What are the essential topics for a new resident to know when starting a nephrology (renal) rotation?

From the Guidelines

A new resident starting a renal rotation should focus on mastering several key topics, including acute kidney injury assessment, fluid and electrolyte management, acid-base disorders, chronic kidney disease staging, and renal replacement therapy, as these are crucial for managing renal patients effectively and improving patient outcomes, as emphasized by the most recent guidelines 1.

Key Topics to Master

• Acute kidney injury (AKI) assessment using the KDIGO criteria, including creatinine trends, urine output, and common causes like pre-renal, intrinsic, and post-renal etiologies
• Fluid and electrolyte management, particularly hyperkalemia treatment, using medications such as calcium gluconate, insulin, sodium bicarbonate, and potassium binders like sodium polystyrene sulfonate or patiromer
• Acid-base disorders using the Henderson-Hasselbalch equation and anion gap calculations
• Chronic kidney disease staging, management of complications like anemia, mineral bone disease, and indications for renal replacement therapy
• Different dialysis modalities, including hemodialysis, peritoneal dialysis, and continuous renal replacement therapy (CRRT), along with their indications, contraindications, and complications

Additional Considerations

• Common glomerular diseases and their management
• Hypertension management in kidney disease
• Medication dosing adjustments for renal impairment
• The importance of shared decision-making and patient education in renal replacement therapy, as highlighted in the clinical practice guidelines 1
• The need for a comprehensive approach to patient care, including regular evaluation of the demand and renal capacity relationship, and the use of standardized criteria for initiating renal replacement therapy, as discussed in the KDIGO conference 1

Prioritizing Patient Outcomes

• The primary goal of renal care is to improve patient outcomes, including morbidity, mortality, and quality of life, as emphasized by the Renal Physicians Association and the American Society of Nephrology 1
• The selection of renal replacement therapy modality should be based on shared decision-making, local expertise, logistic factors, and patient characteristics, with the aim of optimizing patient outcomes, as recommended by the KDIGO conference 1

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Key Topics for a New Resident on a Renal Rotation

When starting a renal rotation, a new resident should be familiar with the following topics:

• Acute kidney injury (AKI) definition, diagnosis, and management 2, 3, 4
• Renal physiology, particularly acid-base physiology 5
• Pathogenesis and management of AKI in patients with nephrotic syndrome due to primary glomerulopathies 3
• Medical causes and pathogenesis of AKI 4
• Patient perspectives on the optimal start of renal replacement therapy 6

Acute Kidney Injury (AKI)

AKI is a critical topic in renal medicine, and residents should understand:

• The definition and staging of AKI based on serum creatinine concentration and urine output rates 2, 4
• The etiology of AKI, including prerenal, intrarenal, and postrenal causes 4
• The importance of timely and accurate identification of AKI and understanding its pathophysiological mechanisms 4

Renal Physiology and Patient Care

Residents should also be familiar with:

• Renal physiology, particularly acid-base physiology, and its importance in understanding nephrology 5
• Patient perspectives on preparing for renal replacement therapy, including emotional and psychosocial needs 6
• The importance of individualized approach and management in patients with AKI and nephrotic syndrome 3