Acute Renal Failure and ICU Nephrology

I.    Program Content

A.   Trainees must acquire knowledge and understanding of the following areas during the course of their training:

1. Normal regulation of renal and glomerular hemodynamics.

2. Differential diagnosis of acute renal failure.

a. Pathophysiology of prerenal azotemia.

b. Pathophysiology of intrinsic renal failure, including acute glomerular diseases, acute tubular necrosis, and acute interstitial disease.

c. Pathophysiology of obstructive renal failure.

3. Mechanisms of acute renal failure in the postoperative patient.

4. Mechanisms of acute renal failure in patients with hepatobiliary disease.

5. Causes of acute renal failure in patients with cancer and immunosuppression.

6. Causes of acute renal failure in patients with AIDS.

7. Metabolic consequences of acute renal failure.

a. Hormonal

b. Nutritional

c. Electrolyte

d. Acid-base

e. Volume.

8. Evaluation and management of acute renal failure.

a. Radiologic techniques in acute renal failure.

b. Biochemical evaluation of ARF.

c. Role of the renal biopsy in acute renal failure.

d. Nondialytic therapies

i. Role of hemodialysis.

ii. Role of peritoneal dialysis.

iii. Role of continuous therapy.

9. Hemodynamic monitoring of the critically ill patient.

10. Management of electrolyte/acid-base disturbances in the critically ill patient.

11. Fluid management of the critically ill patient.

12. The use of vasoactive drugs in the critically ill patient.

13. Role of extracorporeal therapy in the management of drug overdose, specifically ethylene glycol, methanol, lithium, theophylline, salicylate, barbiturate.

II.    Patient Care Experience

1. Trainees must have experience in the evaluation and management of acute renal failure. 

2. Trainees must have experience in the evaluation and management of fluid-electrolyte and acid-base disturbances in the critically ill patient.

3. Trainees should have experience in the evaluation of hemodynamics and the proper use of fluids and vasoactive drugs in critically ill patients.

4. Trainees should have experience in the use of various dialytic techniques including hemodialysis, peritoneal dialysis, and continuous hemodialysis.

5. Trainees should have experience in the sues of extracorporeal therapy to remove specific toxins.

6. Trainees should have experience in the placement of central lines.