University of Toronto
Hospital for Sick Children
Division of Nephrology
LONGITUDINAL ROTATION
GOALS & OBJECTIVES
The Longitudinal Rotation entails a weekly clinic during 2nd year to provide a longitudinal experience in
an area of interest. During this month, there is increased responsibility as the patients are followed on
a longitudinal basis with follow-up in clinic and communication outside of clinic.
By the end of the Residents’ training, he/she should:
General Clinical Skills (expert content depends on which
longitudinal clinic)
Be proficient in history-taking and physical examination of the patient
with renal disease
Medical Expert
Be proficient in the independent and comprehensive care of the
nephrology patient, including formulation of a diagnosis and differential
diagnosis, plan of investigation, plan of treatment, and long-term followup
Use appropriate judgment and decision-making skills
Recognize emergency situations, and use appropriate management
strategies for common nephrology emergencies
E.g: hyperkalemia, severe hypertension, diuretic
unresponsive pulmonary edema
Demonstrate competence in long-term kidney disease management
Have an awareness of the medico-legal responsibilities of a physician
including accurate record keeping
Know the natural history of various renal diseases and the importance of
continuity of care.
Prescribe and monitor ongoing care of a child with renal disease.
Monitor growth and development of children with renal disease.
Medical Expert
Hematuria/Proteinuria & Nephritis/Nephrosis
 ProteinuriaKnow of the etiology, differential diagnosis,
diagnostic tests, and role of renal biopsy
 Use appropriate pharmacological treatments for proteinuria of
varying degrees
Nephrotic syndrome,
 Know the etiology, and diagnosis of Nephrotic Syndrome
 Know the indications for renal biopsy
 Recognize complications of nephrotic syndrome
 Direct appropriate pharmacological and non-pharmacological
treatments of Nephrotic syndrome
 Use albumin in nephrotic syndrome appropriately
Hematuria

Know the etiology, differential diagnosis, diagnostic tests and
role of renal biopsy
Glomerulonephritis
 Know the etiology, differential diagnosis, diagnostic tests and
role of renal biopsy
 Recognize complications of GN, including renal impairment,
and hypertension
 Direct appropriate pharmacological and non-pharmacological
treatments for patients with GN
Genetic Renal Diseases
Know about pediatric genetic renal diseases (e.g.:ARPKD, congenital
nephrotic syndrome, Denys-Drash, cystinosis) and those diseases of
adults which may manifest in childhood (e.g.: ADPKD, Alport’s)
Correctly diagnose and manageme genetic renal diseases
Drug dosing in renal disease
Know the pathophysiology of altered drug metabolism in renal disease
Demonstrate a working knowledge of which drug classes require
adjustment for reduced levels of renal function
Be proficient in drug dosing for varying degrees of renal failure
Demonstrate a working knowledge of drug nephrotoxicity
Goals and Objectives – Ambulatory
Reviewed: September 2012
Medical Expert
Congenital/Urological diseases
Demonstrate knowledge of the common congenital and urological
diseases of children, such as:
Posterior urethral valves
Renal dysplasia
Renal hypoplasia
Vesico-ureteric reflux
Reflux nephropathy
Multicystic-dysplastic kidney
Hydronephrosis
Ureteropelvic junction obstruction
Correctly diagnose and manage congenital/urological diseases of
children
Hypertension
Demonstrate proficiency in the investigation and management of
children with hypertension, including:
 Knowledge of the etiology of hypertension
 Ability to diagnose and investigate hypertension
Correctly use antihypertensive agents, and demonstrate knowledge of
their effects, side-effects, dosing, and indications
Renal Biopsy
Demonstrate knowledge of the indications for renal biopsy (closed and
open) in the pediatric population
Demonstrate knowledge of the preparation of a patient for a renal
biopsy, the biopsy procedure and post-procedure complications and
management.
Plan an appropriate course of treatment and/or follow-up based on the
renal biopsy results (Clinico-pathological correlation)
Nephrolithiasis/Nephrocalcinosis
Demonstrate knowledge of the pathophysiology, differential diagnosis,
diagnostic tests and management of patients presenting with
nephrolithiasis and nephrocalcinosis
Urinalysis
Order urinalysis and urine microscopy appropriately for the diagnosis
and management of renal diseases
Have proficiency in urine microscopy
Goals and Objectives – Ambulatory
Reviewed: September 2012
Medical Expert
Elevated serum creatinine
Demonstrate an appropriate approach to the patient with an elevated
creatinine, including knowledge of the:
 Pathophysiology of renal dysfunction
 differential diagnosis
 diagnostic tests
 management including dialysis
Chronic Renal Failure (CRF)
Demonstrate knowledge of the etiologies of CRF
Demonstrate knowledge of the staging of chronic kidney disease
Demonstrate knowledge of the means of preservation of renal function
Appropriately monitor the patient with CRF
Demonstrate knowledge of the complications of CRF, and their
management, including:
 anemia
 metabolic bone disease
 acidosis/electrolyte disorders
 hypertension
 growth impairment
 cardiovascular disease/hyperlipidemia
Fluid & Electrolyte Disorders
Demonstrate knowledge of the etiology, diagnosis and management of
common fluid and electrolyte disorders, including:
 hyponatremia/hypernatremia
 hypokalemia/hyperkalemia
 hypocalcemia/hypercalcemia
 hypophosphatemia/hyperphosphatemia
 magnesium disorders
 metabolic acidosis
 metabolic alkalosis
Goals and Objectives – Ambulatory
Reviewed: September 2012
Medical Expert
Dysuria/pyuria
Demonstrate knowledge of the pathophysiology, differential diagnosis,
diagnostic tests and management of patients with dysuria and pyuria
Tubular Disorders including polyuria
Demonstrate knowledge of the pathophysiology, differential diagnosis,
diagnostic tests and management of tubular disorders, including those
with polyuria.
Fetal Renal Disease
Demonstrate knowledge of the renal disorders which may be detected
antenatally.
Counsel pregnant mothers on the differential diagnosis, prognosis and
post-natal management of antenatally detected fetal renal disorders
Communicator
Demonstrate good communication with members of the multidisciplinary
team caring for outpatients with renal disease and long-term
management of the patient.
Be proficient in creating clinic notes and dictations
Recognize and respond to situations requiring direct physician-tophysician contact.
Communicate well with families and patients.
Establish a therapeutic relationship with families and patients.
Collaborator
Value the need for a multi-disciplinary team approach to optimize the
care of patients with acute and chronic renal dysfunction.
Manage the long term care of a patient with kidney disease among the
multidisciplinary team members and also the patient and family.
Acknowledge and respect the individual team members’ contributions
and roles in the care of patients with acute and chronic renal
dysfunction.
Work collaboratively as a member of a multidisciplinary care team.
Facilitate learning of other health professionals, and learn from allied
health professionals.
Goals and Objectives – Ambulatory
Reviewed: September 2012
Attend assigned clinics promptly.
Manager
Follow-up outstanding results and long-term management of clinical
issues in patients seen in a longitudinal clinic.
Use appropriate resources in the outpatient setting for care of patients
with renal disease.
Use appropriate resource allocation, with consideration of limited
resources while in clinic
Scholar
Health Advocate
Prioritize clinical problems of the patient and assess short term and longterm goals for the patient
Recommend appropriate vaccinations for patients with renal diseases.
Refer to appropriate programs to provide support to patients with
complex medical needs (e.g.: Easter Seals catheter grants, Assistance
for Children with Severe Disabilities).
Refer to appropriate avenues of funding for medications (e.g.: private
insurance, Ontario Drug Benefits) and additional resources (e.g.: Section
8).
Identify the determinants of health (e.g.: drug coverage, socioeconomic
status, family mental illness etc) and advocate on the patient’s behalf.
Be proficient in self-directed learning.
Demonstrate the maintenance of competency through continuing self
medical education.
Professional
Demonstrate the attributes of professionalism, namely: reliability,
integrity, and compassion.
Be aware of their personal limitations, and the impact of same on the
ability to deliver care
Use appropriate personal and inter-professional behaviour.
Balance professional and personal roles.
Demonstrate an ethical approach to the management of fetal/congenital
renal disease.
These goals and objectives will be attained by the Resident through attendance at a variety of outpatient clinics throughout the year with the supervision of the responsible staff nephrologist, through
Goals and Objectives – Ambulatory
Reviewed: September 2012
self-directed learning, and through didactic teaching sessions, both at SickKids and at the University
of Toronto, the latter in conjunction with the adult nephrology trainees.
Achievement of these objectives will be evaluated every 3 months by the Staff Nephrologist(s) in the
Residents regular nephrology clinic.
Created: June, 2012
Reviewed/Revised: September 14, 2012/PGME reviewed
Goals and Objectives – Ambulatory
Reviewed: September 2012