Core Curriculum in Nephrology
Installments of the Core Curriculum in Nephrology provide trainees in nephrology with a strong knowledge base in core topics in the specialty by providing an overview of the topic and citing key references, including the foundational literature that led to current clinical approaches.
- Automated urine technology and centralized laboratory testing are becoming the standard for providing urinalysis data to clinicians, including nephrologists. This trend has had the unintended consequence of making examination of urine sediment by nephrologists a relatively rare event. In addition, the nephrology community appears to have lost interest in and forgotten the utility of provider-performed urine microscopy. However, it is critical to remember that urine sediment examination remains a time-honored test that provides a wealth of information about the patient's underlying kidney disease.
- Toxic nephropathies are an important and relatively common category of kidney damage. Although they generally are reversible when detected early, they may be permanent, leading to chronic kidney disease (CKD). Toxic nephropathies are defined primarily as kidney injury caused by any number of medications, diagnostic agents, alternative products, herbal adulterants, or other toxin exposures, which includes environmental agents and chemicals. Because the kidney performs a number of essential bodily functions, including clearance of endogenous waste products, control of volume status, maintenance of electrolyte and acid-base balance, and modulation of endocrine activity, loss of kidney function leads to a number of clinical problems.
- It is important to understand how to appropriately prescribe medications to patients with various levels of acute or chronic kidney disease (CKD), particularly those undergoing some form of renal replacement therapy. Drug effects and their handling by the body also are influenced by underlying comorbidities, age, liver function, nutritional status, critical illness, and other concurrently prescribed medications. This is best achieved by developing a firm grasp of the following concepts.