therapy & dialysis adequacy on
…………………….
different manifestations & consequences of chronic renal functional impair-
…………………….
……………………. ment
…………………….
…………………….  Describe the methods to diagnose, assess and monitor treatment of differ-
…………………….
……………………. ent manifestations and consequences of chronic renal functional impairment
…………………….
…………………….  Describe the impact of cardiovascular disease as the leading cause of mortal-
…………………….
……………………. ity in renal patients including those on RRT and list the risk factors, methods
……………………. to assess and modify them
…………………….
…………………….
…………………….  Describe the treatment strategies (both general and specific) and discuss the
……………………. indications, use and complications of different therapeutic lines used for
……………………. management of CKD, its manifestations and consequences
…………………….
…………………….
…………………….  Discuss the indications & timing for initiation of chronic renal replacement
……………………. therapy
…………………….
…………………….
…………………….
…………………….  Take an accurate clinical history during the assessment of chronic kidney
…………………….
……………………. disease including drug history, family, social and environmental history
…………………….
…………………….  Perform reliable and accurate clinical examination of the patient
…………………….
…………………….
…………………….  Undertake appropriate investigations
…………………….
…………………….
…………………….  Manage the patient with chronic kidney disease to ensure that reversible
……………………. causes are identified and treated; and that appropriate preparation for renal
……………………. replacement therapy is undertaken when necessary
…………………….
…………………….
…………………….  Prevent (when applicable), diagnose and manage different manifestations
……………………. and consequences of CKD in patients on conservative management, on di-
…………………….
…………………….
alysis and after transplantation
…………………….
…………………….  Use drug formularies to ensure safe and effective drug prescribing and fol-
…………………….
…………………….
low appropriate methods to improve compliance and reduce complications of
……………………. prescribing in patients with renal disease
…………………….
…………………….
 Monitor the effect of treatment and make necessary adjustments
…………………….
…………………….
…………………….  Use national standards and nationally accepted guidelines in the manage-
…………………….
ment of patients
…………………….
…………………….
32
……………………
………………….. Attitudes and Behaviors
……………………
…………………..  Appreciate the role of the multi-professional team in the management of
…………………… CKD
…………………..
……………………
…………………..  Recognize the role of primary care in the identification and management
…………………… of patients with early stages of CKD
…………………..
……………………
…………………..
…………………… Training content
…………………..
…………………… Manifestations and consequences of chronic renal functional impairment:
…………………..  Nutritional problems
……………………
…………………..  CKD-associated Metabolic Bone Disease (CKD-MBD)
……………………
…………………..
 Anemia and other hematological/ immunological changes
……………………  Cardiovascular disease
…………………..
……………………  Endocrine manifestations
…………………..  Neurological manifestations
……………………
…………………..  Psychological and social problems
……………………
…………………..
…………………..
…………………..
……………………
…………………..
……………………
………………….. G. FLUID, ELECTROLYTE AND ACID-BASE DISORDERS
……………………
…………………..
……………………
……………………
…………………..
…………………… The trainee will be able to carry out specialist assessment and treatment of
………………….. patients with disorders of fluid, electrolyte and acid base regulation
……………………
…………………..
……………………
……………………
…………………..
…………………..
……………………  Define the pathophysiology of sodium, potassium and hydrogen ion imbal-
………………….. ance; calcium, phosphate and bone mineral metabolism; and the patho-
……………………
………………….. physiology of water imbalance
33
…………………….
 Describe the methods used to investigate fluid, electrolyte and acid base
…………………….
……………………. regulation; and bone mineral metabolism
…………………….
…………………….
…………………….  Describe the management of fluid, electrolyte and acid base disorders and
……………………. abnormalities of bone mineral metabolism
…………………….
…………………….
…………………….  Define the fluid and electrolyte disturbances occurring after the relief of
…………………….
obstruction and their management
…………………….
…………………….
…………………….
…………………….
Intellectual and Professional Skills
…………………….
…………………….  Take an accurate clinical history, including family history, in the assessment
…………………….
…………………….
of patients
…………………….
…………………….
 Perform reliable and accurate clinical examination of the patient, including
…………………….
……………………. assessment of fluid balance
…………………….
…………………….
…………………….  Interpret biochemical investigations
…………………….
…………………….
…………………….  Interpret radiological and histological investigations of bone mineral disor-
……………………. ders
…………………….
…………………….
…………………….  Manage these disorders effectively, including both acute conditions and long
……………………. term management
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….  Explain the implications of familial disorders
…………………….
…………………….
…………………….  Recognize the role of nurses and dietitians in the long term management
…………………….
…………………….
…………………….
……………………. Teaching Learning Methods
…………………….
…………………….
……………………. -Lectures
…………………….
……………………. -Clinical nephrology rotations
……………………. -Nephrology critical care rotation
……………………. -Independent reading
…………………….
…………………….
…………………….
34
…………………… H. RENAL REPLACEMENT THERAPY

…………………..
……………………
………………….. H1. GENERAL PRINCIPLES OF RENAL REPLACEMENT THERAPY
……………………
…………………..
…………………..
…………………… The trainee will be able to manage acute and chronic renal replacement
………………….. therapy and provide integrated management for patients with end-stage renal
……………………
………………….. disease
……………………
……………………
…………………..
……………………
……………………
…………………..  Describe the principles of dialysis & compare and contrast different di-
……………………
alysis modalities
…………………..
……………………  Explain the role of renal transplantation in the management of ESRD
…………………..
…………………..
……………………
…………………..
……………………  Identify the appropriate renal replacement modality for each patient, iden-
………………….. tify expected difficulties and determine alternative choices
……………………
…………………..
…………………..
……………………
…………………..  Discuss with the patients and their families relevant treatment options
…………………… and the differences between hemodialysis, chronic ambulatory peritoneal
…………………..
dialysis and automated peritoneal dialysis in a manner that will allow clear
……………………
………………….. understanding of choice
……………………
…………………..
……………………  Communicate with them about potential complications
…………………..
……………………
…………………..  Work closely with management and purchasers to ensure cost effective
…………………… treatment
…………………..
……………………
…………………..  Discuss the implications of failure of a dialysis modality & the complemen-
…………………… tary nature of renal replacement therapy
…………………..
……………………
…………………..  Discuss the implications of a failing transplant & the planning for subse-
……………………
………………….. quent renal replacement
……………………
…………………..
 Discuss the withdrawal of dialysis with patients, carers and other health
care professionals 35
…………………….
…………………….
…………………….
……………………. -Dialysis rotations
……………………. -Transplantation rotations
…………………….
…………………….
…………………….
……………………. H2. HEMODIALYSIS
…………………….
…………………….
……………………. The trainee will be able to supervise and manage patients on chronic hemodialy-
…………………….
……………………. sis
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….  Describe the principles of hemodialysis and compare and contrast hemodi-
……………………. alysis with other treatment modalities
…………………….
…………………….
…………………….  Describe the methods of creating vascular access for hemodialysis
…………………….
…………………….
…………………….  Describe the means to deliver purified water, the necessary standards & meth-
……………………. ods of assessing them
…………………….
…………………….
…………………….  Describe different dialysis membranes and dialysate fluids
…………………….
…………………….
…………………….
 Describe the theory of sodium profiling and ultrafiltration
…………………….
…………………….  Define the methods to assess adequacy of hemodialysis
…………………….
…………………….
…………………….  Describe the complications associated with dialysis vascular access and dialy-
……………………. sis line and their management (including poor flow, thrombosis, hemorrhage,
…………………….
infection and air embolism)
…………………….
…………………….
…………………….  Describe the management of hard water syndrome and ETO reactions
…………………….
…………………….
…………………….  Define the principles behind the causation and management of intradialytic
……………………. hypotension
…………………….
…………………….
…………………….  Describe the pathophysiology and management of patient complications
……………………. associated with dialysis (e.g. amyloid)
…………………….
36

…………………..
……………………  Assess the suitability of a patient for hemodialysis and plan for the initiation of
…………………..
…………………… hemodialysis
…………………..
……………………  Prepare the patient both physically and psychologically for hemodialysis
…………………..
……………………
………………….. Plan for vascular access and anticipate and overcome related difficulties
……………………
…………………..
……………………  Adjust the prescription of hemodialysis and monitor change
…………………..
……………………
…………………..
 Advise on ultrafiltration, sodium profiling and use of different dialysate solutions
……………………
………………….. Organize the day to day management of a dialysis unit
……………………
…………………..
……………………  Follow measures to prevent blood borne viral infections and vascular access re-
………………….. lated infections
……………………
…………………..
……………………  Deal with acute dialysis complications and emergencies
…………………..
……………………
………………….. Identify and manage the complications of vascular access involving, when
…………………… necessary, surgeons and radiologists
…………………..
……………………
………………….. Manage dialysis related sepsis
……………………
…………………..
…………………..
……………………
………………….. Develop a framework to discuss with patients and their families problems related
…………………… to hemodialysis including the withdrawal of dialysis
…………………..
……………………
………………….. Appreciate the role of nurses in the initial counseling of patients, initiation, day to
…………………… day and long term management of hemodialysis and its complications
…………………..
……………………
………………….. Appreciate the multidisciplinary nature of management of hemodialysis & its
…………………… complications & develop close working relationships with surgeons & radiologists
…………………..
…………………… in the management of vascular access and its complications
…………………..
……………………
…………………..
……………………
Teaching Learning Methods
…………………..
…………………..-Dialysis rotations
……………………
…………………..
37
…………………….
……………………. H3. ACUTE HEMODIALYSIS AND PLASMAPHERESIS
…………………….
…………………….
…………………….
……………………. The trainee will be able to supervise & manage acute renal replacement therapy
……………………. and plasmapheresis
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….  Describe the methods of creating vascular access for acute renal replacement
……………………. therapy
…………………….
…………………….
…………………….  Describe the principles, indications and complications of acute hemodialy-
……………………. sis, Hemofiltration and hemodiafiltration, as well as the differences between
……………………. them.
…………………….
…………………….
…………………….  Describe the principles, indications (renal and non-renal) and complications
……………………. of plasmapheresis
…………………….
…………………….
Intellectual and Professional Skills
…………………….
…………………….
…………………….
…………………….
 Assess the suitability of a patient for acute hemodialysis, hemofiltration,
……………………. hemodiafiltration or plasmapheresis
…………………….
…………………….
 Adjust the prescription of these procedures, monitor changes and response
…………………….
……………………. to therapy
…………………….
…………………….
 Manage the patient with multiorgan failure or systemic disease requiring
…………………….
……………………. acute renal replacement therapy
…………………….
…………………….
 Manage the patient with acute renal failure requiring both plasmapheresis
…………………….
……………………. and acute renal replacement therapy
…………………….
…………………….
…………………….
…………………….
…………………….  Appreciate role of nurses in the management of acute renal replacement
…………………….
therapy
…………………….
…………………….
…………………….  Appreciate the role of intensivists and cooperate with them in the manage-
…………………….
ment of patients with multisystem disease or multiorgan failure requiring
…………………….
acute renal replacement therapy
38

…………………..
…………………..
…………………… -Nephrology critical care rotation
………………….. -Dialysis II rotation
……………………
…………………..
……………………
…………………..
……………………
………………….. Insertion of temporary hemodialysis catheters
……………………
…………………..
…………………..
…………………… The trainee will be competent at carrying out the insertion of temporary
…………………..
hemodialysis catheters
……………………
…………………..
……………………
……………………
…………………..
…………………..
……………………  Define the indications for insertion of temporary hemodialysis catheters,
………………….. the complications and means to minimize these including ultrasound guid-
……………………
ance
…………………..
……………………
…………………..  Describe the treatment of catheter sepsis and blocked catheters
……………………
…………………..
…………………… Skills and Attitudes
…………………..
……………………  Discuss the indications, benefits and adverse events of the procedure to pa-
…………………..
…………………… tients, relatives and carers in a manner that will allow informed consent
…………………..
……………………  Perform insertion of temporary hemodialysis catheters using the Seldinger
…………………..
…………………… technique, using both internal jugular and femoral veins
…………………..
……………………  Explain the use of the catheter and its management to the patient, relatives
…………………..
…………………… and carers
…………………..
……………………  Appreciate role of nurses in the management of a catheter after its inser-
…………………..
…………………… tion and to ensure education of patients and carers
…………………..
……………………  Demonstrate appropriate self-confidence and recognition of limitations
…………………..
……………………
…………………..
……………………
…………………..
39
…………………….
…………………….
……………………. -Dialysis rotations
…………………….
-Nephrology critical care rotation
…………………….
…………………….
…………………….
…………………….
H4. PERITONEAL DIALYSIS
…………………….
…………………….
…………………….
…………………….
The trainee will be able to supervise and manage patients on acute and chronic
…………………….
……………………. peritoneal dialysis
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….  Describe the principles of peritoneal dialysis and compare and contrast
……………………. acute peritoneal dialysis, chronic ambulatory peritoneal dialysis and auto-
……………………. mated peritoneal dialysis
…………………….
…………………….
…………………….  Describe the different methods of insertion of peritoneal dialysis catheters
…………………….
……………………. and their advantages and disadvantages
…………………….
…………………….
…………………….  Explain the principles underlying acute and chronic peritoneal dialysis
……………………. prescriptions
…………………….
…………………….
…………………….  Describe the methods to assess adequacy of peritoneal dialysis
…………………….
…………………….
…………………….  Describe the methods to assess failure of ultrafiltration
…………………….
…………………….
…………………….  Describe the diagnosis and management of peritoneal dialysis complica-
……………………. tions, including:
…………………….
…………………….  Bacterial and non-bacterial peritonitis
…………………….  Catheter and exit site associated infection
…………………….  Mechanical problems (leaks, catheter malfunction, hernia)
…………………….
…………………….  Inadequate dialysis or ultrafiltration
…………………….
…………………….
…………………….
…………………….
40

…………………..
……………………  Assess the suitability of a patient for peritoneal dialysis in the context of other
…………………..
methods of renal replacement therapy
……………………
…………………..
……………………  Adjust the prescription of peritoneal dialysis and monitor change
…………………..
……………………
…………………..  Manage the nutrition of peritoneal dialysis patients
……………………
…………………..
……………………  Follow measures for prevention of dialysis associated peritonitis
…………………..
……………………
 Recognize the cost implications of different catheters, fluids & systems in
…………………..
…………………… peritoneal dialysis
…………………..
……………………
…………………..  Manage the treatment of peritoneal dialysis complications
……………………
…………………..
…………………..
……………………
…………………..
Appreciate role of nurses in the initial counseling of patients, initiation and the long
……………………
………………….. term management of peritoneal dialysis
……………………
…………………..
……………………
………………….. Teaching Learning Methods
……………………
…………………..
……………………-Lectures
………………….. -Dialysis II rotation
……………………
……………………
…………………..
……………………
………………….. H5. RENAL TRANSPLANTATION
……………………
…………………..
……………………
……………………
…………………..
…………………… The trainee will be able to supervise and manage the preparation of patients
…………………..
…………………… who are suitable for renal transplantation
…………………..
……………………
…………………..  The trainee will be able to manage patients in the early and long-term stages of
…………………… renal transplantation
…………………..
……………………
…………………..
41
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….  Describe the principles of renal transplantation, its medical and surgical, so-
……………………. cial and ethical aspects
…………………….
…………………….
…………………….  Describe the ethical and legal framework for renal transplantation
…………………….
…………………….
 Compare and contrast renal transplantation with other treatment modalities
…………………….
…………………….
…………………….  Discuss the recommendations for live renal transplantation
…………………….
…………………….
…………………….  Describe the advantages and disadvantages of pre-emptive transplantation
…………………….
…………………….  Outline the operative & early postoperative management of renal transplanta-
…………………….
……………………. tion
…………………….
…………………….  Discuss the use & adverse effects of immunosuppressive agents, including
…………………….
……………………. routine protocols and methods used to treat acute rejection
…………………….
…………………….  Discuss recent and future prospects such as tolerance, stem cell therapy and
…………………….
……………………. combined organ transplantation (e.g. hepatic-renal and pancreatic-renal)
…………………….
…………………….  Describe the medical and surgical problems which occur following renal
…………………….
……………………. transplantation
…………………….
…………………….  Describe the indications for ultrasound scanning, isotope scanning & radio-
…………………….
…………………….
logical investigations in the acute stage following renal transplantation
…………………….
…………………….  Define methods used to diagnose acute rejection including biopsy
…………………….
…………………….
…………………….  Explain the differences in management and anticipated problems both in early
……………………. and late post transplantation stages
…………………….
…………………….
…………………….  Describe strategies in the acute and chronic phases of renal transplantation
……………………. which will influence long term graft function
…………………….
…………………….
…………………….  Describe the pathophysiology & consequences of post transplantation intersti-
……………………. tial and tubular atrophy- Not Otherwise Specified (ISTANOS, chronic al-
……………………. lograft nephropathy)
…………………….
…………………….
42
……………………
………………….. Intellectual and Professional Skills
……………………
…………………..
 Assess the suitability of a patient for a renal transplant
……………………
…………………..
…………………… Discuss the pros, cons and timing of renal transplantation
…………………..
……………………
………………….. Plan and carry out protocols for pre transplant assessment and post transplant
…………………… follow up
…………………..
……………………
………………….. Perform intraoperative kidney perfusion
……………………
………………….. Assess renal transplant function and investigate delayed or deteriorating graft
……………………
function
…………………..
……………………
………………….. Interpret investigations used to diagnose acute rejection, surgical complications
…………………… and medical complications of renal transplantation
…………………..
……………………
………………….. Plan, monitor and modify immunosuppressive therapy
……………………
…………………..
…………………… Interpret investigations to identify nonimmunologic problems and manage them
…………………..
…………………… Manage residual renal problems (hypertension, bone disease, etc) and different
…………………..
degrees of chronic renal functional impairment (CKD-T) following transplantation
……………………
…………………..
…………………… Manage associated conditions in the renal transplant recipient (cardiovascular
………………….. disease, pregnancy, other illness, surgery, etc)
……………………
…………………..
……………………
………………….. Attitudes and Behaviors
……………………
 Counsel patients, relatives & potential donors in all aspects of renal transplantation
…………………..
……………………
………………….. Respect and follow ethical and legal requirements related to renal transplantation
……………………
…………………..
…………………… Appreciate the multidisciplinary nature of management of renal transplantation
…………………..
…………………… Appreciate role of nurses in the care of patients undergoing renal transplantation
…………………..
……………………
………………….. Encourage patients, relatives and carers to participate in the joint care
……………………
…………………..
…………………..
………………….. -Transplantation rotations
……………………
43
…………………….
H6. END OF LIFE CARE
…………………….
…………………….
…………………….
…………………….
…………………….  The trainee will be able to identify patients with chronic kidney disease who
……………………. require end of life palliative care, and will be able to supervise and manage their
……………………. care as a part of multi-disciplinary team
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….  Describe factors affecting outcome & survival in patients with end stage renal dis-
……………………. ease
…………………….
…………………….
 Describe the principles of pain relief & use of analgesia in end stage renal disease
…………………….
…………………….
…………………….  Explain the need for modification or withdrawal of dialysis and withdrawal of im-
……………………. munosuppressive medications in some cases
…………………….
…………………….
…………………….  Describe a medicolegal framework for decisions about treatment & advanced di-
……………………. rectives
…………………….
…………………….
…………………….  Outline integrated care pathways for dying patients
…………………….
…………………….  Describe the principles of bereavement management
…………………….
…………………….
…………………….
…………………….  Identify patients who require end of life palliative care and manage them appropri-
……………………. ately .
…………………….
…………………….
…………………….  Recognize and institute management of depression
…………………….
…………………….
…………………….
…………………….
…………………….  Counsel patients and carers concerning conservative (nondialyzed, non-transplant)
……………………. management of end stage renal disease
…………………….
…………………….
…………………….  Be aware of & appreciate the complex needs of patients and families when facing
……………………. death (including physical, social, spiritual and psychological needs)
…………………….
…………………….
…………………….
…………………….
…………………….
44
Teaching Learning Methods

……………………
…………………..-Lectures
…………………… -Dialysis rotations
…………………..
-Nephrology critical care rotation
……………………
…………………..-Clinical nephrology rotation
…………………… -Independent reading
…………………..
……………………
………………….. Kidney Biopsy
……………………
…………………..
……………………MAIN OBJECTIVE
…………………..
……………………The trainee will be competent in performing native and transplant renal biopsy
…………………..
……………………
……………………
…………………..
…………………..
……………………  Define the indications for renal biopsy of native and transplant kidneys
…………………..
……………………
…………………..  Describe the complications and methods to minimize them
……………………
…………………..
…………………..
……………………  Discuss the indications, benefits and adverse events of the procedure with
…………………..
…………………… patients, relatives and carers in a manner that will allow informed consent
…………………..
……………………
 Perform ultrasound guided renal biopsy on native and transplant kidneys
…………………..
……………………
…………………..  Comply with needs regarding sampling, processing and preservation of
……………………
………………….. specimens for different pathological examinations (light microscopy,
…………………… immunofluorescence and electron microscopy)
…………………..
……………………
…………………..  Manage the complications of renal biopsy
……………………
…………………..
 Interpret renal biopsy results and standard scoring systems (e.g. SLE, Banff
……………………
………………….. scoring of rejection)
……………………
…………………..
…………………..
……………………  Appreciate the role of radiologist and histopathologist and collaborate with
…………………..
…………………… them
…………………..
……………………
 Have appropriate self confidence and recognition of limitations
…………………..
45
…………………….
…………………….
TRAINING METHODS DESCRIPTION
…………………….
…………………….
……………………. I. Lectures
…………………….
…………………….
……………………. Lectures would provide candidates with
…………………….  Appropriate knowledge and understanding of relevant basic medical sci-
…………………….
……………………. ence
…………………….  An overview of patient assessment including history, examination, com-
…………………….
……………………. munication and diagnostic tests
…………………….  Knowledge and understanding of diseases and their management, including renal
…………………….
replacement therapy
…………………….
…………………….
……………………. II. On the job training:
…………………….
……………………. Provision of patient care under supervision with feedback is the main learning
…………………….
……………………. method. Trainees will be involved in patient care during different clinical
……………………. nephrology, dialysis and transplantation rotations. During this, learner centered
…………………….
…………………….
& trainer centered activities will provide the necessary intellectual, clinical and
……………………. procedural skills, attitudes and behaviors as well as opportunities for applica-
……………………. tion & enhancement of knowledge. Responsibilities of trainees in patient man-
…………………….
……………………. agement shall increase as they develop more competencies. In addition, Rota-
……………………. tions would include regular formal clinical teaching sessions
…………………….
…………………….
……………………. On the job, learning activities include:
…………………….
…………………….
…………………….
-Participation in different outpatient clinics including the assessment of new
……………………. and follow up patients, pre and post transplantation clinics
……………………. -Comprehensive assessment & management planning for admitted patients,
…………………….
……………………. including complicated cases
……………………. -Ward rounds, management and follow up of admitted patients
……………………. -Consultant led ward rounds
…………………….
……………………. -Assessment of patients referred for consultation from other specialties
……………………. -Participation in patient management in acute settings, including intensive care
…………………….
-Participation in acute and chronic dialysis management
…………………….
……………………. -Participation in the perioperative management of renal transplantation
……………………. -Training in skills & procedures through observation, performance under su-
…………………….
……………………. pervision with feedback then independent practice
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
46
……………………
Clinical teaching activities represent formal teaching sessions that include:
…………………..
……………………
…………………..-Case taking, presentation and discussion
…………………… --Journal clubs
…………………..
…………………… -Joint specialty meetings
…………………..
…………………… III. Other activities:
…………………..
……………………
………………….. Field study
……………………
…………………..
…………………… Trainees will be required to plan, conduct and report a community/ primary care
…………………..based field study in nephrology. Recommended fields of study include:
……………………
…………………..  Screening for microscopic hematuria/ asymptomatic proteinuria
……………………  Screening for hypertension
…………………..
……………………  Screening of diabetics for early renal involvement
…………………..
…………………… Participation in scientific meetings
…………………..
…………………… Trainees are expected to participate in at least two scientific meetings relevant to the
…………………..field of nephrology. These include conferences, seminars, workshops and other
……………………
…………………..similar activities. Proof of attendance will be required
……………………
………………….. Self-learning activities
……………………
…………………..
…………………… Trainees are expected to use self-learning activities such as independent reading and
…………………..
…………………… internet search for relevant EBM resources. They are also expected to be able to
…………………..identify their learning needs & target them through discussion with trainers and/ or
…………………… appropriate self-learning activities.
…………………..
……………………
………………….. LEARNING AND REFERENCE MATERIALS
……………………
…………………..
…………………… Basic textbook
…………………..
…………………… Primer on Kidney Diseases, National Kidney Foundation
…………………..
……………………
………………….. Recommended references
……………………
…………………..
……………………  The Kidney, Brenner and Rector
…………………..
……………………
 Handbook of Dialysis, JT Daugirdas, PG Blake, TS Ing
…………………..  Handbook of Kidney Transplantation, GM Danovitch
……………………
…………………..  Handbook of Nephrologic Emergencies, AE Parrish
……………………  www.uptodateonline.com
…………………..
47
…………………….
…………………….
……………………. LIST OF LECTURES
…………………….
…………………….
……………………. Lectures are arranged in 25 blocks. Each block will be provided on a sepa-
……………………. rate day, as follows:
…………………….
…………………….
…………………….
The first year: blocks 1-17
…………………….
……………………. (topics covered in blocks 1-13 will be included in the first part examination)
…………………….
…………………….
……………………. The second year: blocks 18-26
…………………….
…………………….
…………………….
……………………. BASIC SCIENCE:
……………………. -Development, anatomy and histology of the kidneys
…………………….
and urinary tract (2 lectures)
…………………….
…………………….
……………………. Block 1
PATIENT ASSESSMENT:
…………………….
……………………. -Clinical case taking (2 lectures)
……………………. -Principles of communication with patients and
……………………. families (1 lecture)
…………………….
…………………….
-Physiology of the kidney
…………………….
……………………. Block 2 -Water, electrolyte and acid-base homeostasis
……………………. -Immunology of the kidney
…………………….
……………………. (2 lectures each)
…………………….
…………………….
……………………. PATIENT ASSESSMENT
……………………. -Principles and interpretation of immunological tests
…………………….
……………………. (2 lectures)
……………………. Block 3
…………………….
……………………. -Microbiology and principles of infection control
……………………. (3 lectures)
…………………….
-Drug prescribing for renal patients (1 lecture)
…………………….
……………………. PATIENT ASSESSMENT:
…………………….
……………………. Principles and interpretation of laboratory tests:
……………………. -Assessment of renal function (1 lecture)
……………………. -Urinalysis (2 lectures)
……………………. Block 4
……………………. -Biochemical, hematological and microbiological
……………………. tests (3 lectures)
…………………….
48
……………………
………………….. BASIC SCIENCE:
…………………… -Pathology of the kidney (2 lectures)
…………………..
……………………
…………………..
Block 5
PATIENT ASSESSMENT:
……………………
-Pathological examination (4 lectures)
…………………..
……………………
…………………..
PATIENT ASSESSMENT:
…………………… Block 6
………………….. Renal and urinary tract ultrasound (5 lectures)
……………………
………………….. PATIENT ASSESSMENT:
…………………… Block 7 Other imaging modalities (4 lectures)
…………………..
…………………… HEMATURIA AND PROTEINURIA (2 lectures)
…………………..
……………………
…………………..
…………………… RENAL DISEASES: Glomerulopathies
………………….. Block 8
…………………… -Clinicopathological syndromes, Nephrotic Syndrome,
………………….. Nephritic Syndrome (2 lectures)
……………………
…………………..
……………………
…………………..
RENAL DISEASES: Glomerulopathies
……………………
…………………..
……………………
-Primary and secondary glomerulopathies, Minimal change
…………………..
…………………… nephropathy, focal segmental glomerulosclerosis,
………………….. membranous nephropathy, membranoproliferative
……………………
………………….. Block 9 glomerulonephritis, Congenital nephrosis, IgA
…………………… nephropathy/ HSP, Goodpasture’s syndrome, acute post-
………………….. infectious glomerulonephritis, Hereditary nephritis.
……………………
………………….. (4 lectures)
…………………… -Rapidly progressive glomerulonephritis (1 lecture)
…………………..
-Chronic glomerulonephritis (1 lecture)
……………………
…………………..
……………………
………………….. RENAL DISEASES: Vascular disorders (3 lectures)
…………………… -Renovascular disease
………………….. -Arterial and venous thrombosis
……………………
………………….. -Thrombotic microangiopathies
…………………… Block 10 -Renal vasculitis
…………………..
……………………
………………….. SURVEY/ FIELD STUDY (3 lectures)
……………………
…………………..
……………………
…………………..
49
…………………….
……………………. RENAL DISEASES: Urinary tract disorders
……………………. -Urinary tract infections
……………………. -Stone diseases
…………………….
……………………. Block 11 -Obstructive uropathies
……………………. -Neurogenic bladder and voiding disorders
…………………….
-Vesico-ureteric reflux and reflux nephropathy
…………………….
……………………. (1 lecture each)
…………………….
……………………. SYSTEMIC CONDITIONS AND THE KIDNEY:
……………………. -Pregnancy (1 lecture)
…………………….
…………………….
Block 12 -Hypertension (3 lectures)
……………………. -Hyperlipidemia (1 lecture)
…………………….
…………………….
……………………. SYSTEMIC CONDITIONS AND THE KIDNEY:
……………………. -Diabetic nephropathy (2 lectures)
……………………. -SLE and other collagen diseases (1 lecture)
…………………….
……………………. Block 13 RENAL REPLACEMENT THERAPY: general
……………………. principles (1 lecture)
…………………….
…………………….
…………………….
…………………….
……………………. RENAL REPLACEMENT THERAPY:
…………………….
hemodialysis (6 lectures)
……………………. Block 14
…………………….
…………………….
…………………….
…………………….
……………………. RENAL REPLACEMENT THERAPY: peritoneal
……………………. Block 15 dialysis(6 lectures)
…………………….
…………………….
…………………….
…………………….
……………………. RENAL REPLACEMENT THERAPY: renal trans-
……………………. plantation
…………………….
……………………. -Pretransplant: evaluation of the recipient, immunologi-
…………………….
Block 16 cal basis, donor selection and evaluation (2 lectures)
……………………. -Acute stage: the operation, immunosuppressive ther-
…………………….
……………………. apy, infections (2 lectures)
…………………….
…………………….
…………………….
……………………. RENAL REPLACEMENT THERAPY: renal trans-
……………………. plantation
…………………….
…………………….
Block 17 -Acute stage: Delayed graft function, rejection (2 lec-
……………………. tures)
…………………….
-Long-term management (2 lectures)
50
……………………
………………….. RENAL DISEASES: Tubulo-interstitial diseases
……………………
………………….. -Tubular disorders: primary & secondary tubular disorders,
……………………
Block 18 renal tubular acidosis, nephrogenic diabetes insipidus,
…………………..
tubular disorders of electrolyte and mineral reabsorption (4
……………………
………………….. lectures)
……………………
…………………..
…………………… RENAL DISEASES: Tubulo-interstitial diseases
………………….. -Acute interstitial nephritis
……………………
…………………..
-Hyperoxaluria
…………………… -Chronic Tubulo-interstitial diseases
………………….. -Renal papillary necrosis
……………………
………………….. (2 lectures)
……………………
………………….. Block 19 RENAL DISEASES: Congenital renal anomalies
……………………
………………….. -Aplasia, hypoplasia, dysplasia
…………………… -Polycystic Kidney Disease
…………………..
-Nephronophthisis/ Medullary cystic disease/ Medullary
……………………
………………….. sponge kidney
…………………… (2 lectures)
…………………..
…………………… RENAL DISEASES: Renal and urinary tract neoplasia
………………….. (1 lecture)
……………………
………………….. SYSTEMIC CONDITIONS AND THE KIDNEY:
……………………
-Liver disease
…………………..
…………………… -Specific infections (e.g. Bilharziasis, Malaria)
………………….. (1 lecture)
……………………
…………………..
…………………… -Congestive heart failure
………………….. -Sickle cell nephropathy
……………………
………………….. (1 lecture)
……………………
………………….. Block 20
-Dysproteinemias
……………………
………………….. -Amyloidosis
…………………… -Metabolic errors (e.g. Fabry)
…………………..
…………………… (1 lecture)
…………………..
…………………… -Cancer and its treatment (1 lecture)
…………………..
……………………
………………….. -Chemicals and drugs (2 lectures)
……………………
…………………..
……………………
…………………..
51
…………………….
……………………. ACUTE KIDNEY INJURY:
…………………….
……………………. -Pathophysiology of AKI (1 lecture)
…………………….
……………………. Block 21 -Ischemic, toxic & metabolic AKI (1 lecture)
……………………. -Management of AKI (2 lectures)
……………………. -Management of AKI in the context of multisystem fail-
……………………. ure (1 lecture)
…………………….
……………………. CHRONIC KIDNEY DISEASE:
…………………….
…………………….
…………………….
-The uremic syndrome (1 lecture)
……………………. -Progression of CKD (1 lecture)
……………………. Block 22 -Management of CKD (1 lecture)
……………………. -Nutrition in renal patients (1 lecture)
…………………….
……………………. -CKD-associated Metabolic Bone Disease (CKD-BD) (1
……………………. lecture)
…………………….
……………………. CHRONIC KIDNEY DISEASE:
…………………….
……………………. -Anemia and other hematological/ immunological
…………………….
changes (1 lecture)
……………………. Block 23 -Cardiovascular disease (1 lecture)
…………………….
……………………. -Endocrine manifestations (1 lecture)
……………………. -Neurological manifestations (1 lecture)
…………………….
…………………….
-Psychological and social aspects (1 lecture)
……………………. FLUID, ELECTROLYTE AND ACID-BASE DIS-
…………………….
……………………. ORDERS:
…………………….
……………………. -Edema and dehydration
……………………. -Hyponatremia and hypo-osmolar disorders
…………………….
……………………. Block 24 -Hypernatremia
……………………. -Potassium disorders
……………………. -Disorders of calcium and phosphorous
…………………….
-Acid-base disturbances
…………………….
……………………. (1 lecture each)
…………………….
…………………….
…………………….
RENAL REPLACEMENT THERAPY:
…………………….
…………………….
……………………. Block 25 -Slow continuous therapies & plasmapheresis (3 lectures)
…………………….
……………………. -Outcome of ESRD therapies (1 lecture)
……………………. -End of life care (2 lectures)
…………………….
……………………. -Physiological considerations (1 lectures)
……………………. -Congenital and acquired diseases; pediatric considera-
……………………. Block 26 tions (2 lectures)
…………………….
-Pediatric renal replacement therapy (1 lecture)
52
…………………… OVERALL LIST OF CLINICAL CASES

…………………..
……………………
…………………..
…………………… Glomerular
…………………..
Gross hematuria
……………………
………………….. Microscopic hematuria
…………………… Asymptomatic proteinuria
…………………..
…………………… Nephrotic syndrome
………………….. Nephritic syndrome
…………………… Rapidly progressive glomerulonephritis
…………………..
…………………… Chronic glomerulonephritis
…………………..
……………………
………………….. Vascular
……………………
………………….. Renovascular disease
……………………
………………….. Arterial and venous thrombosis
…………………… Thrombotic microangiopathies
………………….. Renal vasculitis
……………………
…………………..
……………………
………………….. Tubulo-interstitial
……………………
………………….. Renal tubular acidosis
…………………… Renal tubular rickets
…………………..
…………………… Bartter syndrome
………………….. Nephrogenic Diabetes Insipidus
…………………… Interstitial nephritis
…………………..
…………………… Hyperoxaluria
…………………..
……………………
………………….. Cystic renal diseases
……………………
…………………..
……………………
…………………..
…………………… Urinary tract
………………….. Acute and recurrent urinary tract infections
……………………
………………….. Stone diseases & Obstructive uropathies
…………………… Neurogenic bladder and voiding disorders
…………………..
……………………
Vesico-ureteric reflux and reflux nephropathy
…………………..
……………………
…………………..
Renal and urinary tract neoplasia
……………………
…………………..
……………………
…………………..
53
…………………….
……………………. Systemic conditions with renal involvement
…………………….  Pregnancy with preexisting renal disease
…………………….
…………………….  Pregnancy with new renal involvement
…………………….  Essential hypertension
…………………….  Secondary hypertension
…………………….
…………………….  Hyperlipidemia
…………………….  Diabetic nephropathy
…………………….
 SLE
…………………….
…………………….  Other collagen diseases
…………………….  Liver disease
…………………….
…………………….  Specific infections
…………………….  Congestive heart failure
…………………….  Sickle cell nephropathy
…………………….
…………………….  Dysproteinemias
…………………….  Amyloidosis
…………………….
 Metabolic errors (e.g. Fabry)
…………………….
…………………….
…………………….
…………………….
…………………….
Fluid, electrolyte and acid-base disturbances
…………………….
…………………….
…………………….
……………………. Acute Kidney Injury of various causes
…………………….
…………………….
…………………….
……………………. Acute conditions and emergencies complicating/
……………………. associated with renal disease
…………………….
…………………….
…………………….  Acute coronary syndrome
…………………….  Hypertensive emergencies
…………………….
…………………….  Pulmonary edema
…………………….  Sepsis/ severe acute infections
…………………….
 Status epilepticus
…………………….
…………………….  Cerebrovascular stroke
…………………….  Hepatorenal syndrome
…………………….
…………………….
…………………….
……………………. Chronic Kidney Disease of various causes and
…………………….
……………………. stages
…………………….
…………………….
…………………….
…………………….
…………………….
54
……………………
…………………..
Pediatric cases
……………………  Nephrotic syndrome
…………………..
……………………
 Congenital/ infantile nephrosis
…………………..
……………………
…………………..  Nephritic syndrome
……………………
…………………..  Hemolytic-Uremic syndrome
……………………
…………………..  Renal tubular acidosis
……………………
…………………..  Renal tubular rickets
……………………
…………………..
 Bartter syndrome
……………………
…………………..
……………………  Nephrogenic Diabetes Insipidus
…………………..
……………………  Cystic renal diseases
…………………..
……………………  Acute and recurrent urinary tract infections
…………………..
……………………  Congenital obstructive uropathies
…………………..
……………………
 Neurogenic bladder and voiding disorders
…………………..
……………………
…………………..  Vesico-ureteric reflux and reflux nephropathy
……………………
…………………..  Fluid, electrolyte and acid-base disturbances
……………………
…………………..  Acute Kidney Injury of various causes
……………………
…………………..  Chronic Kidney Disease of various causes and stages
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
55
…………………….
RENAL REPLACEMENT THERAPY COMPETENCIES
…………………….
…………………….
…………………….
…………………….  Chronic hemodialysis, initial prescription*
…………………….
…………………….  Chronic hemodialysis, ongoing management*
…………………….
 Acute hemodialysis
…………………….
…………………….  Slow continuous HD
…………………….
…………………….  Hemodialysis, session complications*
…………………….
…………………….  Hemodialysis, access complications*
…………………….
…………………….  Plasmapheresis
…………………….
…………………….  Acute peritoneal dialysis*
…………………….
…………………….  Chronic peritoneal dialysis, initial prescription
…………………….
…………………….
 Chronic peritoneal dialysis, ongoing management
…………………….  Peritoneal dialysis, complications
…………………….
…………………….  Pretransplant evaluation
…………………….
…………………….  Transplantation day management
…………………….
…………………….  Transplantation, postoperative hospital stay management
…………………….
…………………….  Post transplant follow up
…………………….
…………………….  Transplantation, acute stage complications
…………………….
…………………….  Transplantation, long term complications
……………………. Cases marked * are specifically required in both adult and pediatric patients
…………………….
…………………….
LIST OF PROCEDURES
…………………….
…………………….
…………………….
…………………….
…………………….  Renal and urinary tract ultrasonography
…………………….
…………………….
 Native kidney ultrasound guided kidney biopsy
…………………….
 Graft ultrasound guided kidney biopsy
…………………….
…………………….  Insertion of femoral catheters
…………………….
…………………….  Insertion of double lumen central venous dialysis catheters
…………………….
…………………….  Insertion of acute peritoneal catheters
…………………….
…………………….  Renal graft perfusion
…………………….
……………………. Trainees are assumed to have developed competency in routine medical
……………………. procedures and advanced life support as part of their training in Internal
…………………….
Medicine prior to starting the nephrology program.
56
……………………INTERPRETATION OF DIAGNOSTIC STUDIES

…………………..
……………………
…………………..
……………………
………………….. TESTS USED FOR ASSESSMENT OF RENAL CONDITION
……………………
…………………..
……………………
…………………..  Laboratory assessment of renal function
……………………
…………………..  Urinalysis
……………………
…………………..  Common biochemical, hematological and microbiological tests
……………………
…………………..  Immunological tests
……………………
…………………..  Renal pathology reports
……………………
…………………..  Renal and urinary tract ultrasonography
……………………
…………………..  Plain X rays, excretory urography, antegrade pyelography, ascending &
…………………… voiding cystourethrography
…………………..
……………………  CT and MR scan (including CT and MR angiography and MR urography)
…………………..
……………………  Renal isotopic scan
…………………..
……………………  Urodynamic studies
…………………..
……………………
…………………..
……………………
…………………..
……………………
………………….. TESTS USED IN ACUTE CARE
…………………… (to the extent needed for specialist management of renal patients in
………………….. acute conditions)
……………………
…………………..
……………………
…………………..
……………………  Chest X rays
…………………..
……………………
…………………..  ECG
……………………
…………………..
……………………  Echocardiography
…………………..
……………………
…………………..
 Brain CT scans
……………………
…………………..
……………………
…………………..
……………………
…………………..
57
…………………….
METHODS OF ASSESSMENT
…………………….
…………………….
…………………….
……………………. Regulations
…………………….
…………………….
…………………….
……………………. The general rules and regulations of assessment approved by the Egyptian
……………………. fellowship board and published at the training handbook and the board website
…………………….
……………………. apply for the Nephrology specialty. In addition to the successful completion
……………………. of the training program and submission of the logbook, each candidate
……………………. must pass three examinations in order to receive his/ her fellowship certifi-
…………………….
……………………. cate.
…………………….
……………………. First part Exam
…………………….
…………………….
……………………. This is a written examination testing topics covered in blocks 1-13, including
…………………….
……………………. knowledge, understanding, application to clinical case studies and problem
……………………. solving.
…………………….
…………………….
……………………. Each candidate has TWO chances to pass the exam & one more chance
……………………. may be granted in exceptional circumstances approved by the secretary
…………………….
general of the higher committee of medical specialties.
…………………….
…………………….
……………………. Pre-requisites
……………………. To be eligible to sit for the exam, candidates must
…………………….
…………………….
……………………. -Complete at least six months of the training program
…………………….
……………………. -Pass the following courses:
…………………….  Local TOEFEL with a score of at least 500
…………………….
…………………….
…………………….
 Computer courses in word processing, internet and power
……………………. point presentations
…………………….
…………………….
…………………….
……………………. Exam structure:
……………………. The first part examination consists of two written papers that will include case
…………………….
……………………. studies.
…………………….
…………………….
-Paper 1 (2 hours): composed of multiple choice questions with a single best
…………………….
……………………. of four or best of five answers.
……………………. -Paper two (2 hours): a written paper including short answer essay questions
…………………….
…………………….
…………………….
58
…………………… Second part exam

…………………..
……………………
…………………..
…………………… This is a written examination testing the entire curriculum.
…………………..
……………………
Each candidate has THREE chances to pass the exam and one more chance
…………………..
…………………… may be granted in exceptional circumstances approved by the secretary
………………….. general of the higher committee of medical specialties.
……………………
…………………..
…………………… Exam structure:
………………….. The second part examination consists of four papers (2 hours each) in which all
……………………
………………….. topics will be tested including knowledge & understanding, intellectual, problem
…………………… solving and clinical management skills. Papers may include case studies.
…………………..
……………………
………………….. -TWO multiple-choice papers
…………………… Composed of questions with a single best of four or best of five answer
…………………..
…………………… -TWO written papers
………………….. Composed of short answer essay questions
……………………
…………………..
…………………… Pre-requisites
…………………..
……………………
To be eligible to sit for the second part exam, candidates must
…………………..
…………………… -Pass successfully the first part examination
…………………..
-Complete the field study and submit an acceptable field study report
……………………
………………….. (required at the end of the first year of training)
…………………… -Complete the training program (two years of training)
…………………..
……………………
-Complete the logbook and have it approved and signed by the trainer
………………….. and educational supervisor.
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
59
…………………….
…………………….
……………………. Third part exam
…………………….
…………………….
……………………. This is the final clinical and oral examination. Candidates must pass the second
……………………. part examination to be eligible for entering the third part exam. Each candidate
…………………….
……………………. has THREE chances to pass the exam and one more chance may be granted in
……………………. exceptional circumstances approved by the secretary general of the higher com-
…………………….
mittee of medical specialties.
…………………….
…………………….
……………………. The examination consists of four components:
…………………….
…………………….
……………………. A. Long Clinical Case:
……………………. This component tests the ability of the candidate to obtain data from history
…………………….
taking and clinical examination, to present and interpret these data, to discuss
…………………….
……………………. patient management and to demonstrate appropriate attitudes. The candidate will
……………………. be required to take a history and examine the patient while being observed by
…………………….
……………………. two examiners who will not interfere. Subsequently, the candidate will orally
……………………. present the findings and discuss clinical data and proposed patient management.
……………………. Scoring is based on a predetermined weight for each component of the exam
…………………….
…………………….
……………………. B. Objective Structured Clinical Exam (OSCE):
…………………….
This is composed of 5-10 stations. In each station, the candidate will be required
…………………….
……………………. to perform a specific clinical task. Tasks will test different clinical skills included
……………………. in the curriculum. Scoring of each station will be based on a predefined scheme
…………………….
…………………….
……………………. C. Tracing Exam:
……………………. This is composed of 20 items testing data interpretation skills. Items will include
…………………….
……………………. different diagnostic tests and pictures. The candidate will be required to make an
……………………. open-ended written comment or to answer short questions on each item.
…………………….
…………………….
……………………. D. Viva:
……………………. The oral exam is composed of two oral exam stations. Predetermined sets of
…………………….
……………………. topics will be used, with opening and supplementary questions, as well as
……………………. expected answers & scoring criteria. This component will explore the candidate's
……………………. depth of knowledge and ability to manage patients. It will also test interpersonal
…………………….
……………………. communication skills and attitudes.
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
60

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Nephrology

T he Egyptian Fellowship Board and the Nephrology Scientific Council worked

Esmat Ahmed Sheba

 Professor Dr Hany Hafez , Professor of nephrology , Cairo University and

Head of the nephrology scientific council

 Dr Hafez Bazaraa, Associate Professor of pediatric nephrology, Cairo

University, Medical Education Expert and member of the fellowship cur-

The fellowship curriculum committee and the nephrology scientific council

consulted international and national curricula in nephrology. The external ref-

erences for the development of this curriculum are:

1. The Joint Committee on Higher Medical Training Nephrology curriculum

…………………… Teaching Learning Methods

……………………. Attitudes and Behaviors

…………………… Congenital renal anomalies

…………………… Attitudes and Behaviors

……………………Intellectual and Professional

…………………… Attitudes and Behaviors

…………………… H. RENAL REPLACEMENT THERAPY

…………………… Intellectual and Professional Skills

…………………… Teaching Learning Methods

…………………… Intellectual and Professional Skills

Teaching Learning Methods

…………………… OVERALL LIST OF CLINICAL CASES

……………………INTERPRETATION OF DIAGNOSTIC STUDIES

…………………… Second part exam

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