Urinary

• Position, surface anatomy and coverings of the kidneys in the retroperitoneum (the space behind the peritoneal lining of the abdomen).
• Internal renal architecture: cortex (outer layer), medulla (inner part), pyramids (cone-shaped sections of medulla), calyces (cup-shaped spaces that collect urine) and the collecting system.
• The renal arterial tree, venous drainage and the lymphatic and autonomic supply.
• Anatomy of the ureters, bladder and urethra, with the clinically important constrictions and sphincters.

2. Development of the Urinary System

• Understand urinary system embryology (development in the embryo) from the intermediate mesoderm (the middle layer of the early embryo): the progression from pronephros to mesonephros to metanephros (three successive embryonic kidneys, the last becoming the permanent kidney)
• Describe how the ureteric bud (the outgrowth that forms the collecting system) and the metanephric mesenchyme (the tissue that forms the nephrons) interact to drive formation of the nephrons and collecting system
• Explain ascent and rotation of kidneys and blood supply changes during development
• Outline how the cloaca (the common embryonic chamber for the gut and urinary tract) is divided into the urogenital sinus (which gives rise to the bladder and urethra) and the anorectal canal (the future rectum and upper anal canal)
• Recognise congenital anomalies: renal agenesis (a kidney fails to form), horseshoe kidney (the two kidneys are joined across the midline, usually at the lower end), duplex ureter (a doubled ureter draining one kidney) and vesicoureteral reflux (urine flows back from the bladder towards the kidney)
• Correlate embryological defects with clinical presentations and imaging findings in neonates (newborn babies)

3. The Nephron

• Understand the role of the nephron within the kidney
• Be aware of the anatomical segments of the nephron and each of their basic functions within the filtering process of the kidney

• The three-layer glomerular filtration barrier and the Starling forces (the pressures that push fluid out of a capillary and hold it in) that drive filtration.
• Filtration fraction (the proportion of plasma entering the kidney that is filtered) and the role of afferent vs efferent arteriolar tone (how constricted the small arteries carrying blood into and out of the glomerulus are) in setting glomerular pressure.
• Segment-by-segment tubular reabsorption: proximal convoluted tubule (PCT), loop of Henle (the hairpin-shaped segment), distal convoluted tubule (DCT) and collecting duct.
• Tubular secretion via the organic anion and cation transporters (carrier proteins for negatively and positively charged molecules) and its role in drug clearance.

5. Control of Plasma Volume

• Understand the components of extracellular fluid (all body fluid outside the cells, including plasma) and their effect on plasma concentrations and diffusion
• Understand some of the mechanisms by which the kidneys help to regulate blood pressure
• Be aware of the transporters within each section of the kidney nephron and their roles within homeostasis
• Be aware of how drugs such as diuretics can target these transporters and how they can be used to treat patients

6. Control of Plasma Osmolarity

• Understand how the body controls plasma osmolarity
• Understand the role of the hypothalamus, pituitary gland and antidiuretic hormone (ADH) in the control of plasma osmolarity
• Understand the effect of ADH on the collecting ducts of the kidney
• Understand the medullary counter-current mechanism (fluid flowing in opposite directions in the medulla builds a salt gradient that lets the kidney concentrate urine) for sensitively controlling the reabsorption of water
• Understand some of the things that can go wrong with controlling plasma osmolarity

7. Control of Potassium

• Understand potassium’s essential cellular roles: volume, pH, enzymes, excitability, cardiac function.
• Explain internal balance: rapid shifts of potassium (K⁺) between intracellular (inside the cells) and extracellular (outside the cells) compartments.
• Describe external (renal) balance: long-term potassium control via nephron reabsorption and secretion.
• Identify factors influencing cellular K⁺ uptake: insulin, aldosterone (a hormone from the adrenal glands), catecholamines (hormones such as adrenaline) and acid-base status.
• Outline mechanisms regulating renal K⁺ secretion in distal nephron regions.
• Recognise clinical features and management strategies of hypokalaemia and hyperkalaemia (low and high blood potassium).

8. Micturition

• Understand the phases of micturition (urination)
• Understand the neural mechanisms that regulate these phases
• Understand some of the pathophysiology (how disease disturbs normal function) that can affect micturition and why certain neurological conditions can present with urinary symptoms

9. Diuretics

• Understand the mechanisms by which different diuretics reduce sodium and water reabsorption.
• Identify uses and side effects of loop, thiazide (for example bendroflumethiazide), potassium-sparing, osmotic, and carbonic anhydrase inhibitor diuretics (which block the enzyme carbonic anhydrase, for example acetazolamide).
• Recognise which diuretics cause hypokalaemia (loops, thiazides) versus hyperkalaemia (amiloride and spironolactone, which are potassium-sparing diuretics).
• Understand clinical indications like hypertension, oedema, heart failure, hypercalcaemia, glaucoma, and cerebral oedema.

10. Glomerular Filtration Rate and the Measurement of Kidney Function

• Understand what the Glomerular Filtration Rate (GFR) is: the volume of fluid the kidneys filter from the blood each minute
• Understand how GFR is estimated for patients (eGFR, calculated from a blood creatinine test) and why it matters
• Understand the purpose of urinalysis (testing a urine sample, for example with a dipstick)
• Be aware of urodynamic studies (tests that measure how well the bladder and urethra store and release urine) and what they involve

• Definition of hyponatraemia (a low blood sodium concentration), severity grading, and the importance of acute vs chronic timing.
• The two-step diagnostic approach: plasma tonicity first, then volume status (whether the body is dry, normal or overloaded with fluid).
• Major aetiologies (causes) including the syndrome of inappropriate antidiuretic hormone secretion (SIADH), heart failure, cirrhosis and adrenal insufficiency.
• Principles of safe correction and the rationale for the ceiling on how fast blood sodium may rise: 10 mmol/L (millimoles per litre) in the first 24 hours.

12. Urinary Incontinence

• Define urinary incontinence and distinguish types (stress, urge, mixed).
• Identify key risk factors contributing to urinary incontinence.
• Understand pathophysiology behind stress and urge incontinence.
• Describe conservative management strategies (lifestyle, and pelvic floor exercises for the muscles that support the bladder and bowel).
• Explain when and why surgical or pharmacological treatments are appropriate.

13. Glomerular Disease

• Define glomerular disease and differentiate nephritic syndrome (inflamed glomeruli, with blood in the urine) from nephrotic syndrome (heavy protein loss in the urine, with swelling).
• Recognise underlying pathophysiology of key glomerulopathies (diseases of the glomeruli), e.g., IgA nephropathy (kidney damage from IgA antibody deposits) and anti-glomerular basement membrane (anti-GBM) disease, also known as Goodpasture’s.
• Describe major clinical features: haematuria (blood in the urine), proteinuria (protein in the urine), oedema, hypertension.
• Explain diagnostic approach: urine tests, renal biopsy, serology (blood tests for antibodies) and complement levels (blood levels of complement proteins, part of the immune system).
• Understand basic management principles including immunosuppression (drugs that damp down the immune system) and supportive care strategies.

14. Diabetic Nephropathy

• Understand the pathophysiology of diabetic nephropathy (kidney damage caused by diabetes)
• Understand how diabetes can cause nephrotic syndrome (heavy protein loss in the urine, with swelling)
• Be aware of the signs and symptoms of diabetic nephropathy
• Know the risk factors for developing diabetic nephropathy in a person with diabetes

15. Acute Kidney Injury

• Define AKI and identify prerenal (before the kidney), intrinsic (within the kidney) and postrenal (after the kidney) categories.
• Recognise key risk factors and early clinical indicators of AKI.
• Use the KDIGO (Kidney Disease: Improving Global Outcomes) or RIFLE (Risk, Injury, Failure, Loss, End stage renal disease) criteria to diagnose and stage AKI.
• Interpret lab findings, including serum creatinine, urine output and the fractional excretion of sodium (FeNa, the proportion of filtered sodium passed in the urine), for AKI assessment.
• Apply a structured differential diagnosis and diagnostic approach (urine, imaging, biopsy).
• Understand management principles: treat the cause, fluid balance, nephrotoxins (substances that damage the kidney), and renal replacement therapy.

16. Chronic Kidney Disease

• Define CKD as abnormal kidney function or structure (for example a reduced GFR, or protein in the urine) that has been present for more than three months.
• Recognise main causes, such as diabetes, hypertension, glomerulonephritis (inflammation of the glomeruli), tubular injury, infection and idiopathic disease (no cause found).
• Understand CKD staging and histological changes (seen under the microscope) like fibrosis, sclerotic glomeruli (scarred, hardened glomeruli), inflammation, arterial thickening.
• Learn diagnostic investigations to assess cause, severity, and complications of CKD.
• Explore management strategies: slow progression, control hypertension, proteinuria, diabetes, and treat key complications.

17. Urinary Tract Obstruction

• Understand the causes of urinary tract obstruction
• Be aware of specific conditions that can cause urinary tract obstruction, and how they do so
• Understand the different types of urinary retention (being unable to empty the bladder fully, or at all) and their presentations
• Be aware of the complications of urinary retention and the related syndromes, such as post-obstructive diuresis (a large rise in urine output after a blockage is relieved) and obstructive uropathy (damage caused by blocked urine flow)

• Definitions and classification of UTI: lower vs upper, uncomplicated vs complicated.
• Microbiology and pathogenesis, including the dominance of uropathogenic (able to cause urinary tract infection) Escherichia coli (E. coli).
• Investigation principles, including the urine dipstick (a strip test) and the midstream urine (MSU) sample sent for culture, and when each is useful.
• Antibiotic management of uncomplicated cystitis, pyelonephritis (kidney infection), and special situations (pregnancy, children, catheter-associated and recurrent infection).

19. Prostate Pathology

• Understand prostate zones and their relevance to disease localisation.
• Recognise histological (microscopic) differences between benign prostatic hyperplasia and prostate adenocarcinoma (cancer arising from gland cells).
• Describe Gleason grading (a score of how abnormal the cancer cells look) and its prognostic implications for prostate cancer.
• Identify high-grade prostatic intraepithelial neoplasia (PIN; abnormal cells lining the prostate ducts) as a premalignant lesion (a change that can lead to cancer).
• Appreciate types of inflammation, such as granulomatous prostatitis (inflammation with clumps of immune cells), that can look like cancer.

20. Male Urological Conditions

• Describe the causes and management of phimosis (a tight foreskin that cannot be pulled back) and paraphimosis (a retracted foreskin that cannot be returned).
• Recognise key features of epididymo-orchitis and differentiate it from testicular torsion.
• Understand the urgency and treatment of testicular torsion.
• Identify the clinical presentation of a varicocele (enlarged veins in the scrotum) and its potential impact on fertility.
• Know when urgent referral to a urologist (a doctor who specialises in the urinary tract and male genital organs) is required.
• Understand the typical age and presentation pattern of each condition.

21. Urological Malignancy

• Define urological malignancies and recognise renal cell and transitional cell carcinomas.
• Identify key risk factors and classic presentation signs such as haematuria.
• Understand investigations and management approaches for renal cell carcinoma.
• Describe urothelial (previously called transitional cell) carcinoma of the bladder, including risk factors, symptoms, investigations, and treatment.
• Appreciate the overall importance of haematuria as a diagnostic clue in urological cancer.