Nephrology Study Topics Guide: Curated UpToDate Reading Plan
Learning Objectives
By the end of this guide, you will: - Have a structured reading plan covering essential nephrology topics - Understand the progression from foundational to advanced nephrology knowledge - Know which UpToDate topics provide the most clinically-relevant content - Be able to prioritize reading based on your rotation schedule and level - Have a reference resource for systematic nephrology learning
Introduction
This handout provides a curated list of UpToDate clinical topic readings organized by clinical priority and learning progression. The topics span from foundational kidney function assessment through specialized disease management, giving you a comprehensive self-study curriculum that complements didactic teaching and clinical practice.
How to use this guide: - Week 1-2 (Foundation): Read Sections A and B - Week 3-4 (Core Acute Problems): Read Sections C and D - Week 5-6 (Chronic Management): Read Sections E and F - Week 7-8 (Advanced Topics): Read Sections G and H - Ongoing: Reference Sections I and J during specific patient encounters
SECTION A: FOUNDATIONAL ASSESSMENT — START HERE
Essential Diagnostic Skills (Read in this order)
1. Urinalysis in the diagnosis of kidney disease - Why read: Urinalysis is your first window into kidney pathology - Key learning: Interpretation of proteinuria, hematuria, casts, crystals - Clinical pearls: - RBC casts = glomerulonephritis until proven otherwise - Dysmorphic RBCs suggest glomerular source - WBC casts suggest pyelonephritis or interstitial inflammation - Time needed: 45-60 minutes - How to study: Review case examples; practice interpreting microscopy images
2. Radiologic assessment of kidney disease - Why read: Imaging often provides diagnosis when labs are ambiguous - Key learning: Understanding ultrasound, CT, MRI findings in different kidney diseases - Clinical pearls: - Echogenicity correlates with fibrosis burden - Hydronephrosis = obstruction until proven otherwise - “Normal-appearing kidneys” on ultrasound can still have disease on biopsy - Time needed: 60-90 minutes - How to study: Look at images while reading; memorize normal measurements
3. Laboratory evaluation of kidney function - Why read: Creatinine and eGFR are imperfect; understand their limitations - Key learning: How to interpret eGFR, creatinine, BUN; when to use cystatin C - Clinical pearls: - A “normal” creatinine can represent significant kidney dysfunction in elderly/frail - eGFR less reliable during acute changes - BUN:Cr ratio distinguishes prerenal from intrinsic disease - Time needed: 45-60 minutes - How to study: Learn equations; practice calculating eGFR by hand
SECTION B: ACUTE KIDNEY INJURY — CRITICAL FOUNDATION
Recognizing and Managing AKI
4. Evaluation of acute kidney injury among hospitalized adult patients - Why read: AKI is common and often managed incorrectly (over-fluiding or under-fluiding) - Key learning: KDIGO staging, differentiation of prerenal vs. intrinsic vs. postrenal AKI - Clinical pearls: - FENa <1% = kidney conserving sodium (prerenal) - FENa >2% = kidney wasting sodium (intrinsic) - Always get baseline creatinine before diagnosing AKI - Time needed: 60-90 minutes - Key sections: KDIGO staging (memorize), diagnostic approach by type, management principles - How to study: Create a decision tree for AKI classification; practice with case examples
5. Causes of acute interstitial nephritis - Why read: AIN is easily missed and can be reversible if caught early - Key learning: Common medications causing AIN, diagnostic findings, treatment - Clinical pearls: - Eosinophiluria (>5% of WBC) suggests drug-induced AIN - NSAIDs, antibiotics, PPIs are most common causes - Can develop 1-2 weeks after medication start - Time needed: 30-45 minutes - How to study: Make a list of AIN-causing drugs; present a case to a colleague
SECTION C: CHRONIC KIDNEY DISEASE FUNDAMENTALS
Understanding CKD Across Stages
6. Overview of the management of chronic kidney disease in adults - Why read: This is THE comprehensive management topic — foundational for all CKD patients - Key learning: Staging, complications, slowing progression, preparing for RRT - Clinical pearls: - Proteinuria reduction is universal goal (every patient benefits from ACEi/ARB) - BP target <120 systolic in many CKD patients (personalize) - Screen for complications at each CKD stage - Time needed: 90-120 minutes - Key sections: Definition and staging, complications, management by stage, progression factors - How to study: Create management checklists for each CKD stage (1-5)
7. Evaluation and diagnosis of diabetic kidney disease - Why read: Diabetic nephropathy is the #1 cause of ESRD in developed countries - Key learning: Early detection (microalbuminuria), differentiation from non-diabetic disease - Clinical pearls: - Microalbuminuria (30-300 mg/g) is often first sign - Absence of retinopathy suggests non-diabetic kidney disease - SGLT2i now recommended for all T2DM with albuminuria/CKD - Time needed: 45-60 minutes - How to study: Review criteria for diabetic vs. non-diabetic kidney disease
8. Treatment of diabetic kidney disease - Why read: SGLT2 inhibitors and GLP-1 agonists have transformed diabetic kidney disease management - Key learning: SGLT2i are now first-line; GLP-1 agents add benefit - Clinical pearls: - SGLT2i reduce progression even without diabetes (surprising finding) - GLP-1 agents reduce albuminuria and cardiovascular risk - Traditional therapy: ACEi/ARB + SGLT2i + GLP-1 ± low-dose diuretic - Time needed: 45-60 minutes - How to study: Compare outcomes in SGLT2i trials; understand mechanisms
SECTION D: GLOMERULAR DISEASE AND RAPID DECLINE
When to Worry: Glomerulonephritis
9. Rapidly progressive glomerulonephritis: A clinical overview and diagnostic approach - Why read: RPGN is a medical emergency; missing it costs kidney function - Key learning: Clinical presentation, diagnostic categories (ANCA, anti-GBM, immune complex), urgency of treatment - Clinical pearls: - RBC casts + rising creatinine = possible RPGN (urgent biopsy) - 4-week timeline: 2 weeks pre-symptomatic, 2 weeks for diagnosis/treatment - Plasma exchange required for anti-GBM and ANCA with pulmonary hemorrhage - Time needed: 60-90 minutes - Key sections: Clinical presentation, diagnostic approach, treatment by type - How to study: Present a RPGN case; understand why plasma exchange must be urgent
10. IgA nephropathy: Clinical features and diagnosis - Why read: IgA nephropathy is most common glomerulonephritis worldwide; often presents in young patients - Key learning: Presentation (hematuria, proteinuria), progression patterns, biopsy findings - Clinical pearls: - Hematuria may be intermittent; proteinuria develops with progression - 20-30% progress to ESRD over 20 years - ACEi/ARB first-line; corticosteroids in high-risk disease - Time needed: 30-45 minutes - How to study: Review pathology photos; understand Oxford classification prognostic factors
11. Membranous nephropathy: Clinical presentation and diagnosis - Why read: Common cause of nephrotic syndrome in adults; prognosis highly variable - Key learning: Clinical features, progression patterns, distinction between primary and secondary - Clinical pearls: - Serologic: Check PLA2R and THSD7A antibodies - ~33% spontaneous remission, ~33% persistent proteinuria, ~33% progression to ESRD - Treatment varies by risk stratification - Time needed: 30-45 minutes - How to study: Understand risk factors for progression; know secondary causes (malignancy, infections)
12. Focal segmental glomerulosclerosis (FSGS): Clinical features and diagnosis - Why read: Common cause of nephrotic syndrome; understanding variants guides treatment - Key learning: Primary vs. secondary FSGS, prognosis, treatment - Clinical pearls: - Primary (genetic) FSGS: Younger age, positive family history, severe proteinuria - Secondary: Obesity, hyperfiltration, sickle cell, HIV, heroin - Treatment: Corticosteroids, calcineurin inhibitors, SGLT2i - Time needed: 30-45 minutes - How to study: Compare genetics of primary vs. secondary; review immunosuppression protocols
SECTION E: SPECIALIZED NEPHROLOGY CONDITIONS
The Cardiorenal Connection
13. Cardiorenal syndrome: Definition, prevalence, diagnosis and pathophysiology - Why read: Heart failure and kidney disease are inextricably linked; treatment requires understanding both - Key learning: CRS types (1-5), mechanisms, diagnostic approach - Clinical pearls: - Type 1: Acute heart failure → acute kidney injury - Type 2: Chronic heart failure → progressive CKD - Type 5: Systemic disease affecting both (sepsis, cardiorenal-hepatic) - Time needed: 60-90 minutes - Key sections: Pathophysiology, diagnosis, prognostic markers - How to study: Compare medication effects in CHF+CKD scenarios
14. Cardiorenal syndrome: Prognosis and treatment - Why read: Treatment differs from isolated CKD or isolated CHF - Key learning: Diuretic use, RAAS inhibitor dosing, novel agents - Clinical pearls: - Avoid aggressive diuresis if possible; gentle diuresis preferred - ARNI (sacubitril/valsartan) superior to ACE inhibitor in CHF - Sodium-glucose cotransporter inhibitors benefit both organs - Time needed: 45-60 minutes - How to study: Build management algorithms for different CRS types
SECTION F: DIALYSIS AND RENAL REPLACEMENT THERAPY
When Kidneys Fail: RRT Modalities
15. Overview of the hemodialysis apparatus - Why read: Understanding how dialysis works helps you manage dialysis patients - Key learning: Vascular access types, dialyzer characteristics, anticoagulation - Clinical pearls: - Arteriovenous fistula (AVF) best access; can last 20+ years - Arteriovenous graft (AVG) intermediate longevity - Central venous catheter (CVC) temporary but has highest infection risk - Time needed: 45-60 minutes - How to study: Review vascular anatomy; understand why AVF superior to other access
16. Prescribing and assessing adequate hemodialysis - Why read: Dialysis prescription directly impacts patient survival and quality of life - Key learning: Kt/V, urea reduction ratio, adjusting dialysis dose - Clinical pearls: - Kt/V target >1.2; URR target >65% - Inadequate dialysis linked to higher mortality and morbidity - Can be improved by longer sessions, more frequent sessions, or higher flow rates - Time needed: 45-60 minutes - How to study: Calculate Kt/V for case examples; understand how to adjust prescriptions
17. Prescribing peritoneal dialysis - Why read: PD is underutilized option; increases residual renal function and allows more autonomy - Key learning: CAPD vs. APD, dosing, adequacy assessment, complications - Clinical pearls: - Better quality of life for many patients - Preserves residual renal function longer than HD - Higher cost barrier and patient selection critical - Time needed: 30-45 minutes - How to study: Compare PD vs. HD; understand patient selection factors
18. Acute complications during hemodialysis - Why read: Dialysis sessions can trigger serious complications; knowledge prevents morbidity - Key learning: Hypotension, cramping, arrhythmias, dialysis disequilibrium - Clinical pearls: - Hypotension most common; managed by ultrafiltration goals and fluid removal rate - Dialysis disequilibrium: Headache, nausea, seizures from osmotic shifts - Hypoxemia occurs in 5-10% of sessions - Time needed: 30-45 minutes - How to study: Make a management flow chart for common complications
SECTION G: ELECTROLYTE AND ACID-BASE DISORDERS
Critical Fluid and Electrolyte Management
19. Hyponatremia: Etiology, clinical manifestations, and diagnosis - Why read: Hyponatremia is most common electrolyte disorder; mismanagement causes brain damage - Key learning: Classification by volume status, pathophysiology, diagnostic approach - Clinical pearls: - Most important factor: Is it acute (<48 hrs) or chronic (>48 hrs)? - Acute: Risk of seizures; rapid correction possible - Chronic: Risk of osmotic demyelination; correction must be slow (<8 mEq/L per 24 hrs) - Time needed: 60-90 minutes - Key sections: Classification, diagnosis by urine osmolality + serum osmolality, treatment
20. Hypernatremia: Etiology, clinical manifestations, and diagnosis - Why read: Hypernatremia carries worse prognosis than hyponatremia - Key learning: Classification, pathophysiology, when diabetes insipidus is involved - Clinical pearls: - Water deprivation test distinguishes central from nephrogenic DI - Central DI: Responds to desmopressin - Nephrogenic DI: Does NOT respond to desmopressin - Time needed: 45-60 minutes - How to study: Practice interpreting water deprivation test results
21. Hypokalemia: Treatment - Why read: Hypokalemia causes cardiac arrhythmias; treatment requires thoughtfulness about replacement rate and route - Key learning: Calculating deficits, oral vs. IV replacement, monitoring - Clinical pearls: - Each 1 g KCl = 13.4 mEq K+ - Refractory hypokalemia often due to magnesium depletion - Must replete magnesium for potassium to normalize - Time needed: 30-45 minutes - How to study: Calculate replacement amounts for case examples
22. Hyperkalemia: Causes, clinical features, diagnosis, and treatment - Why read: Hyperkalemia with ECG changes is a medical emergency; treatment has narrow margins - Key learning: “ABCs” approach: Antagonize (calcium), Shift (insulin/glucose), Remove (diuretics/dialysis) - Clinical pearls: - ECG progression: Peaked T waves → widened QRS → loss of P wave → sine wave → asystole - Calcium gluconate acts immediately but doesn’t lower K+ - Insulin + dextrose shifts K+ intracellular (onset 10-20 mins) - Time needed: 45-60 minutes - Key sections: Causes, treatment algorithms, monitoring - How to study: Create emergency management protocol for K+ >6.5 with ECG changes
SECTION H: SPECIAL POPULATIONS AND ADVANCED TOPICS
Nephrology Beyond the Mainstream
23. Acute kidney injury in the critically ill patient - Why read: ICU patients have complex AKI; context matters for management - Key learning: Multifactorial AKI, when to dialyze, nutritional support - Clinical pearls: - Often combination of prerenal + intrinsic + toxic insults - CRRT often preferred over IHD in hemodynamically unstable - Nutritional needs change with dialysis; coordinate with nutrition - Time needed: 45-60 minutes - How to study: Review ICU case examples; understand CRRT indications
24. Contrast-induced acute kidney injury - Why read: Preventable complication occurring routinely in medical practice - Key learning: Pathophysiology, prevention strategies, management - Clinical pearls: - Risk highest with high-osmolality contrast; low-osmolality safer - IV hydration is primary prevention - Metformin should be held; check eGFR post-contrast - Time needed: 30 minutes - How to study: Create pre/post-contrast orders for your institution
SECTION I: ESSENTIAL QUICK REFERENCES
Topics for Specific Patient Encounters
Beyond the main reading: - Pregnancy and kidney disease (preeclampsia, gestational hypertension) - Kidney disease in cancer patients (onco-nephrology) - Medication dosing in kidney disease (pharmacokinetics) - Kidney transplant evaluation and management - Nephrolithiasis (kidney stones): Prevention and treatment - Polycystic kidney disease (genetic counseling, management) - Vasculitis and ANCA-associated disease - Systemic lupus erythematosus and lupus nephritis
Read these topics when you encounter patients with these conditions.
SECTION J: STUDY STRATEGY AND INTEGRATION
How to Get Maximum Value from Reading
General Principles:
- Read actively, not passively
- Keep notes while reading
- Write down definitions and key concepts
- Create your own diagrams and algorithms
- Connect to patients you’ve seen
- After each topic, recall a patient encounter
- Ask: “Does this explain what I saw?”
- Discuss cases with faculty and colleagues
- Build your own resource library
- Favorite images and diagrams
- Most useful algorithms
- Key references for common conditions
- Practice clinical reasoning
- Present cases to colleagues
- Ask “What would you do?” before reading answers
- Explain your clinical reasoning to a student
- Focus on clinical applicability
- Every concept should connect to patient care
- Ask “When will I use this knowledge?”
- Prioritize common conditions over rare diseases
Suggested Reading Sequence by Rotation Length
2-Week Rotation
Must-read (Sections A & B): Topics 1, 2, 4, 5 Time commitment: ~4 hours
4-Week Rotation
Add (Sections C & D): Topics 3, 6, 7, 9 Time commitment: ~8 hours total
6-Week Rotation
Add (Sections E & F): Topics 13, 14, 15, 16 Time commitment: ~12 hours total
8-Week Rotation
Add (Sections G & H): Topics 19, 20, 21, 22 Time commitment: ~16 hours total
Clinical Pearls Summary (Read First)
If you read nothing else, understand these principles:
- Urinalysis interpretation = kidney disease diagnosis
- RBC casts = glomerulonephritis
- WBC casts = infection/inflammation
- Proteinuria = glomerular disease
- FENa <1% = kidney conserving sodium (prerenal)
- FENa >2% = kidney wasting sodium (intrinsic AKI)
- Proteinuria reduction is universal therapy for CKD
- ACEi/ARB first-line (all stages)
- SGLT2i now added for most
- Lower proteinuria = slower progression
- Tight BP control slows CKD
- Target individualized
- Goal <120 systolic in many patients
- RAAS inhibition priority
- Know thy baseline creatinine
- Can’t diagnose AKI without it
- Most important number in chart
Acknowledgments
This reading guide is based on UpToDate™ clinical topics and reflects current evidence-based practice in nephrology as of early 2026. Topics are current, but always verify recommendations against your institution’s protocols and current guidelines.
This study guide provides structure; clinical experience provides wisdom. Combine both.