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. 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. Many also suitable for educated patients.

10-30 mins
Simple curriculum with links (Edinburgh)
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A webpage defining a very simple Core Curriculum for healthcare professionals or students new to renal medicine. Headings with a sentence and links to topics, mostly within the Edinburgh web resources. A bit like the Curriculum pages on OpenMed. From www.edren.org / www.edrep.org
collection

10-30 mins
Advanced Patient Info sites
full description
Various sites shown here deserve 3-5 stars for different articles. 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. Many other... read more
10-30 mins
Links list from Renal PatientView
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Showing the disease-by-disease links from Renal PatientView, a UK system through which patients can look up their test results and elements of their electronic records online. It gives selected information links according to Renal Diagnosis, and Treatment (General Nephrology, Peritoneal Dialysis, Haemodialysis, Transplant). These are mostly qu... read more
30-60 mins
The Edren Textbook
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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. Quick link is www.edrep.org/textbook... read more

Anatomy and physiology

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.
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.

30-60 mins
Hypertension tutorial (Edinburgh)
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Interactive tutorial based on simple case to take you through the diagnosis, classes of drug, etc.
30-60 mins
Hypertension management (NHS Evidence CKS)
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Good summary of management of hypertension including details of treatment. Covers initial diagnosis and secondary causes too.

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

30-60 mins
Urinalysis interpretation (Indiana U)
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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. 30-45 mins. Level is 'straightf... read more
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. The definitive account of a technique that is now practised much less than it used to be, and probably less than it ought to be. Well explained, pictures not as clear as in h... read more
10-30 mins
Urinalysis tutorial (WebPath)
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A nice summary of what the key tests on a urine dipstick measure, and an introduction to urine microscopy. No mention of automated urinalysis. Quite old-school presentation and photos in a different stream of pages. Note 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)

30-60 mins
UTI in men (NHS Evidence CKS)
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Another excellent account from NHS evidence. The landing page lists another series of related topics including prostatitis, pyelonephritis etc.
Less than 10 mins
UTI in more detail (Edinburgh)
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A page of more advanced info about UTIs, dwelling on particular circumstances
- pregnancy
- asymptomatic bacturia
- relationship to reflux
Declaration of interest: an Edinburgh resource
UTI (Edren textbook)
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Very simple introduction with links to further sources and detail. Declaration of interest: an Edinburgh resource.
30-60 mins
SIGN Guideline 88 – Management of suspected bacterial urinary tract infection in adults
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This is a comprehensive guideline, published in July 2006, which details evidence-based recommendations regarding diagnosis and management of urinary infections. It provides very detailed information, and can take time to get through, but it does offer clear and simple algorithms as a summary. These can be used at a glance in only a few minutes and... read more
30-60 mins
Urinary tract infection – females (NHS-CKS)
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A resource, aimed at Primary Care, which details the current evidence-based guidelines for the diagnosis and treatment of urinary tract infection in female patients. The site is concise, easy to negotiate and there is also important emphasis based on the difference in guidance for male patients, catheter associated urinary infection, suspected pyelonephritis, and pregnancy.

Urinary tract obstruction

10-30 mins
Urinary Tract Obstruction (Medscape)
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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. Important as a numerically very important and treatable cause of both acute and chronic renal failure.

Less than 10 mins
Glomerulonephritis primer (Edren textbook)
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A simple introduction to glomerulonephritis with links to further resources, from the Edren textbook. Declaration of interest: an Edinburgh resource
2 hours
Glomerulonephritis (Edinburgh)
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Text or lectures on glomerulonephritis. A bit on background principles suitable for students or doctors, but the individual diseases are pitched at Postgraduate level. The online lecture format requires Flash. Declaration of interest: one of our resources.... read more

Tubulointerstitial diseases

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

Less than 10 mins
Interstitial nephritis (Edinburgh)
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10 min lecture on interstitial nephritis (causes, acute, chronic). Requires Flash. Declaration of interest: one of ours. 'Gratifyingly short' (a reviewer). A short older version without commentary but script and a quiz on 6 case histories with intrinsic renal disease is also available.

Inherited diseases

10-30 mins
Cleveland Clinic – Interactive case on Autosomal dominant polycystic kidney disease
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This resource, provided by the Cleveland Clinic, provides an overview of the diagnosis and management of ADPKD. The module can be done with or without registration, which is free. A review article from the Cleveland Clinic Journal of Medicine is also available as a pdf for further reading upon completion of the module. The format is interesting, co... read more
Inherited renal disease (Edren textbook)
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A very simple introduction with links to more info
30-60 mins
rarerenal.org
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www.rarerenal.org is developing invaluable information on a whole list of uncommon renal disorders, mostly genetic. It is also the entry point to UK Rare Renal Disease Registers. Its pages collate info and links to external info sources of which some key C/C+ ones (in case your disease isn't there yet) are: GeneReviews (NCBI) OMIM (NCBI) ... read more
2 hours
Inherited Kidney Diseases: Patient.co.uk
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This independent resource offers patient information, but also provides up to date evidence-based information for medical professionals. The detail can be variable, but the section on Inherited Kidney Diseases provides a broad overview of the subject, with individual links to the more common conditions such as Alport's and Autosomal dominant polycy... read more

Systemic disorders, infections and malignancy

30-60 mins
Management of multiple myeloma from CCO
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Gives an excellent advanced update on myeloma management that is very useful for the nephrologist. CCO requires free registration, quick and easy and open to all. Other resources linked.... read more
10-30 mins
HIV nephropathy resource from CCO
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CCO InPractice provides outstanding HIV resources, and this is a very good and relatively concise summary of renal issues. Skip the introductory first half of this page if you are a nephrologist; start at Differential Diagnosis of kidney disease in the HIV infected person. Also available as a smartphone app which is invaluable if you are pract... read more

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.

2 hours
AKI tutorials (Kidn-E from e-LfH)
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(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. It uses... read more
30-60 mins
Acute renal failure (Medscape)
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This open-access article is content-rich (long) but rather theoretical rather than practical, yet glosses over uncertainties around pathogenesis etc. 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 section, ... read more
30-60 mins
AKI cases – tutorial from Edinburgh
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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. Covers a good range of causes and questions.... read more
AKI – Scottish Intensive Care Society module (part 1)
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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)

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
30-60 mins
CKD guideline (British Columbia)
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Quite detailed with 2,500 words and over 40 references, so includes justification and sources. Carefully thought through and written. Proteinuria criteria loosely defined or very low threshold.
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
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. It is presented as their original Q, you are given an opportunity to think, then the expert answer can be revealed. Growing number of cases; and links to supporting resources for learning or reference, including ar... read more
2 hours
CKD: a course for primary care (UK; BRS)
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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
CKD (National Kidney disease education programme)
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This website provides educational material targeted at both health professional and patients. A lot of reliable info, nicely presented. The most useful bit for professionals may be the CKD info. Some useful Q+A for patients. There are also a number of provider education videos (doctors speaking to patients) on a number of topics from ho... read more
30-60 mins
The UK eCKD Guide
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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. It's pretty good for quickly learning prioritisation and approach. Its referral criteria are UK-specific and assume a high standard of primary care - thoug... read more

Fluid and Electrolyte abnormalities

30-60 mins
Acid base tutorial and 6 cases (Edinburgh)
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Starts with How To Approach, then gives you 6 cases to work through. Declaration of interest: It's Edinburgh's again.
10-30 mins
Hyponatraemia – two interactive cases
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Two very nicely produced cases from Mitch Halperin and Razeen Davids
30-60 mins
Tufts: acid base notes
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These open-access lecture notes series provide notes on an introduction to acid base disorders, metabolic acidosis and metabolic alkalosis. They are very clearly laid out and start from 1st principles as well as giving some clinical examples. They would benefit from further clinical examples with worked solutions.
10-30 mins
Water and electrolyte handling (BartterSite)
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This website is aimed at providing information for patients with tubular disorders, but does include this tutorial - a good introduction to water and electrolyte handling by the kidney.
Acid Base Tutorial (U Connecticut)
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University of Connecticut have produces this nice, interactive step through ABG learning resource with a section showing clinical cases.

Dialysis

Haemodialysis

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
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.
10-30 mins
Examination of the AV fistula (YouTube video)
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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.
2 hours
Fistula First
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An outstanding resource for physicians and surgeons caring for haemodialysis patients. It presents practical guidance to creation, cannulation of fistulas; recognition of complications of fistulas and CV catheters. There are videos and practical guidance for patients and all grades of staff, though finding exactly what you want on the site take... read more

Peritoneal dialysis

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
Longer than 4 hours
Peritoneal Dialysis Academy
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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
10-30 mins
PD (mykidney, Guy’s Hosp)
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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. Complications of pregnancy can cause renal diseases, and pregnancy may influence pre-existing diseases (e.g. autoimmune diseases) that may affect the kidney.

30-60 mins
Hypertension in Pregnancy (NHS)
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Excellent, well-presented and readable recommendations with evidence, not specifically renal. Tip-top first read for trainees or update for experienced clinicians. From the very good NHS Clinical Knowledge Summaries series. It is presented as a series of scenarios. It is best to 'View full scenario' from the outset. ... read more
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. Good on physiology. Then a list of possible complications without clear introduction. 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. Even non-specialist pathologists tend to run away from analysing renal biopsies.

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. 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 histo... read more
30-60 mins
Renal Pathology from NDT Educational
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This is a good series of disease-based studies illustrating the features of each. Authored by Drs Franco Ferrario and Maria Pia Rastaldi (Milan). Images 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 and visit... read more
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. There is a useful account of the history of transplant immunology and HLA testing though coverage of the latest test... read more
10-30 mins
Photo-library of pathology (University of Tokushima)
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A good many nice quality photomicrographs, but without any explanation. 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
10-30 mins
Pathology of Infections of the genitourinary tract
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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. In other sections of this site he goes through other organ systems too; a valuable resource for any specialty. Created in 2003, not apparently updated, but it's... read more
2 hours
Atlas of Renal Pathology (AJKD)
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The AJKD Atlas of Renal Pathology comes mostly from Agnes Fogo (Vanderbilt). It is very good indeed, and covers 55 diagnoses with excellent downloadable images and explanation. 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
30-60 mins
Renal pathology from the Pathology Guy
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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. There is a good range and it is a very useful overview though. The rest of the Pathology Guy's website is quite extraordinary, try not to spend too many ... read more
30-60 mins
Iowa virtual microscopy
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Realistic virtual recreation of the experience of looking at renal biopsies through a Google map-like interface, instead of snapshots showing 'typical' lesions. 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.

Renal Fellow Network
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A website written by renal fellows for renal fellows - regularly updates with nephrology related teaching cases. Contains a wealth of clinical teaching material for trainees in the speciality. Founded by Nate Hellman, and kept up by his peers in his memory.
The Nephron Information Centre
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This eclectic, hectic, info-rich site by Houston nephrologist Stephen Fadem has all sorts of info - for patients info scroll down to tips for healthy care, and kidney resources for patients. It includes information about dialysis units, nutritional resources, discussion groups etc. It also has online calculators useful for renal disease and ge... read more
History of Nephrology Blog
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This is a nicely written and interesting site cataloging the history of various renal diseases and dialysis and transplantation.

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. Valerie Luyckx contributed to the development of the curriculum.