Goals and Objectives

1. Following this rotation, the resident will be able to manage patients with chronic kidney disease in their outpatient office.

2. The resident will be able evaluate and treat patients with acute kidney injury.

Objectives

Acute Kidney InjuryChronic Kidney Disease

Medical Knowledge

1. Define and differentiate pre-renal failure, intrinsic renal disease, and post-renal failure.

2. Describe the symptoms and signs of pre-renal failure, intrinsic renal disease, and post-renal failure.

3. Describe the laboratory studies that are utilized to differentiate pre-renal failure from acute tubular necrosis, and describe how diuretics may effect studies.

4. Distinguish the causes of pre-renal failure, intrinsic renal failure, and post-renal failure.

5. Identify common electrolyte abnormalities that occur with acute renal failure and the corrective therapy.

6. Describe the indicated tests required to evaluate AKI, with special attention to those test required to differentiate the three major categories.

7. Calculate the risk for contrast induced nephropathy utilizing scoring system and describe the methods for prevention of CIN.

8. Describe the indications for acute hemodialysis.

9. Identify clinical, laboratory, and imaging studies that indicate severity of disease.

10. Explain the renal and systemic effects of IV contrast agents including IV dye and gadolinium.

Patient Care

1. Elicit a thorough and relevant history and review the medical record for factors predisposing or contributing to the development of AKI.

2. Review all drug use including prescription and over-the-counter medications, herbal remedies, nutritional supplements, and elicit drugs.

3. Perform a physical examination to assess volume status and to identify underlying co-morbid states that may result in AKI.

4. Order and interpret indicated diagnostic studies that may include urinalysis and microscopic sediment analysis, urinary diagnostic indices, urinary protein excretion, serologic evaluation, and renal imaging.

5. Identify patients who may benefit from early hemodialysis.

6. Formulate a treatment plan tailored to the individual patient, which may include fluid management, pharmacologic agents and dosing, nutritional recommendations, and patient compliance.

7. Identify and treat factors that may complicate the management of AKI, including extremes of blood pressure and underlying infections.

8. Adjust medications according to estimated renal function and route of excretion.
   9. Avoidance of nephrotoxic agent in patients with AKI.

9. Assess patients with suspected AKI in a timely manner, and initiate management.

Interpersonal and Communication Skills

1. Communicate with patients and families to explain the history and prognosis of AKI.

2. Communicate with patients and families to explain goals of care plan, discharge instructions, and management after release from hospital.

3. Communicate with patients and families to explain tests and procedure and their indications and potential side effects.

System Based Practice

1. Recognize indications for early specialty consultation.

Chronic Kidney Disease

Medical Knowledge

1. Define the stages of chronic kidney stage.

2. Describe the methods for calculating GFR in patients with chronic kidney disease.

3. List the medications that have been shown to reduce mortality or progression of disease in patients with chronic kidney disease.

4. List the indicators for prognosis for patients with chronic kidney disease.

5. List the indicators for prognosis for patients with chronic kidney disease. List the indications for hemodialysis in patients with chronic kidney disease.

6. Explain the electrolyte abnormalities related to chronic kidney disease and the resultant mortality and morbidity associated with these.

7. Describe the initial work-up and monitoring for patient with chronic kidney disease.

8. Explain the pathophysiology, treatment, and monitoring for secondary hyperparathyroidism.

9. Differentiate primary, secondary, and tertiary hyperparathyroidism

10. List the risk factors for developing chronic kidney disease.

11. Be familiar with the causes of chronic kidney disease, being able to list the most common causes in the U.S.

Patient Care

1. Elicit a thorough and relevant history and review medical records to identify the risk factors and predisposing factors leading to chronic kidney disease.

2. Review medications, including herbals and over the counter medications, and adjust according to estimated renal function and route of excretion.

3. Order and interpret laboratory and imaging data which can assist in the diagnosing the etiology of chronic kidney disease.

4. Order and interpret laboratory data utilize to predict mortality and progression of disease.

5. Prescribe treatments and medications based upon evidence shown to reduce mortality, morbidity, and progression of chronic kidney disease.

6. Formulate a treatment plan tailored to the individual patient, which may include fluid management, pharmacologic agents and dosing, nutritional recommendations, and patient compliance.

7. Identify and treat factors that may complicate the management of CKD, including secondary hyperparathyrodism, HTN, Anemia, and malnutrition.

Interpersonal and Communication

1. Communicate with patients and families to explain the history and prognosis of CKD.

2. Communicate with patients and families to explain goals of care plan, discharge instructions, and management.

3. Communicate with patients and families to explain tests and procedure and their indications and potential side effects.

System Based Practice

1. Recognize indications for early specialty consultation.