FNB Paediatric Nephrology: Check out NBE released curriculum

Published On 2023-02-08 09:30 GMT   |   Update On 2023-04-21 11:58 GMT

The National Board of Examinations has released the curriculum for FNB in Paediatric Nephrology.


1. Programme Goal

To provide training for pediatricians who shall provide high quality, clinical care to children with renal diseases

2. Programme Objectives

Learning Objectives

After completing the course, the student should be able to:

a. 2Analyze problems scientifically, taking into account the biological basis and epidemiology of renal diseases in children


b. Provide acute care to patients with renal diseases

c. Recognize surgically treatable conditions

d. Implement a follow-up plan for patients with chronic kidney disease including renal transplantation

e. Seek and analyze new literature in the specialty, and apply it in their work

f. Play a catalytic role in prevention of renal disorders


The fundamental components of the teaching programme should include:

1. Case presentations & discussion- once a week

2. Seminar – Once a week

3. Journal club- Once a week

4. Grand round presentation (by rotation departments and subspecialties)- once a week

5. Faculty lecture teaching- once a month

6. Clinical Audit-Once a Month

7. A poster and have one oral presentation at least once during their training period in a recognized conference.

The rounds should include bedside sessions, file rounds & documentation of case history and examination, progress notes, round discussions, investigations and management plan) interesting and difficult case unit discussions.

The training program would focus on knowledge, skills and attitudes (behavior), all essential components of education. It is being divided into theoretical, clinical and practical in all aspects of the delivery of the rehabilitative care, including methodology of research and teaching.

Theoretical: The theoretical knowledge would be imparted to the candidates through discussions, journal clubs, symposia and seminars. The students are exposed to recent advances through discussions in journal clubs. These are considered necessary in view of an inadequate exposure to the subject in the undergraduate curriculum.


Symposia: Trainees would be required to present a minimum of 20 topics based on the curriculum in a period of two years to the combined class of teachers and students. A free discussion would be encouraged in these symposia. The topics of the symposia would be given to the trainees with the dates for presentation.

Clinical: The trainee would be attached to a faculty member to be able to pick up methods of history taking, examination, prescription writing and management in rehabilitation practice.

Bedside: The trainee would work up cases, learn management of cases by discussion with faculty of the department.

Journal Clubs: This would be a weekly academic exercise. A list of suggested Journals is given towards the end of this document. The candidate would summarize and discuss the scientific article critically. A faculty member will suggest the article and moderate the discussion, with participation by other faculty members and resident doctors. The contributions made by the article in furtherance of the scientific knowledge and limitations, if any, will be highlighted.

Research: The student would carry out the research project and write a thesis/ dissertation in accordance with NBE guidelines. He/ she would also be given exposure to partake in the research projects going on in the departments to learn their planning, methodology and execution so as to learn various aspects of research.


Overview of Curriculum

During the training, satisfactory understanding and expertise should be obtained in both inpatient and outpatient environments of

• Pathophysiology of congenital & acquired diseases of the kidney and urinary tract in the growing child

• Etiology, clinical features, diagnosis and differential diagnosis of congenital & acquired renal diseases in the fetus, infant and child, their evaluation and management

• Performance/knowledge of Renal biopsy, interpretation of renal histology

• Renal ultrasound

• Techniques for the assessment of glomerular and tubular function

• Application of acute peritoneal dialysis,CAPD, CCPD, hemodialysis

• Application of CRRT and Plasma Exchange is desirable

• Use of diet and drugs for the treatment of renal diseases

• Understanding the management of surgical conditions of the urinary tract • Understanding Bladder Disfunction and Urodynamics

Curriculum Content



To understand the role, limitations and interpretation of commonly used imaging modalities

To know the practicalities and safety precautions associated with each test


To request the different radiological investigations

To be able to interpret scan images

Renal Physiology

Skills, Knowledge

 To appropriately request & interpret investigations for assessment of

a. GFR from height and plasma creatinine

b. Calcium, phosphate & bone

mineral metabolism

c. Urinary concentrating and diluting ability

d. Tubular handling of fluid and electrolytes

e. Acid-base balance

 To understand the practicalities, limitations and precautions for measurement of:

a. Creatinine clearance

b. Protein and calcium excretion

c. Tubular handling

d. Tests for urinary acidification

Renal Biopsy


To know the indications, procedure and complications


To perform a kidney biopsy safely

To recognize common histological appearances and consequences for diagnosis, prognosis and treatment

Urinary tract infection (UTI) and vesicoureteric reflux


To understand the epidemiology, clinical

features and issues in diagnosis

Role of imaging, other investigations and therapy

To understand the options/management of UTI &



To perform an MCU


Structural malformations


To know the presentations of developmental variants and abnormalities, including obstruction

To be aware of different reconstructive procedures


To be able to provide medical support to urological services

Disorders of micturition & neuropathic bladder



To know the common renal and non-renal diagnoses associated with enuresis

Understand the appropriate use of urodynamic studies and instigate management strategies


To appropriately assess a child with bladder dysfunction

To interpret Urodynamic studies



To understand the pathophysiology and etiology of macroscopic and microscopic hematuria


To be able to perform urinalysis

To demonstrate appropriate investigation and management of the child with hematuria, including role of imaging, urological assessment, renal biopsy and genetic and molecular studies



To know and differentiate between physiological and pathological causes of proteinuria

To know the methods of investigation, indications for biopsy; and management of a child with proteinuria

 Glomerular disease


To know the etiology and immunological basis of glomerulonephritis

To know the different forms of presentation and their appropriate management

To understand the clinical course and prognosis of acute and chronic glomerulonephritis

To know the indications for immunosuppressive agents, cytotoxic drugs, plasmapheresis and dialysis

Nephrotic syndrome


To know the pathophysiology of nephrotic syndrome

To understand the investigation of nephrotic syndrome including indications for renal biopsy

To know the pharmacology and side-effects of steroids, other immunosuppressive agents and other agents


To detect and manage associated complications

To manage the initial presentation of nephrotic syndrome

To manage steroid-sensitive, steroid-dependent & steroid-resistant nephrotic syndrome, including indications and choice of treatment

To be able to manage congenital nephrotic syndrome

Systemic lupus erythematosus


To understand the classification, clinical course and treatment options in lupus nephritis


To perform clinical examination, plan and interpret investigations, including histology & immunology



To know the causes, presentation, patterns of multisystem involvement and spectrum of disease

To describe the investigation and monitoring of the patient with vasculitis

To list the different therapeutic options available, including adverse effects


To be able to appropriately investigate and treat vasculitis, including use of immunosuppression

Hemolytic uremic syndrome


To understand its pathophysiology epidemiology


To know the presentation and clinical course of diarrhea-positive and atypical HUS

To understand principles of treatment, role of plasma exchange and dialysis, and long-term management

including implications for transplantation


To be able to investigate, diagnose and manage the initial presentation of HUS

Interstitial nephritis


To list causes of interstitial nephritis/ tubulointerstitial disease


To appropriately investigate and manage the child

with interstitial nephritis, including use of corticosteroids



To define & understand the diagnosis of hypertension; know the common conditions in different age groups

To describe the possible mechanisms causing essential and secondary hypertension

To describe the investigations in these cases

To describe the mechanism of action and side- effects of anti-hypertensive agents


To be able to investigate a child with hypertension

To be competent in management of

hypertensive emergencies

To be competent in the management of chronic hypertension, and in using various drugs

To interpret Ambulatory Blood Pressure monitoring



To know the etiology of renal stone formation, including underlying tubular abnormalities

To know the biochemical and radiological investigations

To understand the medical (including prevention of stones) and surgical management


To demonstrate ability to appropriately

investigate the child with renal stones

To manage the child with renal stones

Tubular disorders


To understand the causes and different presentations of primary and secondary tubular disorders

To understand the investigation of tubulopathies


To be competent in the investigation and management of tubular disorders

Cystic disease


To list the different causes of renal cystic disease in different age groups

To describe the mode of inheritance and methods of screening, including for multicystic dysplasia

To know the clinical course of polycystic kidney disease, nephronophthisis


To examine and investigate the child with renal cysts in different age groups

To manage a child with cystic kidney disease

Genetic disorders


To know the presentation and management of common inherited renal disease including renal involvement in syndromes, familial nephritis and cystic kidney disease

To understand basic genetic principles


To be able to advise parents of the risk of recurrence and the need for family screening

Fluid and electrolyte disturbances


To understand the physiology of fluid and electrolyte imbalance

To know the principles of treatment of fluid and electrolyte imbalance

To know the endocrine diseases associated with imbalance


To be able to manage fluid and electrolyte

imbalances in non-renal disease including overdose

Acute kidney injury


To know the differential diagnosis of AKI

To know the investigation including role of biopsy

To describe the methods to correct fluid/biochemical abnormalities and indications for dialysis

To know the treatment of reversible causes of AKI


To perform a reliable and accurate clinical assessment of the patient’s fluid status

To be able to appropriately manage the complications of AKI – conservative and dialysis

To be able to select and practically manage the different dialysis modalities including peritoneal dialysis, hemodialysis and hemofiltration

To be able to begin treatment of the underlying cause

To manage the patient with multiorgan failure or systemic disease requiring renal replacement therapy

Chronic kidney disease (CKD); chronic renal failure (CRF)


To know the epidemiology, causes of CKD

To know the investigations required in a child with new presentation, including assessment of the degree of renal failure and reversibility of the condition

To understand the natural history and prognosis of common diseases causing CKD, and treatment

strategies that may ameliorate the condition

To understand factors involved in failure to thrive

To describe the pathophysiology, investigation and indications for treatment in mineral bone disease

To describe the pathophysiology of renal anemia, its investigation and appropriate management


To identify/appropriately manage the underlying cause

To diagnose and treat the child with CKD including biochemical disturbance, bone disease and anemia

To appropriately counsel the family to facilitate the selection of dialysis modality and prior to referral for renal transplantation

To make an accurate assessment of nutritional status & use appropriate advice with the assistance of dietitians

To show ability to prevent, diagnose and manage mineral bone disease

(T) Transplantation



• To understand the ethical issues surrounding organ donation/ transplant; principles of recipient selection, indications and contraindications

• To know what is involved in a transplant work- up


• To know the basic surgical procedures involved  To know the medications used, including side- effects


• To know the indications for renal transplant biopsy

• To understand the immune mechanisms of rejection, know the recurrence rate of disease & complications



• To assess the suitability of a patient, discuss issues of transplantation


• To be able to manage the stable transplant patient

• To be able to advise the child, family and school




To describe the principles of hemodialysis & compare & contrast with other methods

To describe the methods of vascular access, and their complications

To list the complications occurring during dialysis


To be able to plan the initiation of hemodialysis

To manage different forms of vascular access

To adjust the prescription, manage

complications of hemodialysis


Peritoneal Dialysis


To describe the principles of acute and chronic dialysis, & the advantages/disadvantages compared to hemodialysis

To know the complications of peritoneal dialysis, both infective and mechanical


To be able to prescribe/monitor patients on dialysis

To manage the complications of peritoneal dialysis



To define principles of pharmacokinetics and drug handling in renal impairment

To list ways in which different classes of drugs act on the nephron and affect renal function

To list the effects of hemodialysis, hemofiltration and peritoneal dialysis on drug prescribing

To describe principles of drug interactions, especially immunosuppressive agents


To prescribe safely to patients with renal disease

Other areas in which knowledge is to be acquired:

• Biostatistics, Research Methodology and Clinical Epidemiology

• Ethics

• Medico legal aspects relevant to the discipline

• Health Policy issues as may be applicable to the discipline


A high standard of expertise should be obtained in performance of the following procedures:

• Urine collection including suprapubic aspiration, Urinalysis

• Renal biopsy and interpretation of histology

• Tests for assessment of glomerular and tubular functions

• Insertion of bedside Tenchkoff catheter and Venous Catheters for Dialysis

• Application of peritoneal dialysis, hemodialysis and related techniques

• Use of diet and drugs for the treatment of renal diseases

• Communication with patients


A candidate shall maintain a log book of operations (assisted / performed) during the training period, certified by the concerned post graduate teacher / Head of the department / senior consultant.

This log book shall be made available to the board of examiners for their perusal at the time of the final examination.

The log book should show evidence that the before mentioned subjects were covered (with dates and the name of teacher(s) The candidate will maintain the record of all academic activities undertaken by him/her in log book.

1. Personal profile of the candidate

2. Educational qualification/Professional data

3. Record of case histories

4. Procedures learnt

5. Record of case Demonstration/Presentations

6. Every candidate, at the time of practical examination, will be required to produce performance record (log book) containing details of the work done by him/her during the entire period of training as per requirements of the log book. It should be duly certified by the supervisor as work done by the candidate and countersigned by the administrative Head of the Institution.

7. In the absence of production of log book, the result will not be declared.


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