Renal

Here we show a selected set of resources for understanding kidney diseases, arranged to follow a curriculum. The level of the resources ranges from introductory to specialist level, according to the scale shown below right.킠 Although the fine details of Renal Medicine may be fairly regarded as a very specialist material, some parts of it are very general:

  • Hypertension, haematuria, proteinuria and mild to moderate CKD (CRF)
  • Acute kidney injury (AKI, or ARF)
  • Patients kept alive by dialysis and transplantation are now encountered in every specialty

Overview

Mostly simple resources that look across the whole field of renal (kidney) medicine, for students, qualified newcomers.킠 Many also suitable for educated patients.

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    Level A

    Duration
    10-30 mins

    Simple curriculum with links (Edinburgh)

    more info full description    link view external resource

    A webpage defining a very simple Core Curriculum for healthcare professionals or students new to renal medicine.킠 Headings with a sentence and links to topics, mostly within the Edinburgh web resources.킠 A bit like the Curriculum pages on OpenMed.킠 From www.edren.org / www.edrep.org
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    Level ALevel B

    Duration
    10-30 mins

    Advanced Patient Info sites

    more info full description   

    Various sites shown here deserve 3-5 stars for different articles.킠 We have looked for sites that give useful, reliable info for patients with lifelong chronic diseases here, so have excluded sites offering only very short info. NIDDK (USA) has an excellent series of articles arranged alphabetically - much improved in recent years.킠 Ma... read more
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    Level ALevel B

    Duration
    30-60 mins

    The Edren Textbook

    more info full description    link view external resource

    A brief guide for medical students or for any professionals joining a renal service, from the Edinburgh Renal Unit (www.edren.org). Alphabetically organised, 'guaranteed to cover core clinical material'. A 2-3 minute read on each topic, but it would take you an hour or more to read and follow the whole lot. 킠Quick link is www.edrep.org/text... read more

Anatomy and physiology

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    Level ALevel B

    Duration
    10-30 mins

    Anatomy of the Urinary System (US National Cancer Inst)

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    Basic overview of the anatomy of the urinary tract from kidneys to urethra, split into easily-navigable sections so you can choose the bits you want to read. Well-presented and easy to read, but contains simple macro-anatomical information only, with no discussion of the physiology. A good resource for its purpose, but probably not detailed enough for most.
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    Level BLevel C

    Duration
    30-60 mins

    Tufts: Renal Anatomy and Physiology

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    Thirteen page factsheet encompassing the structure and key functions of the kidney. This resource would be appropriate for medical students learning for the first time, up to specialty doctors using it for revision. There are a couple of helpful diagrams, but overall is a bit wordy, and the structure makes it quite difficult to follow. A degree of ... read more

Manifestations of renal disease

Content in progress …

Hypertension A key consequence of renal disease but also capable of worsening or causing renal damage.

Urinalysis One of the most basic but informative tests in nephrology is the urine dipstick and microscopy.

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    Level B

    Duration
    30-60 mins

    Urinalysis interpretation (Indiana U)

    more info full description    link view external resource

    Summary of urinalysis findings with colour images and clear explanations, some bullet-pointed, from the Medical School at Indiana University. It is in slide show form but is interactive and easy to follow. There are 8 case studies and a quiz at the end to guide your thought process and assess your understanding.킠 30-45 mins. Level is 'strai... read more
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    Level C Plus

    Duration
    2 hours

    Urine Microscopy: Fogazzi online course

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    Dr Fogazzi is almost the only person qualified to deliver learned lectures on this topic - here is a series of lectures set out as web pages with full transcipt alongside. 킠The definitive account of a technique that is now practised much less than it used to be, and probably less than it ought to be. 킠Well explained, pictures not as clear... read more
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    Level B

    Duration
    10-30 mins

    Urinalysis tutorial (WebPath)

    more info full description    link view external resource

    A nice summary of what the key tests on a urine dipstick measure, and an introduction to urine microscopy.킠 No mention of automated urinalysis. Quite old-school presentation and photos in a different stream of pages. 킠Note that once you're into the images, you can click from one to another then return to the main text later.... read more

Urinary Tract Infection (UTI)

Urinary tract obstruction

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    Level B

    Duration
    10-30 mins

    Urinary Tract Obstruction (Medscape)

    more info full description    link view external resource

    A simple run-through of the diagnosis, aetiology, and management of urinary tract obstruction. Although there is a lot of information provided, it is broken down in to sections which are easy to negotiate, and the reader can easily interchange them. The website is USA-based and so some of the advice such as investigations, in particular imaging, ar... read more

Glomerular diseases

Has an unfair reputation for complexity – only some diseases are complex. 킠Important as a numerically very important and treatable cause of both acute and chronic renal failure.

Tubulointerstitial diseases

The other category of ‘intrinsic renal disease’ – mostly toxic, allergic, infective. 킠Important but can be difficult to pick up.

Inherited diseases

Systemic disorders, infections and malignancy

Renovascular diseases

Content coming …

Acute Kidney Injury (AKI; Acute Renal Failure, ARF)

Increasingly recognised to be an important determinant of prognosis for all medical and surgical admissions, not just a problem for renal units.

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    Level B

    Duration
    2 hours

    AKI tutorials (Kidn-E from e-LfH)

    more info full description    link view external resource

    (UK doctors only, which loses it a star) Acute kidney injury broken into seven interactive tutorials, around 30 mins each, including question/answer sections which help identify gaps in knowledge. Slide show style presentation allows for easy first-time reading, but lots of clicking required, and this format is not useful for revision.킠 It ... read more
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    Level B

    Duration
    30-60 mins

    Acute renal failure (Medscape)

    more info full description    link view external resource

    This open-access article is content-rich (long) but rather theoretical rather than practical, yet glosses over uncertainties around pathogenesis etc.킠 Doesn't really fill the bill fully as either a clinical introduction or as a theoretical learning resource, but there is a lot there, and it's free. The articles in Medscape's Reference secti... read more
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    Level B

    Duration
    30-60 mins

    AKI cases – tutorial from Edinburgh

    more info full description    link view external resource

    Three interactive cases are used to illustrate the approach to AKI (acute kidney injury, or acute renal failure, ARF) at a level appropriate for senior medical students or early clinical practitioners. 킠Covers a good range of causes and questions.... read more
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    Level B

    AKI – Scottish Intensive Care Society module (part 1)

    more info full description    link view external resource

    This 11 page primer module from the Scottish Intensive Care Society discusses the presentation, assessment and immediate management of acute kidney injury (AKI, = ARF). Suitable for junior doctors/ senior medical students. No figures and not very beautifully presented, but has key content in a form that is quick to read without too much clicking. ... read more

Chronic Kidney Disease (CKD; Chronic Renal Failure, CRF)

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    Level C

    Duration
    30-60 mins

    CKD core curriculum from uKidney

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    A series of excellent articles from Dr Jordan Weinstein (supported by Amgen) at uKidney. They are essentially textbook pdf documents (so lose a point or two) that can be viewed in rather horrible pseudo-book format onscreen, or downloaded one by one (when in full screen reading view, a Download icon appears at the top of the screen). However ... read more
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    Level BLevel C

    Duration
    30-60 mins

    CKD guideline (British Columbia)

    more info full description    link view external resource

    Quite detailed with 2,500 words and over 40 references, so includes justification and sources.킠 Carefully thought through and written.킠 Proteinuria criteria loosely defined or very low threshold.
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    Level B

    Duration
    10-30 mins

    CKD: NIH guide for professionals

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    Nice and simple guide - but too simple. Very US orientated. You could maybe add a star to the rating if that's where you are. Suggests without qualification that all with GFR below 60 should be referred to a nephrologist - this cannot be justified, and it is not internationally achievable. (It suggests that they should all see a dietitian too... read more
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    Level BLevel C

    Duration
    2 hours

    CKD virtual clinic

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    This growing resource is compiled from email enquiries from UK Primary Care practitioners to their local (Edinburgh) renal service.킠 It is presented as their original Q, you are given an opportunity to think, then the expert answer can be revealed.킠 Growing number of cases; and links to supporting resources for learning or reference, incl... read more
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    Level B

    Duration
    2 hours

    CKD: a course for primary care (UK; BRS)

    more info full description    link view external resource

    This online course is aimed at education of primary care physicians but could be useful for anyone wanting to know more about CKD. It works it way through anatomy, pathophysiology, diagnosis, management and links to guidelines. Nicely produced with colourful diagrams and links for more information, but: Cumbersome process to get a free login, i... read more
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    Level ALevel B

    CKD (National Kidney disease education programme)

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    This website provides educational material targeted at both health professional and patients.킠 A lot of reliable info, nicely presented. The most useful bit for professionals may be the킠 CKD info.킠 Some useful Q+A for patients. There are also a number of provider education videos (doctors speaking to patients) on a number of to... read more
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    Level ALevel B

    Duration
    30-60 mins

    The UK eCKD Guide

    more info full description    link view external resource

    This digest of the NICE, SIGN and UK Renal Association guidelines on CKD aims to provide quick online support for the diagnosis and management of chronic kidney disease in the community.킠 It's pretty good for quickly learning prioritisation and approach.킠 Its referral criteria are UK-specific and assume a high standard of primary care... read more

Fluid and Electrolyte abnormalities

Dialysis

Haemodialysis

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    Level BLevel C

    Duration
    30-60 mins

    Renal Replacement Therapy in Critical Care

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    This is a pdf document, which uses the format of self-assessment to lead in to a tutorial about renal replacement therapy in the critical care environment. It discusses the differences between dialysis and filtration, and the indications for each. There is some discussion about the use of RRT for the removal of drugs and toxins, and practical issue... read more
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    Level A

    Duration
    10-30 mins

    Overview of Dialysis (NHS Choices)

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    NHS Choices is aimed at patients but gives a good general view of available options for renal replacement therapy, including their advantages and disadvantages, and long term complications. There are useful videos providing the patients' perspectives, and these are the best bit, but the text is wordy in a long narrow column.
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    Level BLevel C

    Duration
    10-30 mins

    Examination of the AV fistula (YouTube video)

    more info full description    link view external resource

    Dr Vipul Vachharajani's excellent 30 minute video gives lots of info for those new to the field, and for those with experience too. See also his Atlas of Vascular Access at Fistula First.
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    Level C Plus

    Duration
    2 hours

    Fistula First

    more info full description    link view external resource

    An outstanding resource for physicians and surgeons caring for haemodialysis patients. 킠It presents practical guidance to creation, cannulation of fistulas; recognition of complications of fistulas and CV catheters. 킠There are videos and practical guidance for patients and all grades of staff, though finding exactly what you want on the s... read more

Peritoneal dialysis

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    Level A

    Duration
    10-30 mins

    Continuous Ambulatory Peritoneal Dialysis – Kidney Research UK

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    This is a factsheet, aimed at patients, which explains the basics behind Continuous Ambulatory Peritoneal Dialysis (CAPD). There are also links to Ambulatory Peritoneal Dialysis (APD), haemodialysis and transplant. The layout is easy to follow, and obviously the patient's perspective is paramount. It highlights the pros and cons of each mode of ... read more
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    Level CLevel C Plus

    Duration
    Longer than 4 hours

    Peritoneal Dialysis Academy

    more info full description    link view external resource

    This online resource, in association with the Renal Association, offers a comprehensive detail regarding the theory behind peritoneal dialysis (PD), through its clinical applications, and then goes on to discuss how to prescribe PD and deal with complications. The site is easy to negotiate, with clear descriptions, and references for further readin... read more
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    Level ALevel B

    Duration
    10-30 mins

    PD (mykidney, Guy’s Hosp)

    more info full description    link view external resource

    This free resource is aimed primarily at patients but would also be of use to medical professionals who are looking for an overview about different modes of renal replacement therapy and the decision-making involved. For peritoneal dialysis in particular, the explanation is straightforward, and there are helpful illustrative videos.

Transplantation

Content on the way …

Pregnancy

Pregnancy in patients with CKD raises some important questions.킠 Complications of pregnancy can cause renal diseases, and pregnancy may influence pre-existing diseases (e.g. autoimmune diseases) that may affect the kidney.

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    Level BLevel C

    Duration
    30-60 mins

    Hypertension in Pregnancy (NHS)

    more info full description    link view external resource

    Excellent, well-presented and readable recommendations with evidence, not specifically renal. Tip-top first read for trainees or update for experienced clinicians. 킠From the very good NHS Clinical Knowledge Summaries series. It is presented as a series of scenarios. 킠It is best to 'View full scenario' from the outset.  ... read more
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    Level BLevel C

    Duration
    30-60 mins

    Renal disease and pregnancy (Medscape)

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    Disappointing, feels long but is superficial on important areas, quite misleading in others.킠 Good on physiology.킠 Then a list of possible complications without clear introduction.킠 Evidence for recommendations/statements often unclear. US-specific and in some areas varying significantly from international practice.  

Pathology

The intricacies of renal pathology are mostly a postgraduate subject.킠 Even non-specialist pathologists tend to run away from analysing renal biopsies.

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    Level C Plus

    Duration
    2 hours

    Pathology course and UNC renal pathology resources

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    Good but quite long and heavy online tutorial with not brilliant image quality.킠 Not comprehensive but you'll learn a lot. Various other University of North Carolina resources are linked from here - some of these are good and good quality, but they are pdf files, often large, and some are simply pdfs of powerpoint presentations. The case h... read more
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    Level C Plus

    Duration
    30-60 mins

    Renal Pathology from NDT Educational

    more info full description    link view external resource

    This is a good series of disease-based studies illustrating the features of each. 킠Authored by Drs Franco Ferrario and Maria Pia Rastaldi (Milan). 킠Images not great quality but the presentation is clear and simple You need 10 mins each subject maybe, and there are 13 topics, so the 30-60 mins is based on a dipping in and out strategy a... read more
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    Level C Plus

    Duration
    30-60 mins

    Transplant pathology and immunology (Pittsburgh)

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      The Transplant Pathology Internet Services website from the Pittsburgh unit gives an excellent account of biopsy appearances in all sorts of acute and chronic transplant settings, including different types of rejection.킠 There킠 is a useful account of the history of transplant immunology and HLA testing though coverage of the lat... read more
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    Level C Plus

    Duration
    10-30 mins

    Photo-library of pathology (University of Tokushima)

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    A good many nice quality photomicrographs, but without any explanation.킠 Created at the University of Tokushima in 2005 apparently (http://www.med.tokushima-u.ac.jp/english/article/0013468.html - but the Japanese pages look so much more interesting). So it's really for illustrating rather than learning.... read more
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    Level C

    Duration
    10-30 mins

    Pathology of Infections of the genitourinary tract

    more info full description    link view external resource

    An excellent breeze through the pathology of common and uncommon infections, of the genitourinary tract, simply presented with short explanations from Fujita University, Toyoake, Japan.킠 In other sections of this site he goes through other organ systems too; a valuable resource for any specialty.킠 Created in 2003, not apparently updated, ... read more
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    Level C Plus

    Duration
    2 hours

    Atlas of Renal Pathology (AJKD)

    more info full description    link view external resource

    The AJKD Atlas of Renal Pathology comes mostly from Agnes Fogo (Vanderbilt).킠 It is very good indeed, and covers 55 diagnoses with excellent downloadable images and explanation.킠 However it is an atlas, so more useful as a reference than a learning resource, which is the only reason it drops a star in our rating system.... read more
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    Level BLevel C

    Duration
    30-60 mins

    Renal pathology from the Pathology Guy

    more info full description    link view external resource

    The macroscopic images are excellent, but the histopathology pics are not such high quality and the commentary on them is very brief and can sometimes be misleading, so use those with caution.킠 There is a good range and it is a very useful overview though.킠 The rest of the Pathology Guy's website is quite extraordinary, try not to spend t... read more
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    Level CLevel C Plus

    Duration
    30-60 mins

    Iowa virtual microscopy

    more info full description    link view external resource

    Realistic virtual recreation of the experience of looking at renal biopsies through a Google map-like interface, instead of snapshots showing 'typical' lesions.킠 Pity it gives the answers in advance, and only a few examples, but very good. Requires good bandwidth to work well.... read more

 

Blogs and other resources

Here we list some outstanding resources that are difficult to categorise.

 

The curriculum was developed with reference to textbooks and realities of practice, plus for postgraduate level resources the ISN’s Core Curriculum for postgraduate training in nephrology (no longer online), and the UK’s (unreadable) postgraduate curriculum.

Acknowledgements: Reviewers for this section were Drs Fiona Duthie, David Ferenbach, Jennifer Lees, Eleri Williams, Iain Drummond, and Neil Turner.킠 Valerie Luyckx contributed to the development of the curriculum.

  • Curriculum

  • How to …

    help information OpenMed rates and lists good resources for learning Medicine. Browse a curriculum to see a selection, or Search (top right) to find more. See Help for more info about the why, what and how of what we are doing here.

    Level Guideexplanation of level ratings

    A/B/C = Learner, Practitioner, Expert.

  • RSS Level B/C cases from internalmeded.org

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