Renal & Electrolyte System

COURSE OBJECTIVES

Students will be able to

identify and explain the nature of abnormalities seen in Renal and Electrolyte system in relation to normal structure and functions.
Outline the principles of therapeutic and behavioural management of patient and families of renal disorder.
correlate the normal structure and functions of Renal and Electrolyte system to the signs, symptoms patho-physioiogical states, diagnosis and management of the following common conditions: burning micturition; haematuria; UTI; oedema of face and feet; acute and chronic nephritis; nephrotic syndrome; renal colic; polyuria; uraemia; gout; prostatitis;

ANATOMY

Students will be able to

list the organs of urinary system; explain the development of different organs of urinary system and the urogenital anomalies associated with their development.
define the location, gross anatomy, relations, and blood supply and lymphatic drainage of and nerve supply of kidney; explain the structures and organs related to the kidney; define renal fascia and its attachments.
explain the kidney in the coronal section.
explain the different parts of nephron and correlate conditions like nephritic syndrome with altered structures of glomerulus.
list the parts, constrictions, relations, blood supply, lymphatic drainage and innervations of the ureters; explain the microscopic anatomy of the ureter.
explain the location, gross anatomy, relations, blood supply, lymphatic drainage and innervation of urinary bladder; explain the microscopic anatomy of urinary bladder explain the mechanism of bladder evacuation
explain the gross anatomy and sphincteric control of urethra in male and female; mention the blood supply, lymphatic drainage and nerve supply of the urethra; explain the microscopic anatomy of urethra especially the lining epithelium.

CLINICAL PHYSIOLOGY

Students will be able to

describe the structure and functions of Nephron (structure of Juxta Glomerular Apparatus and its function ).
describe GFR and factors affecting it.
discuss renal handling of glucose, Sodium, Potassium, Bicarbonate, Phosphate and H ion.
describe fluid and electrolyte balance.
describe the mechanism of micturition — Nerve supply of urinary bladder, applied importance.
describe cystometrogram; urine examination — applied importance
describe Renal function tests: Examination of blood.
discuss Clearance — definition and importance of urea, creatinine and PAH Clearance.

CLINICAL BIOCHEMISTRY

Renal functions and electrolyte balance

Students will be able to

recall normal anatomy of nephron.
correlate ultrastructures with their functions.
describe the formation of urine.
describe the functions of tubules, and list threshold substances; describe absorption of glucose water, ions and urea.
describe buffer systems of plasma, interstitial fluid and cells.
state the dissociation constant of physiological organic phosphates, histidine side chain N-terminal aminogroups.
explain role of kidneys in acid base maintenance.
explain the functions of Na-K ATPase in tubules.
define GFR and clearance.
describe urea and creatinine clearance tests.
list the organic and inorganic composition of urine.

Metabolism of amino acids and none nitrogenous compounds

Students will be able to

recall essential, non-essential amino acids and their role in nutrition.
recall with diagram showing relationship of amino acids with other metabolically important biomolecules and list glucogenic and ketogenic amino acids.
recall transamination, action of glutamate dehydrogenase and amino acid oxidases.
describe the formation of urea and its regulation; explain the various abnormal conditions as consequences of defect in urea cycle enzymes.
explain hyper-ammonaemia and hepatic coma.
describe formation of creatinine and their regulation.
describe gamma glutamyl cycle and glutathione synthesis and its control,
explain the abnormalities (haematological and neurological) due to deficiency of enzymes in the gamma glutamyl cycle.

Water, sodium and potassium

Students will be able to

describe water and sodium distribution in the body.
describe the interrelationship between water, sodium and extracellular fluid and osmolality.
describe the causes of water and sodium depletion.
describe water and sodium excess.
describe the causes of hyponatraemia and hypernatraemia and their measurement.
describe the causes of hyper- and hypokalemia.

Metabolic Interrelationships

Students will be able to describe metabolic derangements in:

Starvation and over fed conditions obesity
Protein energy malnutrition (Kwasiorkor, Marasmus)
Diabetes meliitus (IDDM & NIDDM) and its complications
Pregnancy and location
Trauma
Rey’s syndrome
Cancer cachexia

Metabolic aspects of malignant diseases

Students will be able to

describe the general metabolic derangements in malignant disease.
list tumors associated with paraneoplastic syndromes and ectopic secretion of ACTH, ADH, tumors associated with hypercalcemia.
list and interpret normal and abnormal levels of following tumors marker enzymes (ALP, enolase). Carbohydrate antigens (CA-125, CA-19–9, CA-15–3)

PATHOLOGY

Students will be able to

define renal failure; explain the etiopathogenesis of acute and chronic renal failure.
define uremia and azotemia.
define and classify glomerulonephritis.
enumerate the causes of acute nephritic syndrome and nephrotic syndrome.
list the differences between nephrotic syndrome and nephritic syndrome.
explain the pathogenesis of glomerular injury.
define and explain the etiopathogenesis, enumerate the gross and microscopic features and complications of:
acute post-streptococcal glomerulonephritis
rapidly progressive glomerulonephritis
minimal change glomerulonephritis
membranous glomerulonephritis
membranoproliferative glomerulonephritis
Ig A nephropathy
define chronic glomerulonephritis and enumerate its causes and gross and microscopic features.
describe the morphology of kidney in lupus nephritis and diabetic nephropathy, define acute tubular necrosis (ATN) and list its types.
explain the etiopathogenesis and enumerate the gross and microscopic features of ischemic ATN and toxic ATN.
explain the causes and pathogenesis of chronic renal failure and describe its complications.
define pyelonephritis and enumerate its types, describe etiopathogenesis and complications of UTI.
explain the etiopathogenesis, list the gross and microscopic features and complications of acute and chronic pyelonephritis,
define nephrosclerosis and list its types.
enumerate the gross and microscopic features of benign and malignant nephrosclerosis.
define urolithiasis; list different types of urinary calculi. explain the mechanism of stone formation.
define hydronephrosis; enumerate its causes and complications. enumerate the gross and microscopic features of hydronephrosis classify the tumors of kidney.
list the etipathogenesis of tumors of kidney.
describe gross and microscopic features of renal eels carcinoma of kidney,
define Wilm’s tumor; enumerate the gross and microscopic features of Wilm s tumor.
define cystitis and enumerate its causes.
list the gross and microscopic features of acute and chronic cystitis. classify the tumors of urinary bladder.
list its predisposing factors of transitional ceil carcinoma.
list the invasive and non-invasive urothelial lesions of urinary bladder. describe the grading of neoplasms of urinary bladder.
enumerate the gross and microscopic features of papillary urothelial neoplasms and TCC bladder.

CLINICAL MICROBIOLOGY

Students will be able to

list and describe the important pathogens affecting the Renal system;
describe the morphology, pathogenesis, laboratory diagnosis, transmission & prevention of the following organisms:
Esch. coli,
Klebsiella
Proteus mirabilis
Streptococcus faecalis,
define UTI; describe laboratory diagnosis of UTI.

CLINICAL PHARMACOLOGY

Drugs used in oedema

Students will be able to

classify diuretics on the basis of their pharmacology and clinical efficacy and describe their mechanism of action, indications and adverse reactions.
list the commonly used osmotic diuretic and indications for its use.
explain why mannitol is administered only intravenously for diuresis.
explain the effects of hydrocholorothiazide on the rate of excretion of Na+, K+, CI-, HC03 and H2O; state which of these is most significantly related to the diuresis produced.
explain the effect of decreased intake and increased excretion of K+ during chronic therapy with thiazide and high ceiling diuretics.
state the choice between spironolactone and triamterone in the presence of high plasma aldosterone and low plasma aldosterone.

Drugs used in urinary tract diseases

Students will be able to

define the objectives of treatment of urinary tract infection.
list the agents used for urinary tract infection with their mechanism of action and adverse reactions.
list the drugs contraindicated in urinary tract infection in pregnancy.

Drugs used in treatment of disturbances of fluid and electrolytes and acid base balance

Students will be able to

define the objectives of treatment of fluid-electrolyte and acid-base disturbances.
list different types of clinical disturbance of volume and osmolality.
explain the objectives of management of these disturbances.
list the different types of clinical disturbances of acid base balance.

Common renal problems

Students will be able to

use drugs for common renal problems, e.g., glomerulonephritis, nephritic syndrome and renal failure.
list the drugs to be cautiously used in renal failure.