Nephrology Goals Objectives by Competency and Level of Training Assessment Methods PL‐1 PL‐2 PL‐3 GOAL 1: Prevention, Counseling and Screening. Patient Care: Patient Care: Patient Care: Direct Observation Understand the role of the pediatrician in Provide routine prevention counseling 1. Use blood pressures beginning at age 3 In conjunction with a specialist, provide Global Evaluation preventing renal disease and in counseling and about kidney health and disease to all to screen for hypertension, using age‐ specific prevention counseling to parents screening individuals at risk for these diseases. parents and patients, addressing: and height‐specific BP norms and blood and patients with renal diseases, •Normal voiding, toilet training and pressure cuffs appropriate for patient's addressing: attainment of bladder control height and weight; discuss criteria for •Need for medication adjustments in •Female hygiene repeated measurements and further patients with impaired renal function, evaluation or referral. •Urinary tract infections and •Need for prophylactic medications for nonspecificity of physical complaints in 2. Obtain and accurately interpret urine for certain renal conditions infants and young children dipstick examination to screen for blood •Altered immunization schedule for and protein at certain milestones (e.g., children with specific renal diseases •Strategies to assure normal bowel and pre‐school and pre‐sports examinations). bladder habits •Importance of continued home and 3. Differentiate transient or physiological •Importance of routinely measuring office monitoring in children with proteinuria and/or orthostatic specific disorders blood pressures in children, especially proteinuria from clinically significant (i.e. overweight children and those with a pathological) persistent or intermittent •Risks of contact and other sports in family history of hypertension proteinuria. children with a single kidney 4. Differentiate transient hematuria from clinically significant gross or microscopic hematuria Medical Knowledge: Medical Knowledge: Medical Knowledge: Global Evaluation Understand the normal physiological Know age‐related changes in blood Know how the primary care of children In‐Training Exam development of the kidneys and bladder, pressure and normal ranges from birth with chronic kidney disease differs from including renal concentrating ability, through adolescence.. routine primary care, including changes in glomerular filtration and sodium handling, immunization schedules, management of normal voiding pattern, urine output and growth and development, and learning and attainment of bladder control. behavioral issues. GOAL 2: Diagnose and manage patients with Patient Care: Patient Care: Patient Care: Direct Observation common renal conditions with referral as 1. Obtain accurate, relevant history 1. Obtain relevant historical subtleties that 1. Role model gathering subtle and reliable Global Evaluation needed efficiently, demonstrating a inform and prioritize differential information from patient and family developmentally appropriate and diagnoses and diagnostic information 2. Routinely identify subtle or unusual PE 1. Urinary tract infection, uncomplicated prioritized approach. 2. Accurately track changes in PE over time findings, demonstrating an 2. Minor electrolyte disturbances 2. Perform accurate, targeted but thorough 3. Develop a prioritized differential understanding of how they influence 3. Dehydration PE which is developmentally appropriate diagnosis and diagnostic and therapeutic clinical decision making 4. Orthostatic and physiologic proteinuria 3. Synthesize all available clinical plan 3. Modify differential diagnosis and information into a treatment plan therapy based upon clinical course 5. Nonspecific urethritis 4. Implement appropriate antibiotic 4. Discuss findings on clinical history and treatment of a suspected UTI and list 4. Recognize disease patterns which 6. Hypertension, mild examination that lead one to suspect a indicators that would result in changes deviate from common patterns and 7. Steroid‐responsive nephrotic syndrome UTI in therapy. require complex decision making 8. Nocturnal enuresis 5. Classify a patient with hypertension as to 5. Order the appropriate radiologic 5. Independently manage patient with a 9. Urinary frequency without renal cause severity according to current national evaluation for a child presenting with a broad spectrum of common renal 10.Hematuria without proteinuria, including guidelines, e.g., mild, moderate or first UTI, taking into account the age and disorders resolving postinfectious glomerulonephritis severe. sex of the child. 6. Describe indications for antibiotic 11.Henoch‐Schonlein purpura without persistent prophylaxis for recurrent UTI and the renal involvement long‐term risks of recurrent UTIs. Medical Knowledge: Medical Knowledge: Medical Knowledge: Global Evaluation Compare and contrast the different 1. Demonstrate sufficient knowledge to 1. Demonstrate sufficient knowledge to In‐Training Exam methods of obtaining a urine specimen diagnose and treat undifferentiated or evaluate complex or rare conditions and emergent medical conditions multiple co‐existent conditions 2. Describe the method for making an 2. Discuss common remedies and appropriate diagnosis of a UTI prior to medications used to treat vomiting, treatment and differentiate between along with indications, limitations and pyelonephritis and cystitis potential adverse effects. 3. Discuss common remedies and medications used for diarrhea, along with indications, limitations and potential adverse effects. 4. List common signs and symptoms of deficiency in the following nutritional components, and identify children at high risk for deficiency. 5. Describe the typical monitoring of a child on TPN; identify the indicators that would lead you to a nutrition consultation or referral for a child with suspected or identified nutritional deficiency and/or exogenous obesity. 6. Identify the indicators for a gastroenterology consultation 7. Differentiate IgE‐mediated food allergy from non‐IgE mediated food allergy. GOAL 3: Recognize and initiate management of Patient Care: Patient Care: Patient Care: Direct Observation patients with renal conditions that generally Create a strategy to determine if the 1. Discuss indications for, order and Recognize immediate life‐threatening Global Evaluation require referral. following presenting signs and interpret clinical and laboratory tests to complications associated with the 1. Acute and chronic renal failure symptoms are caused by a renal disease identify renal disease. Tests should diagnosis and treatment of renal disorders. 2. Hemolytic uremic syndrome process and determine if the patient include: urinalysis (dipstick and Refer for intensive care as indicated. needs treating, consultation or referral. microscopic), 24‐hr urine studies, spot 3. Hypertension, moderate to severe 1. Hypertension urine calcium/creatinine, 4. Renal mass, cyst, hydronephrosis, dysplasia 2. Edema protein/creatinine and 5. Diabetes insipidus albumin/creatinine ratios, serum 6. Urolithiasis and/or 3. Hematuria electrolytes, BUN, creatinine (and nephrocalcinosis/hypercalcinuria 4. Proteinuria methods to estimate glomerular 7. Tubular defects (e.g., renal tubular acidosis, 5. Growth retardation filtration rate), calcium, phosphorous Fanconi's, Bartter's) 6. Vasculitic ashes and albumin; complete renal ultrasound 8. Glomerulonephritis 7. Arthritis and arthralgia (kidneys, collecting systems, bladder), intravenous pyelography, voiding 9. Steroid‐resistant nephrotic syndrome 8. Urinary frequency and/or dysuria cystourethrogram (radiographic and 10.Severe electrolyte imbalance 9. Oliguria radionuclide), renal nuclear scans 11.Abnormal renal function in the acutely ill 10.Polyuria and/or polydipsia 2. Interpret acid‐base laboratory values 12.Vesicoureteral reflux 11.Abdominal pain and discuss the differential diagnosis of 13.Obstructive uropathy 12.Abdominal mass metabolic acidosis and alkalosis. 14.Henoch‐Schonlein purpura (persistent renal 13.Acidosis Describe one's approach to diagnosis and treatment.. involvement) 14.Enuresis 15.Autoimmune diseases with potential for renal 15.Deteriorating school performance involvement (e.g., systemic lupus 16.Nausea, poor appetite, weight loss erythematosus, Wegener) 17.Pruritus 16.Urinary tract infections with vesicoureteral reflux, hypertension, or other renal 18.Unexpected fractures Unusual cravings abnormalities for salt or potassiumSore throat 17.Unexplained hematuria Medical Knowledge: Medical Knowledge: Global Evaluation 18.Proteinuria, other than orthostatic and Discuss the normal physiology of body Understand the indications for, basic In‐Training Exam physiologic fluids (water) and salts, including: principles and complications of intracellular vs. extracellular component, substitution therapy in renal failure, e.g., 19.Nephrotic syndrome composition of salt in each (Na, K), intake hemodialysis, peritoneal dialysis and and output, measured and insensible continuous hemofiltration losses, and normal daily requirements.