ISN Guidelines

Recommendations for Postgraduate Training in Nephrology

Prepared by the Education Advisory Committee of the International Society of Nephrology.

  1. Objective:
    This document provides recommendations for the training of a nephrologist, defined as a physician who is able to provide comprehensive care to patients with kidney disease. The recommendations set out minimum requirements for the training of nephrologists world-wide, acknowledging that regional resource constraints will influence the capacity for provision of a comprehensive training program.
  2. Duration of program:
    1. Minimum 4 yrs; optimum 6 years (for internal medicine plus nephrology training)
    2. Number of years devoted exclusively to nephrology training:
      Minimum 2 years, optimum 3-4 years

  3. Specific clinical expertise:

    Specific clinical expertise
    Trainees should gain expertise in diagnosis and management of: Level of requirement
    a. Acute kidney failure Essential
    b. Fluid/electrolytes/acid-base disorders Essential
    c. Renal parenchymal diseases Essential
    d. Hypertension and hypertensive kidney disease Essential
    e. Chronic kidney disease (CKD) Essential
    f. Acute peritoneal dialysis Desirable
    g. Hemodialysis Essential
    h. CAPD Essential/Desirable*
    i. Transplant workup Essential/Desirable*
    j. Post-transplant patient:  
       Early management: Desirable
       Long-term management: Essential/Desirable*
    k. Nutrition in patients with kidney disease and patients with ESRD Essential
    l. Urinary tract stone disease Essential
    m. Complicated urinary tract infection Essential
    * Level of requirement depends on regional availability of CAPD and transplantation as treatment modalities.
  4. Clinical training program:

    Clinical training program
    Total training time devoted to % time allocation
    a. Management of patients with kidney disease (non-ESRD), in both inpatients (including ICU) and outpatients ˜ 40%
    b. Management of patients with ESRD, including chronic hemodialysis and/or CAPD ˜ 40%
    c. Transplant nephrology ˜ 20%
    d. Research Optional

  5. Procedures:

    Trainee should gain expertise in the following procedures Level of requirement
    a. Urinalysis and urine microscopy Essential
    b. Renal biopsy Desirable
    c. Placement of central lines/access Essential
    d. Connect patient for hemodialysis Desirable
    e. Placement of acute PD catheter Optional
    f. Placement of CAPD catheter Optional
    g. Urinary tract ultrasound Desirable
    h. Vascular access contrast study Optional
    i. Access/line declotting procedure Optional
    j. Vascular access angioplasty Optional

  6. Training program resources:

    Training program resources
    Training program should have the following resources Level of requirement
    a. Renal pathology service Essential (EM Optional)
    b. Acute hemodialysis Essential
    c. Acute continuous treatment (CVVH, CAVH) Optional
    d. Acute peritoneal dialysis Optional
    e. Chronic hemodialysis Essential
    f. CAPD Essential
    g. Ambulatory nephrology (Outpatient clinic, consultation clinic) Essential
    h. Internet access Desirable
    i. Library with nephrology resources Essential
    j. Availability of imaging:  
       Radiology, ultrasound Essential
       Nuclear medicine, CT scan Desirable

  7. Faculty support:

    Faculty support
    Level of support by faculty to the trainee Level of requirement
    Continuous direct supervision Desirable
    Nephrologist contactable 24 hours/day Essential

November 2004

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