Rotation specific objectives for

ROTATION SPECIFIC OBJECTIVES FOR
NEPHROLOGY TRANSPLANTATION ROTATION

Preamble

The Nephrology-Transplantation rotation is generally undertaken during the first
2 (CORE) years of residency. It is designed to familiarize the resident with
medical and surgical aspects of Nephrology and Renal Transplantation that a
Urologist should be knowledgeable about.
This list of objectives is a guide to the acquisition of relevant knowledge in
Nephrology and Transplantation. It should not be regarded as all encompassing.
In addition to specific Nephro-Urologic topics, the resident should focus on issues
relevant to the peri-operative care of the surgical patient in preparation for the
principles of surgery examination (POS).
Objectives

Medical Expert
As part of the basic training towards the POS examination the resident should
concentrate on the diagnosis and management of common medical problems
such as acute myocardial infarction, congestive heart failure, pulmonary edema,
deep venous thrombosis and pulmonary embolism.
The resident should be knowledgeable regarding the following topics:
1. The differential diagnosis, indications for intervention and management
of:
Hyponatremia
Hypernatremia
Hypokalemia
Hyperkalemia
Hypercalcemia
Metabolic acidosis
Metabolic alkalosis

2. The endocrine functions of the kidney and the expected metabolic
disorders associated with renal failure.
3. The Major Histo-Compatibility Complex (MHC) and it’s significance for
organ transplantation.
4. The process of HLA matching pre-transplantation.
5. The concept of tissue cross matching (T-cell cross match) and mixed
lymphocyte culture.
6. The pathogenesis of Urate Nephropathy.
7. Renal effects of the following drugs:
Furosemide
Thiazides
Spironolactone
Low dose dopamine
Captopril and other angiotensin converting enzyme inhibitors
Losartan and other angiotensin II receptor blockers
8. Mechanism of action and major side effects of the following medications: Mycophenolate
Prednisone
Cyclosporine
OKT-3
Polyclonal antilymphocyte serum (i.e.: Thymoglobulin)
FK506 (Tacrolimus)
Rapamycin (Sirolumus)
Mannitol
Allopurinol

9. The theory of renal hyperfiltration as it applies to living related renal
donation.
10. The biology and regulation of the renin-angiotensin-aldosterone axis
11. The structure, regulation and significance of the juxtaglomerular
apparatus.
12. The differential diagnosis and management of acute renal failure in a post-
operative patient.
13. The basic mechanisms of action and relative merits of the following forms of
a renal replacement therapy:

14. The complications and management of peritoneal dialysis such as early
leaks, late obstructions, recurrent infections and hernias.
15. The routine pre-operative assessment of the potential living related donor
including relevant history, physical exam, basic laboratory tests and
special imaging tests

16. Medical contra-indications to transplantation in the recipient.
17. Describe the 3 main techniques for uretero-neocystostomy in renal
transplantation:
Liche-Gregoire Barry-Hatch Leadbetter-Politano 18. The applications and limitations of the following imaging techniques as applied to renal transplantation: Hippuran/DTPA & Mag-3 renal scanning Doppler ultrasonography with intra-renal resistive indices Venography Arteriography
19. The differential diagnosis and appropriate work up of oligo-anuria in the
immediate post-transplant period.
20. The differential diagnosis and appropriate work up of a slowly rising
creatinine in the late post-transplant period.
21. The 1yr & 5 yr graft and recipient survival rates for cadaveric and live donor
transplants.
22. The different biological mechanisms underlying hyper-acute, acute and
chronic rejection.
23. When questioned regarding the surgical aspects of renal transplantation the
resident should be knowledgeable regarding the following:
• Contra-indications to live renal donation
• Contra-indications to cadaveric donor nephrectomy • The pre-operative assessment of the renal recipient with respect to the Indications for native nephrectomy pre-transplantation. Indications for native ureteral reimplantation pre-transplant. Indications for cystoscopy pre-transplant. The investigation & management of bladder outlet obstruction pre-transplant. Indications for pre-transplant GU tract reconstruction. 24. The published success and complication rates for transplantation in the following situations: Pre-existing ileal conduit Pre-existing ileal-cystoplasty 25. When questioned regarding the technical aspects of renal transplantation the resident will be familiar with the following: • The branches of the Internal Iliac Artery. • The management of an early transplant ureteral leak. • The management of an early transplant ureteral obstruction. • The management of late transplant ureteral obstruction. • The management of graft renal vein thrombosis. • The management of graft arterial stenosis/thrombosis. 26. The evaluation and management of a patient with a peri-graft fluid collection; including the interpretation of biochemical studies of fluid aspirates. 27. The resident will be knowledgeable with regard to the following aspects of renal vascular hypertension (RVH): • When to suspect RVH as a cause of hypertension. • A classification of the causes of RVH. • The natural history of the various forms of RVH. • The appropriate investigations to diagnose RVH including the relative Peripheral vein renin assays Single dose captopril challenge test Doppler ultrasound Captopril renography MR angiography Renal vein renin assays Renal arteriography 28. The resident will become knowledgeable regarding the clinical and radiologic features of renal artery aneurysms and renal arterio-venous malformations and the indications for surgical intervention in these conditions 29. The resident will become knowledgeable regarding the following aspects of renal cystic disease: A classification system. Autosomal dominant polycystic kidney disease (ADPCKD), specifically the following: Radiographic features Clinical & radiographic features distinguishing it from multiple simple cysts Indications for surgical intervention Antibiotics, which best penetrate the cysts The clinical and radiographic features of autosomal recessive polycystic disease (ARPCKD). 30. The clinical and radiographic features of cystic conditions of the medulla, including: 31. The following aspects of simple renal cysts: Bosniak’s classification Ultrasound features CT features MRI features Arteriographic features 32. The following aspects of acquired cystic renal disease: Etiological theories Malignant potential Response to renal replacement therapies Communicator
The Resident will effectively listen to patients with understanding and empathy and obtain and synthesize relevant history from patients and families specifically related, but not limited to the following: 1. Obtaining informed consent for planned procedures 2. Dictating consultation/operative notes to referring physicians Collaborator
The Resident will consult with and delegate to other health care professionals
specifically related, but not limited to the following:
1.
The resident will learn to coordinate the outpatient investigation and management of patients with Nephro urological diseases through interactions with radiological services, anesthetic services, lab-medicine, nursing homecare, and referring physicians 2. The resident will collaborate with the Urological service regarding peri- operative management of the renal transplant recipient and donor The resident will recognize the need for cost containment and wisely allocate finite health care resources regarding the judicious ordering of diagnostic tests The resident will learn to utilize information technology effectively
The resident will learn to balance patient care, learning needs and outside
activities
Health Advocate

The resident will recognize when and how to advocate appropriately on behalf of
patients, families, and their communities
The resident will educate patients on the modifiable risk factors for GU conditions
such as urothelial malignancy (tobacco), urolithiasis (dietary modifications),
prostate cancer (family history awareness)
Scholar

The resident will develop and implement an effective and ongoing personal
education strategy.

Professional

It is expected that Residents will demonstrate a commitment to ethical practice and high personal standards of behavior at all times The Resident will be knowledgeable regarding the ethical principles related to renal donation, both cadaveric and live The resident must recognize her/his limits, make independent decisions when appropriate, but keep attending faculty informed The resident will seek and accept advice graciously The resident will be punctual and meet deadlines and commitments made

Source: http://urology.med.ubc.ca/files/2007/04/ntxo9.pdf