Renal and Urinary Tract Health

Renal and Urinary Tract Health (RN)

  • Conditions affecting the kidneys and urinary system are both common and often asymptomatic in their early stages. General practitioners play a crucial role in the early identification, investigation, and management of a wide spectrum of presentations; from acute kidney injury (AKI) and chronic kidney disease (CKD) to urinary tract infections (UTIs), haematuria, incontinence, nephrolithiasis (kidney stones), and more complex conditions such as glomerulonephritis or nephrotic syndrome. 

    Given the close interrelationship between renal health and chronic conditions like hypertension, diabetes, and cardiovascular disease, GPs are ideally positioned to take a proactive, preventative approach through regular screening, lifestyle counselling, and timely clinical intervention. Similarly, urinary tract health is essential across the life course - with UTIs being one of the most frequently encountered infections in primary care(1), and issues such as recurrent infections, lower urinary tract symptoms, and continence concerns requiring sensitive, structured assessment and management. 

    General practice is central to the coordination of care between patients, nephrology services, urology, and allied health professionals. This ensures continuity, comprehensive support, and person-centred care, especially when managing the long-term burden of chronic renal conditions or complex urinary presentations. Given the physical, emotional, and social impact that renal and urinary tract diseases can have (particularly when progression to end-stage kidney disease or functional impairment is a concern) clear communication, empathy, and shared decision-making are key components of effective management. 
     

    • RN1. Demonstrate competence in managing Acute Kidney Injury, understanding those at increased risk, common causes (including prerenal, renal and post renal) and indications for referral.
    • RN2. Manage chronic kidney disease (CKD) across all stages, incorporating appropriate treatment targets, screening protocols, and timely referrals to secondary care.
    • RN3. Manage common urinary tract conditions such as UTI, recurrent UTIs, incontinence, microscopic haematuria, Renal Stone Disease and Prostatic Conditions.
    • RN4. Demonstrate competence in how to approach and manage a wide range of renal and urinary tract conditions encountered in primary care.
    • RN5. Explain the clinical significance of proteinuria, including its detection, implications for kidney health and when to refer for specialist care.
    • RN6. Explain the clinical significance of haematuria, distinguishing between glomerular and non-glomerular causes and recognising red flag features and indications for referral to urology or nephrology as indicated.
    • RN7. Demonstrate safe and effective medication prescribing in the management of renal conditions, including appropriate dose adjustments or cessation based on renal function, and implement effective monitoring strategies for nephrotoxic medications to ensure patient safety.
    • RN8. Identify, assess, and manage individuals at risk of developing CKD, incorporating preventive measures and early intervention strategies to slow disease progression.
    • RN9. Provide clear communication and patient education in managing renal conditions, addressing lifestyle factors, promoting patient engagement, and considering the psychosocial impact on health outcomes.
    • RN10. Offer compassionate and sensitive care for patients with terminal renal disease, addressing their emotional, social, and palliative care needs.
    • RN11. Demonstrate a patient-centred, culturally sensitive, and inclusive approach to renal care, respecting autonomy, acknowledging diverse perspectives, and supporting informed decision-making, including the right to decline treatment.
    • RN12. Develop a basic understanding of kidney transplantation, including its impact on patients and families and the GP’s role in supporting the transplant process.
    • RN13. Effectively coordinate care for patients with renal conditions by collaborating with community services, multidisciplinary teams, and healthcare professionals to ensure optimal patient outcomes.

    For each problem or disease, consider the following areas within the general context of primary care:  

    • the natural history of the condition, including whether acute or chronic
    • the incidence and prevalence, including in different demographic groups
    • typical and atypical presentations
    • recognition of normal variations throughout life
    • risk factors, including lifestyle, socio-economic and genetic factors
    • diagnostic features and differential diagnosis
    • recognition of ‘alarm’ or ‘red flag’ features
    • appropriate and relevant investigations
    • interpretation of test results
    • management, including initial and continuing care, chronic disease monitoring and emergency care
    • patient and carer information and education
    • prognosis

    Signs, Symptoms & Presentations

    • Abdominal and Loin Masses
    • Abdominal and Loin Pain
    • Anaemia
    • Dysuria
    • Fever and Rigors
    • Haematuria
    • Lower Urinary Tract Symptoms
      • Post Micturition symptoms: Post Micturition Dribble, Sensation of incomplete emptying
      • Storage: Frequency, Nocturia, Urgency
      • Voiding Symptoms: Hesitancy, Poor Stream, Terminal Dribble
    • Oedema
    • Oliguria, Anuria and Polyuria
    • Palpable Kidneys and Bladder
    • Proteinuria
    • Pruritis
    • Recurrent Urinary Tract Infections
    • Symptoms of Vasculitis – rash and arthralgia
    • Thirst
    • Urinary Incontinence – stress, urgency and mixed
    • Urinary Retention

    Common and Important Conditions

    • Acute Kidney Injury
    • Cancer: Bladder, Kidney, Ureteric
    • Chronic Kidney Disease
    • Haematuria (visible/ nonvisible)
    • Nephrotic Syndrome
    • Overactive Bladder Syndrome
    • Polycystic Kidney Disease
    • Prostatic problems
    • Proteinuria
    • Renovascular Disease
    • Urinary Tract Infections
    • Urinary Tract Obstruction
    • Urolithiasis
  • Wherever possible learning resources included here are peer reviewed and externally maintained. This is to ensure that trainees have access to quality assured information that is kept up to date.

    Self-Directed Learning

    Blended Learning Resources (Education Platform)

    Managing and Preventing Chronic Kidney Disease in GP

    Men's Health in General Practice

    Workplace Based Learning

    During hospital rotations, trainees should take the opportunity to attend both general and specialised clinics such as those focused on chronic kidney disease (CKD), dialysis, or kidney transplant care. While the availability of these services may vary by location, most hospital posts offer opportunities to engage with patients experiencing acute kidney injury (AKI) or long-term renal impairment. Observing consultations in CKD clinics enhances your ability to monitor disease progression, interpret renal function tests, and understand the timing and criteria for referral to nephrology services. Spending time in a dialysis unit (whether observing haemodialysis or peritoneal dialysis) provides insight into the practical and emotional challenges faced by patients and equips you to better explain treatment options in primary care. Exposure to these real-world settings reinforces theoretical knowledge, improves communication with patients facing complex treatment decisions, and helps develop the collaborative approach needed to manage kidney disease across primary and secondary care.

    Day Release

    Day release sessions provide a valuable opportunity to explore renal health in a structured yet interactive environment. Through case-based discussions, guideline reviews, and peer learning, trainees can deepen their understanding of common renal issues such as acute kidney injury (AKI), chronic kidney disease (CKD), and urinary tract infections. These sessions are ideal for practising the interpretation of renal function tests, understanding staging and progression of CKD, and reviewing management strategies including blood pressure control, medication review, and when to refer to secondary care. Discussions around real patient cases can also highlight the importance of recognising reversible causes of renal dysfunction and addressing modifiable risk factors such as diabetes, hypertension, and NSAID use. By sharing local experiences and resources, trainees become more confident in supporting patients with renal conditions and engaging in collaborative care with hospital services.

    Registrar Tutorials

    Registrar tutorials offer an excellent setting for focused, personalised learning on renal health. These sessions provide an opportunity to work through real cases from your own clinical practice, such as managing deteriorating renal function, monitoring CKD, or responding to abnormal blood or urine test results. With guidance from your trainer, you can develop a structured approach to assessing renal risk, optimising treatment plans, and communicating effectively with patients about lifestyle changes, medication safety, and the implications of progressive kidney disease. Tutorials are also a great space to discuss referral criteria, review national guidelines, and explore the psychosocial impact of renal disease on patients and their families.

  • Entrustable Professional Activities (EPAs) underpin workplace-based assessment in this curriculum. Each EPA represents an integrated clinical task that General Practitioners must perform safely and independently, assessed through direct or indirect observation in real clinical settings.

    The curriculum and EPA framework are closely aligned: the curriculum defines the required knowledge, skills, and professional behaviours, while EPAs assess their application in practice. Together, they create a coherent approach to developing and demonstrating readiness for independent clinical work.

    The examples show how specific activities within general practice & chapters of the curriculum align with particular EPAs.

     EPA 9: Manage the care of adults, including older people with acute presentations

    A patient presenting with acute kidney injury secondary to dehydration provides an opportunity to demonstrate EPA 9. The trainee could invite the GP Trainer to observe the consultation and assessment, a PIP-C can be used to provide feedback on diagnostic reasoning, medication review for nephrotoxic drugs, and safe planning for monitoring or referral. A succinct case entry could be: “assessment of AKI in older adult.”

    Reflection should explore identification of prerenal, renal, and post-renal causes, risk stratification, and clear explanation of red flags warranting urgent referral.

    Core Knowledge Test (CKT)

    • Management of Urinary Tract Infection. 

    • Investigation of persistent haematuria. 

    • Management of chronic kidney disease.

    Clinical Competency Test (CCT)

    • A patient with symptoms suggestive of recurrent UTIs.
    • A male has noticed that his urine is occasionally red in colour.
    • Holistic management of a patient with a new diagnosis of Chronic Kidney Disease. 

    Disclaimer: The examples provided within this section are intended to be indicative only and are included to illustrate how elements of the curriculum may be assessed in the Clinical Competency Test (CCT).

    Examination questions in the CCT test the ability of candidates to integrate knowledge, skills, and professional behaviours across multiple curriculum areas to address the challenges posed by the question.

    The indicative content should therefore be used solely as a general guide as to some of the topics that may be introduced. Actual examination questions will assess a greater depth and complexity of understanding than the illustrative examples provided.

    Please note that a number of CCT questions will require candidates to undertake a physical examination of the simulated patient. In some circumstances, for example in the case of an intimate examination, candidates may be required to display their examination skills through use of a manikin or other device.

    1.    Overview | Urinary tract infection (lower): antimicrobial prescribing | Guidance | NICE [Internet]. NICE; 2018 [cited 2025 July 21]. Available from: https://www.nice.org.uk/guidance/ng109