THE URINARY SYSTEM MODULE - kaukau.edu.sa/files/140/subjects/9941_urinary_module_-_january_2009[1].pdf · 4 Gross anatomy of upper and lower urinary tract Anatomy 5 Histology / Embryology

THE URINARY

SYSTEM MODULE

Study Guide

Faculty of Medicine

King Abdulaziz University

Phase II, MBBS

2008

TABLE OF CONTENTS

Topic

Page

THE OUTCOMES OF THE UNDERGRADUATE CURRICULUM 4

CURRICULUM MAP 5

PHASE 2 6

STRUCTURE OF THE MODULE 6

INTRODUCTION 7

AIMS & OBJECTIVES 7

TEACHERS CONTACTS 8

ASSESSMENT 9

ICONS 11

TOPIC OUTLINES 12

NO. LECTURES

Page

1 Anatomy of the kidney, ureter, urinary bladder and urethra

2 Development of the kidney, ureter, urinary bladder and urethra.

3 Introduction to renal physiology.

4 Histology of the kidney, ureter, urinary bladder and urethra.

5 Congenital anomalies of the kidney, ureter, urinary bladder and urethra.

6 Renal blood flow and its control

7 Renal function: Glomerular filtration and its control.

8 Renal regulation of acid-base balance

9 Renal function: Tubular processing of the glomerular filtrate ,tubular

reabsorption and tubular secretion

10 Regulation of tubular functions

11 The concept of renal plasma clearance

12 Assessment of renal function

13 Control of sodium and water balance: Regulation of plasma volume and

osmolarity

King Abdulaziz University Faculty of Medicine

The Urinary System Module Page 3 of 79

14 Urine composition and renal stones

15 Medical aspects of proteinuria and haematuria

16 Glomeular Diseases I

17 Glomerular Diseases II

18 Metabolic function of the kidney

19 Renal Tubular and Interstitial Pathology

20 Defence mechanisms of the urinary tract and urinary tract infection

21 Pathology of Renal Vascular System

22 Diabetic nephropathy

23 Pathological aspects of tumours of kidney & urinary tract

24 Clinical aspects of tumours of the urinary tract

25 Mechanisms of formation of concentrated & diluted urine

26 Principles of diuretic therapy.

27 Introduction to acute renal failure

28 Radiological aspects of obstructive uropathy

29 Physiology of Micturition

30 Surgical aspects of hematuria

31 Case studies related to urinary calcium excretion and renal stones analysis.

NO PRACTICAL

1 Examination of prosections of urinary tract anatomy.

2 Radiological imaging techniques, e.g. x-rays, IVPs.

3 Analysis of random and 24-hour urine sample.

4 Nuclear imaging in renal diseases including renal haemodynamics.

5 Blood gas analysis.

6 The anatomy of the lower urinary tract.

7 Diagnosis, investigation and treatment of UTI.

8 Demonstration of haemodialysis, peritoneal dialysis.

9 Pathology of renal disease 1.

10 Pathology of renal disease 2.

11 The anatomy of the lower urinary tract.

12 Investigation of CRF / ARF



Problem-Based Learning (PBL) Sessions

PBL case

Tutorials:

Number Title Department

1 Case studies in diuretic use Pharmacology

2 (i) Problems on acid-base balance (ii) the anion gap. Clinical Biochemistry

3 Bacteruria in extremes of age, pregnancy, and in catheterized patients Microbiology

4 Gross anatomy of upper and lower urinary tract Anatomy

5 Histology / Embryology of upper and lower urinary tract Histology/Embryology

6 Pathology of the urinary system. Pathology

Clinical Presentations:

Number Title Department Lecturer

Male Female

1 Case studies in chronic renal failure. Medicine S. Shohaib F. Beladi

2 Case studies in acute renal failure. Pediatrics Salah Mourshidy J. Kari

Self-Directed Learning:

Number Title Department Lecturer

Male Female

1 i. urinary organic acid excretion ii. the concept of fractional

excretion of solutes

Clinical Biochemistry A.Abdulrafae A. Elgharib

2 Cystic Diseases of the Kidney Pathology G. Mokhtar O.Nassif



OUTCOMES OF THE MEDICAL UNDERGRADUATE

CURRICULUM

1) Knowledge

Graduate should have sufficient knowledge and understanding of:

a. The normal structure, function and development of the human body and interaction between body and mind

b. The normal pregnancy and child birth, the principles of antenatal and postnatal care

c. The aetiology, pathogenesis, clinical presentation, natural history and prognosis of common physical and mental disease, particular those which pose

acute danger to function, life or the community.

d. Common diagnostic tests and procedures, their uses, limitations and costs e. The management of common conditions including pharmacological,

psychological, physical and nutritional therapy

f. The principles of health education, disease prevention, rehabilitation and the care of the suffering and dying.

g. The principles and ethics related to health care and the Islamic and legal responsibilities of the medical profession

2) Skills

Graduate should acquire the skills of

a. Take a tactful, accurate and organised medical history b. Perform a gentle and accurate physical and mental examination c. Integrate history and physical examination to reach a provisional diagnosis of

differential diagnosis

d. Select the most appropriate and cost effective diagnostic procedures e. Formulate a management plan f. Counsel patients and families clearly regarding diagnostic and therapeutic

procedures before eliciting consent

g. Perform common life-saving procedures h. Use information resources to obtain further knowledge and interpret medical

evidence critically and scientifically

i. Communicate clearly and considerately with other health professionals

3) Attitudes

Graduate should have the attitude of

a. Respect for every human being and abide by relevant Islamic ethics b. A desire to ease pain and suffering c. Willingness to work in a team with other health professionals d. Responsibility to remain a life-long learner and maintain the highest ethical

and professional standards

e. Referring patients to other health professional when needed f. A realization that it is not always in the interest of patients to pursue every

diagnostic or therapeutic possibility



CURRICULUM MAP

YOU ARE HERE…

Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Internship

Phase I Phase II Phase III

Phase 2 is the stage towards achieving the objectives specified in the curriculum. The aim is

to implement full-time integrated study of the MBBS program. This phase will include

knowledge, skills and attitudes, particularly attitudes toward the learning process. The

curriculum philosophy in Phase 2 is enforcing the development of a mixture of teaching

approaches. By the end of Phase 2, you should be ready for phase 3 of the learning process.



PHASE II

SECOND YEAR

III- SEMESTER IV - SEMESTER

Foundation Course Musculoskeletal System

General Anatomy Cardiovascular System

Cells and Tissues Respiratory System

Embryology Renal and Urinary System

Biochemical Basis of Medicine Immune, Blood, lymphatic System

Pathology Basic Emergency Care

Islamic Studies (1) Islamic Studies (2)

TIMETABLED HOURS:

TEACHING

DEPARTMENTS:

31 Lectures, 12 Practicals

Anatomy, Clinical Biochemistry, Embryology,

Histology, Medicine, Microbiology, Nuclear Medicine,

Pathology, Pediatric, Pediatric Nephrology,

Pharmacology, Physiology, Radiology, Urology

STRUCTURE OF THE MODULE



INTRODUCTION

WELCOME to the urinary module. This course aims to introduce you to the anatomy,

physiology, biochemistry and pathology of the urinary system and the different common

diseases that affect the system.

AIMS & OBJECTIVES

AIMS:

The aims of this module is to:

Acquire sufficient knowledge of the macroscopic and microscopic structure of the urinary tract in order to understand normal function and common clinical

abnormalities.

Acquire skills and working knowledge and understanding of the principles and concepts applicable to the Urinary System, in general.

Appreciate the role of the kidney in controlling the volume and composition of body fluid and the way in which they respond to departures from normal parameters of

volume, electrolyte concentration and systemic haemodynamics.

Understand renal cellular function in order to appreciate the basis of relevant therapeutics.

Describe normal micturition, the reasons of oliguria, and such common conditions as glomerulonephritis, pyelonephritis, urinary tract infection, haematuria, proteinuria,

and chronic renal failure.



OBJECTIVES:

By the end of this module, the student should be able to:

Outline the structure and relations of the kidney, ureters, bladder and urethra in the

male and the female, and the ways in which these structures may be imaged and

examined

Identify and describe the fluid compartments of the body, their electrolyte

composition, and state the normal concentrations of major electrolytes in extracellular

fluid, blood and urine.

Describe the histological structure of the kidney, and identify the component parts of

the nephron

Identify and describe the structure of the glomerulus and the process of glomerular

ultrafiltration, the processes underlying the formation of dilute and concentrated urine

Describe renal responses to extracellular fluid volume depletion and other common

alterations in systematic haemodynamics.

Understand the mechanisms of controlling sodium and potassium balance

Understand the role of the kidney in maintaining acid base balance, and interpret

uncomplicated cases of acid base disturbances

Identify and describe the classes of diuretics and their mode of action

Describe the bladder and control of micrurition

Describe common pathological changes in the urinary tract, including

glomerulonephritis, pyelonephritis, neoplasia, and prostate enlargement.

Describe and demonstrate the features, consequences, and management of acute and

chronic renal failure.



TEACHERS CONTACTS

Name

Department

E-mail

Prof. Mohammed Badawoud Coordinator [email protected]

Prof. Jameela Kari Coordinator [email protected]

Prof. Adil Abdelrafee Clinical

Biochemistry [email protected]

Prof. M. M. Rawas Radiology [email protected]

Dr. Fatma Albiladi Medicine

[email protected]

Dr. "Sawsan Jalalah Pathology [email protected]

Dr. Khaled Ezam Physiology [email protected]

Prof. Mai abdulalim Pharmacology [email protected]

Dr. Ahmed Saiad Urology [email protected]

mailto:[email protected]:[email protected]:[email protected]



ASSESSMENT

METHODS OF ASSESSMENT

Type of exam:

a) Written: 40% of total marks

b) Practical: 20% of total marks

c) Course work & continuous assessment: 40% of total marks

I. Written Exam:

This will be used as a method of assessment for the final exam.

Total time: 2 hours.

Contributing departments: all departments involved in the teaching of the module.

Types of questions:

o MCQs

II. Practical Exam:

This will be used as a method of assessment for the final exam.

Total time: 2 hours.

Contributing departments: Anatomy, Biochemistry and Pathology.

Types of questions:

o Spotting (50% of total exam mark):

With MCQs (pathology)

Without MCQs (anatomy).

o OSPE (50% of total exam mark).

Time given for each type of question:

o Spotting:

With MCQs: 2 minutes

Without MCQs: 45 seconds

o OSPE (50% of total exam mark): 5 minutes per station

NB: Biochemistry practical exam questions should be given the time for 3 stations (15 minutes) as the student

is usually asked to run an experiment.



III. Course work and continuous assessment:

This will be used as a method of assessment throughout the course during

tutorials.

Contributing departments: all departments involved in the teaching of the module.

Types of questions:

o MCQs

o Assignments: oral presentations or written research projects, one per

student per module (this will be left for each department to be designed as

appropriate).



Assessment Tools

Exams: Written Exams will include short answer and multiple choice questions (MCQs).

They will cover material presented in lecture, readings, and discussion. All exams must be

taken on the date scheduled. In case of an emergency, the coordinator must be notified. No

make-up exams will be provided if you fail to notify and discuss your situation with the

coordinator. Practical Exam will be in an OSPE (Objective Structured Practical Exam)

format, where you will pass through several stations representing all the subjects.

Assignment paper: The purpose of the work is to provide you with the opportunity to

explore an area of basic medical sciences or medical education in depth. The paper is to be a

10-15 page literature review of the topic will constitute 20% of your final grade. Policy:

Topics must be approved in writing by the coordinator. Directions for topic submission will

be discussed during the first week of class. Topics that have not been approved will not be

accepted.

All papers must reference a minimum of eight references from refereed journals. All papers

must be typed, double-spaced, have 1 inch margins.

Note: We will be making the journey from "womb to tomb" in weeks. Therefore, this

course requires an intensive coursework load. Class attendance and participation are

extremely important to your learning and as such are considered in the evaluation of your

course grade. This course is recommended for students that can make the required time and

energy commitment. If there is anything that the coordinator can do to assist you during the

course, please feel free to contact him.



Icons (standards)

The following icons have been used to help you identify the various experiences

you will be exposed to.

Learning objectives

Content of the lecture

Independent learning from textbooks

Independent learning from the CD-ROM. The computer cluster is in the 2

nd floor of the medical library, building

No. 7.

Independent learning from the Internet

Problem-Based Learning

Self- Assessment (the answer to self-assessment exercises will be discussed in tutorial sessions)

The main concepts



Topic Outlines



Lecture 1: Anatomy of the kidney, ureter, urinary bladder and urethra.

Department: Anatomy

Lecturer: Dr. H.Saleh &prof. Amira Elhaggagy

At the end of the lecture you should be able to:

1) Learning the anatomy of the kidney, ureter, urinary bladder and urethra.

1. Structure, site, arterial supply, nerve

supply, venous drainage, lymphatic

drainage and relations of the kidney.

2. Site, arterial supply, nerve supply, venous drainage, lymphatic drainage and

relations of the ureter.

3. Site, arterial supply, nerve supply, venous drainage, lymphatic drainage and

relations of the urinary bladder and

urethra.

Clinical anatomy for medical students (R Snell).

Student Notes:

.

(Insert here handouts and additional

pages for notes if needed)



Lecture 2: Development of the kidney, ureter, urinary bladder and urethra.

Department: Anatomy

Lecturer: Dr. M. Abdulwahab & Dr. H.Saleh


1) Learning the development of the kidney, ureter, urinary bladder and urethra.

2) Learning the Congenital anomalies of the kidney, ureter, urinary bladder and urethra.

Development of pronephros, mesonephros, metanephros.

Development of Cloaca, urogenital sinus, anal canal.

Langman’s medical embryology.

Student Notes:

.





Lecture 3:

Introduction to renal physiology.

Department: Physiology

Lecturer: Dr. H. Al-Kadi and Dr. K. Ezam


1. Describe the different functions of the kidney

and its role in homeostasis.

2. Describe the different parts of the nephron. 3. Distinguish between the 2 different types of

nephrons.

4. State the physiological significance of the juxtaglomerular apparatus.

Role of the kidney in homeostasis, as its role in water and electrolytes balance, regulation

of plasma volume, and acid-base balance.

Other functions of the kidney including excretory, endocrine and metabolic

functions.

Description of the functional unit of the kidney (nephron).

The differences between cortical and juxtamedullary nephrons.

The structure of the glomerular membrane (filtration barrier).

The JGA and its physiological significance.

One major function of the kidney is to

regulate excretion of substances at a rate that

exactly balances their input into the body

and, thereby, maintain total body

homeostatic balance for many substances.

A second major function of the kidney is to regulate blood volume, blood osmolarity, and

total body sodium in a way that determines

average blood pressure.

Student Notes:

.





Continue … Lecture 3: Introduction to renal physiology …

1) Vander’s Renal Physiology. Eaton D.C. and Pooler J.P. 6

th edition (2004), Lange

Medical Books/ McGraw-Hill Medical

Publishing Division.

2) Human Physiology from cells to systems. Sherwood L. 6

th edition (2007), Thomson

Brooks/Cole.

3) Review of Medical Physiology. Ganong W.F., 22

nd edition (2005), Lange Medical

Books/ McGraw-Hill Medical Publishing

Division.

4) Textbook of Medical Physiology. Guyton A.C. and Hall J.E., 11

th edition (2006),

Elsevier Saunders.

Interactive Physiology 9 - system suite (version

1.0) - Urinary system (Bnjamin Cummings),

ISBN 0-8053-6126-X.

http://www2.kumc.edu/ki/physiology/index.htm

http://www.kidneypatientguide.org.uk/site/HDanim.

html

Knowing the normal functions of the kidney, name 3

problems a patient with renal failure may suffer

from?

Student Notes: .

http://www2.kumc.edu/ki/physiology/index.htmhttp://www.kidneypatientguide.org.uk/site/HDanim.htmlhttp://www.kidneypatientguide.org.uk/site/HDanim.html



Lecture 4: Histology of the kidney, ureter, urinary bladder and urethra.

Department: Anatomy

Lecturer: Dr. R.Hamdi & Dr. S.Al-Sagaaf


1) Learning the histological structure of the kidney, ureter, urinary bladder and urethra.

1. The histological structure of the kidney

(capsule, cortex, medulla, cortical

labynith, renal corpuscles, glomerulus

and juxtraglomerular apparatus).

2. The histological structure of the ureter (different layers of the wall).

3. The histological structure of the urinary bladder and the urethra (different layers

of the wall).

Color text book of histology (Gartner L.P. and

Hiatt J.L.)

Student Notes:

.





Lecture 5: Congenital anomalies of the kidney, ureter, urinary bladder and urethra.

Department: Anatomy

Lecturer: Dr. Dr. M. Abdulwahab & Dr. H.Saleh


1) Learning the Congenital anomalies of the kidney, ureter, urinary bladder and urethra.

Langman’s medical embryology.

Student Notes:

.





Lecture 6:

Renal blood flow and its control.




1) Define renal blood flow (RBF), renal plasma flow (RPF), and filtration fraction and give

normal values for each.

2) Define autoregulation of RBF and describe the mechanisms underlying autoregulation.

3) How does the sympathetic nervous system influence RBF?

4) Which hormones regulate renal blood flow?

Definition and normal values for renal blood

flow (RBF), renal plasma flow (RPF), and

filtration fraction.

The relation between flow, pressure and vascular resistance in an organ.

Definition of autoregulation of RBF and its adaptive value.

Mechanisms of autoregulation: the myogenic and tubuloglomerular feedback.

The direct effects of the renal sympathetic nerves on renal arterioles and how these

influence RBF.

The reflexes that cause renal sympathetic nerve activity to increase and the adaptive

value of this increase.

The different vasoconstrictor and vasodilator hormones and locally acting vasoactive

substances that influence RBF.

RBF is much higher than required for

metabolic needs and is regulated for

functional reasons, not metabolic demands.

Student Notes:

.





Continue … Lecture 6: Renal blood flow …







Brooks/Cole.




Division.


th edition (2006),

Elsevier Saunders.



ISBN 0-8053-6126-X.

http://www.uhmc.sunysb.edu/internalmed/nephro/w

ebpages/Part_A.htm

Explain why the administration of nonsteroidal anti-

inflammatory drugs is not recommended for patients

with severe reductions in GFR and RBF.

Student Notes: .



Lecture 7:

Renal function: Glomerular filtration and its control.




1. Define the basic renal processes that result in

urine formation.

2. Explain how glomerular filtrate is formed.

3. Describe the composition of the glomerular

filtrate.

4. State the main determinants of solute

filterability.

6. Define glomerular filtration rate (GFR) and

state its normal value.

7. Predict the forces involved in glomerular

filtration.

8. List the direct determinants of GFR and the

factors that influence them.

The basic renal processes that result in urine formation: glomerular filtration, tubular

reabsorption, and tubular secretion.

Formation of the glomerular filtrate, and forces that favor filtration and those that

oppose filtration.

The composition of the glomerular filtrate and the factors that determine molecule

filterability (molecular size and electrical

charge).

Definition of GFR, its normal value and the formula for the determinants of GFR

(filtration coefficient x net filtration

pressure).

How arterial pressure, afferent and efferent arteriolar resistances determine glomerular

capillary pressure.

What factors may affect Bowman's capsule hydrostatic pressure and plasma colloid

osmotic pressure.

How mesangial cells might alter filtration coefficient.

Student Notes:

.





GFR varies with the net filtration pressure (NFP)

and capillary filtration coefficient.







Brooks/Cole.




Division.


th edition (2006),

Elsevier Saunders.



ISBN 0-8053-6126-X.

http://www.uhmc.sunysb.edu/internalmed/nephro/w

ebpages/Part_A.htm

A drug was noted to cause a decrease in GFR.

Identify 4 possible actions of the drug that might

decrease GFR.



Lecture 8: Renal regulation of acid-base balance. Regulation of potassium balance.

Department: Clinical Biochemistry

Lecturer: Prof. A.Abdulrafae & A. Elgharib


1) Describe the role of the kidneys in regulating extracellular fluid pH.

2) Describe the renal regulation of potassium.

The sources of hydrogen ion gain and loss.

Renal handling of bicarbonate.

Addition of new bicarbonate by the kidneys.

Renal handling of hydrogen-ion.

Control of hydrogen ion secretion by the renal tubules.

Urine buffers.

Proximal tubular production of ammonium ion from glutamine.

Excretion of ammonium ion in urine (addition of new bicarbonate to the blood).

Renal handling of potassium ion (reabsorption and secretion).

Factors affecting potassium excretion: plasma potassium level, aldosterone, and

acid-base balance.

Student Notes: .

(Insert here handouts and additional pages

for notes if needed)



Lecture 9:

Renal function: Tubular processing of the glomerular filtrate: tubular

reabsorption and tubular secretion.




1. Define the renal processes: Tubular

reabsorption & tubular secretion.

2. Define transport maximum (Tm), renal plasma

threshold and splay.

3. Describe the mode of reabsorption of different

substances (e.g. Na+, K

+, Cl

-, glucose, urea,

and water).

4. Describe the mode of secretion of different

substances (e.g. K+, H

+ and organic ions).

Definition of the tubular processes: tubular

reabsorption and tubular secretion.

The different transport mechanisms (active and passive) across the tubular cells.

Definition of transport maximum (Tm), renal plasma threshold, and splay.

The cellular mechanisms for the transport of inorganic ions e.g. sodium, chloride,

potassium, H+, calcium and phosphate ions

by the major tubular segments.

The cellular mechanisms for the transport of organic solutes (e.g. glucose, amino acids,

urea, creatinine, drugs) by the major tubular

segments.

The cellular mechanisms for the transport of water by the major tubular segments.

The reabsorption of water and almost all

solutes is linked, directly or indirectly to the

active reabsorption of sodium.

Student Notes: .





Continue … Lecture 9: Renal function: Tubular processing of the glomerular

filtrate: tubular reabsorption and tubular secretion.







Brooks/Cole.




Division.


th edition (2006),

Elsevier Saunders.



ISBN 0-8053-6126-X.

http://www.spcollege.edu/spg/science/lancraft/bsc20

86/content/worksheets/bal_reabsecretion.pdf

If the plasma concentration of substance X is 200

mg/100 ml and the GFR is 125 ml/min, the

filtered load of this substance is---------------------.

If the Tm for substance X is 200 mg/min, how

much of the substance will be reabsorbed at a

plasma concentration of 200 mg/100ml and a

GFR of 125 ml/min?--------------------------. How

much of substance X will be excreted?-------------

---------.

Student Notes: .



Lecture 10:

Regulation of tubular functions


Lecturer: Dr. K. Ezam and Al-Kadi


1) To describe the nervous mechanisms that regulates tubular function (renal sympathetic

nerves. 2) To describe the hormonal mechanisms that

regulate tubular function: a) Renin-angiotensin system.

b) Aldosterone.

c) Atrial natriuretic peptides.

d) Antidiuretic hormone.

e) Parathyroid hormone.

There are multiple local, nervous, and hormonal

control mechanisms that regulate tubular functions.

An important feature of tubular reabsorption is that

the reabsorption of some solutes can be regulated

independently of others especially through hormonal

control.

All the physiological controls in the proximal

nephron affect the excretion of sodium and water

together, whereas the actions of aldosterone and

ADH in the distal nephron regulate sodium and

water excretion independently.

Student Notes: .





Continue … Lecture 10: Regulation of tubular functions







Brooks/Cole.




Division.


th edition (2006),

Elsevier Saunders.



ISBN 0-8053-6126-X.

http://www.spcollege.edu/spg/science/lancraft/bsc20

86/content/worksheets/bal_hormonecontrol.pdf

1. Conn’s syndrome is an endocrine disorder brought about by a tumor of the adrenal

cortex that secretes excessive aldosterone in

uncontrolled fashion. Based on what you

know about the function of aldosterone,

LIST 3 prominent features of this condition.

2. What are the major renal sites of action of the following hormones?

a. Aldosterone b. ADH c. Renin d. Noradrenaline e. Angiotensin II

Student Notes: .



Lecture 11: The Concept of Renal Plasma Clearance


Lecturer: Dr. H. Al-Kadi & K. Ezam


1. Define the term "renal plasma clearance". 2. Use the clearance equation and an appropriate

compound to estimate glomerular filtration rate

and renal plasma flow.

3. Distinguish between the use of inulin and creatinine as measure of GFR.

4. Given the plasma and urine concentrations and the urine flow rate, calculate the clearance of

any given substance.

5. Predicts whether a substance undergoes net reabsorption or net secretion by comparison of

its clearance to that inulin.

Definition of the term clearance.

The clinical use of clearance and significance of GFR measurement.

The criteria that must be met for a substance in order for its clearance to be

used as a measure of GFR.

Substances that are used to measure GFR and RBF.

Data required for clearance calculation of any substance.

Use of renal clearance to predict the renal handling of any substance (net

reabsorption or net secretion).

Student Notes:

.





Inulin clearance is used to measure GFR

because inulin is freely filtered and neither

secreted nor reabsorbed.

Creatinine clearance is used as a practical estimate of GFR.

PAH clearance is used as a practical estimate of RBF.







Brooks/Cole.




Division.


th edition (2006),

Elsevier Saunders.

http://glencoe.mcgraw-

hill.com/sites/9834092339/student_view0/chapter50/r

enal_clearance.html

List in order of decreasing renal clearance, the

following substances: glucose, urea, sodium,

inulin, creatinine, PAH.



Lecture 12: Assessment of renal function




1) Utilize the knowledge gained from anatomy and physiology in assessment of renal

function.

2) Identify the laboratory procedures used to evaluate glomerular filtration , tubular

reabsorption and secretion, and renal blood

flow

3) Discuss the advantages and disadvantages in using urea, inulin, creatinine, beta²

microglobulin, and radionucleotides to

measure glomerular filtration

4) Given hypotet laboratory data, calculate a creatinine clearance and determine wither the

result is normal.

5) Discuss the clinical significance of the creatinine clearance test

6) Define osmolarity and discuss its relationship to urine concentration

7) Given hypotet laboratory data, calculate a free- water clearance and interprete the result

8) Given hypotet laboratory data, calculate a PAH clearance and relate this result to renal

blood flow.

9) Describe the relationship of urinary ammonia and titratable acidity to the production

Student Notes: .

(Insert here handouts and additional pages for

notes if needed)



Continue … Lecture 12: Assessment of renal …

Glomerular filtration tests Clearance test : creatinine, insulin, B²

microglobulins

Calculation, examples and clinical

significance

Tubular reabsorption test: Osmolarity, osmolality and osmometers and

clinical significance

Free water excretion: calculation and clinical

significance

Tubular secretion and renal blood flow test: PAH test, Titrable acidity and urinary

ammonia.

Glomerular filtration tests Clearance test : creatinine, insulin, B²

microglobulins

Calculation, examples and clinical

significance

Tubular reabsorption test: Osmolarity, osmolality and osmometers and

clinical significance

Free water excretion: calculation and clinical

significance

Tubular secretion and renal blood flow test: PAH test, Titrable acidity and urinary ammonia.

WELL'S Biochemical basis of medicine

Student Notes: .



Lecture 13: Control of sodium and water balance: Regulation of plasma

volume and osmolarity.


Lecturer: Dr. H. Al-Kadi & K.Ezam


1) Describes the renal mechanisms for sodium regulation:

a) Regulation of amount filtered.

b) Regulation of amount reabsorbed.

2) Describes the renal mechanisms for water regulation:

a) Role of osmoreceptors.

b) Role of baroreceptors.

c) Thirst.

3) Describe the role of the kidney in long term regulation of ABP:

through regulating ECF volume.

role of RAAS.

Homeostasis depends on maintaining a balance

between the input and the output of all

constituents present in the ISF. Regulation of

fluid balance involves two separate components:

control of ECF volume and control of ECF

osmolarity.

The kidneys control ECF volume by

maintaining salt balance and control of ECF

osmolarity by maintaining water balance.

The kidneys maintain this balance by adjusting

the output of salt and water in the urine as

needed to compensate for variable input and

abnormal losses of these substances.

Multiple overlapping mechanisms regulate

sodium and water excretion, most are related

to blood pressure.

The kidneys are the ultimate determinant of blood pressure in the long term via their

control of ECF volume.

Student Notes: .





Continue … Lecture 13: Control of sodium and water balance: Regulation of plasma volume and osmolarity

1. Vander’s Renal Physiology. Eaton D.C. and Pooler J.P. 6




2. Human Physiology from cells to systems. Sherwood L. 6


Brooks/Cole.

3. Review of Medical Physiology. Ganong W.F., 22



Division.

4. Textbook of Medical Physiology. Guyton A.C. and Hall J.E., 11

th edition (2006),

Elsevier Saunders.



ISBN 0-8053-6126-X.

http://www.spjc.edu/spg/science/lancraft/bsc2086/co

ntent/urinary.html

If the right renal artery becomes abnormally

constricted, what will happen to renin secretion by

the right kidney and the left kidney?

Student Notes: .



Lecture 14:

Urine composition and renal stones.


Lecturer: Prof. A.Abdulrafae

Dr. A. Elgharib


1) Know the normal and abnormal constituents of urine and its clinical significance.

2) Know the types of renal stones mechanism of its formation and the role of stone

analysis inpatient management.

Urinary Composition:

Normal constituent of urine

Inorganic ions

Non-protein nitrogenous compounds: Urea ,uric acid, creatinine, amino acids,

hippuric acid and indican

No-nitrogenous organic compound

Abnormal constituents of urine

Proteins: prerenal , renal tubular disorders and postrenal proteinuria

Glucose: clinical significance, Hyperglycemia and renal associated

causes of glucosuria

Ketones and its clinical significance

Blood haematuria, hemoglobinuria and myoglobinuria

Bilirubin and its clinical significance

Urobilinogen and its clinical significance RENAL STONE: urinary crystal, type of stone

and stone analysis

Student Notes: .





Continue … Lecture 14: Urine composition …

WELL'S Biochemical basis of medicine

Student Notes: .



Lecture 15:

Medical aspects of proteinuria and haematuria

Department: Medicine

Lecturer: Dr. Fatma Albeladi or

Dr. Saad Shohaib


1) Definition of significant proteinuria and haematuria

2) Understanding the pathophysiology of proteinuria and haematuria

3) Causes of macroscopic haematuria and microscopic haematuria

4) Classification of proteinuria: non-pathological & pathological. Significant and

nephrotic range proteinuria

5) How to diagnose haematuria and its causes 6) How to diagnose proteinuria and its causes

Explain how to diagnose proteinuria and

haematuria.

Discuss the methods of urine collection for urine analysis, microscopy, 24 hours

collection of urine and urine

albumin/creatinine ratio.

Explain the causes of causes of haematuria and the concept of renal and systemic causes

as well as the upper renal tract causes and

lower renal tract causes.

How to differentiate glomerular causes from non-glomerular causes.

Discuss the causes of proteinuria and nephrotic syndrome.

Definition of nephrotic syndrome, its manifestation, indicated investigation and

complication.

Student Notes: .





Continue … Lecture 17: Medical aspects of …

Davidson: textbook of Medicine

Kumar: textbook of Medicine

Student Notes: .



Lecture 16:

Glomerular Diseases I

Department: Pathology

Lecturer: Dr. S. Jalalah and Dr. Taha


1) Discuss the pathogenesis of glomerular injury 2) Discuss the pathogenesis of Nephrotic Syndrome

and correlate with the clinical presentation

3) Identify the glomerular causes of nephrotic syndrome: Primary glomerular diseases and

systemic causes

4) Understand the pathogenesis of the primary glomerular diseases presenting with nephrotic

syndrome

5) Describe and compare the glomerular morphologic changes of these glomerular

disorders

1. Pathogenesis of glomerular injury including:

a. in situ formation of immune complexes, deposition of circulating immune complexes,

cytotoxic antibodies, cell mediated

glomerular damage, activation of alternative

component pathway

b. mediators of glomerular injury and other mechanisms of glomerular injury

2. Glomerular syndromes -- Nephrotic Syndrome -- definition & pathogenesis

3. Causes of nephrotic syndrome a. Primary glomerular diseases b. Systemic diseases

4. Pathogenesis and morphology (light microscopy, immunofluroscent and electron

microscopy findings) of:

a. minimal change disease b. membranous glomerulonephritis c. focal segmental glomrulosclerosis d. membranoproliferative

glomerulonephritis

Student Notes: .



Continue … Lecture 16: Glomerular Diseases I

Book of Basic Pathology: Kumar, Cotran,

Robbins

(Chapter 14: the kidney and its collecting system)

pp 442-451

Student Notes: .



Lecture 17: Glomerular Diseases II


Lecturer: Dr. S. Jalalah and Dr. Taha


1) Discuss the pathogenesis of Nephritic Syndrome

2) Identify the glomerular causes of nephritic syndrome: Primary glomerular diseases

and systemic causes

3) Understand the pathogenesis of the primary glomerular diseases presenting

with nephritic syndrome

4) Describe and compare the glomerular morphologic changes of these glomerular

disorders.

5) Discuss the causes, pathogenesis and morphology of chronic glomerulonephritis

1. Glomerular syndromes -- Nephritic

Syndrome -- definition & pathogenesis

2. Causes of nephritic syndrome a. Primary glomerular diseases b. Systemic diseases

3. Pathogenesis and morphology (light microscopy, immunofluroscent and

electron microscopy findings) of:

a. Acute proliferative (poststreptococcal, postinfectious) glomerulonephritis

b. Rapidly progressive (cresentic) glomerulonephritis

c. IgA nephropathy (Berger's disease) d. Hereditary nephritis (Alport

syndrome)

4. Chronic glomerulonephritis: Causes and

morphology

Student Notes: .





Continue … Lecture 17: Glomerular Diseases II …

Book of

Basic Pathology: Kumar, Cotran, Robbins


pp 451-455

Student Notes: .



Lecture 18:

Metabolic function of the kidney.




1) Discuss energy provision in the kidney

2) Understand metabolic function of the

kidney

3) Know the role of the kidney in erythropoiesis

Metabolic fuel of the kidney

Glucogenesis in kidney cortex

Ammonia production in kidney

Kidney tubular transport mechanisms

Kidney and erthropoiesis

Well's Biochemical basis of medicine

Student Notes:

.





Lecture 19: Congenital anomalies of the kidney,ureter,urinarybladder and urethra.

Department: Anatomy

Lecturer: Dr. H.Saleh &prof. Amira Elhaggagy

TEACHING LOCATION :main auditorium


1) Leaning the Congenital anomalies of the kidney, ureter , urinary bladder and urethra

1. Congenital anomalies of the kidney , ureter, urinary bladder and urethra.

Langman,s medical embryology

Student Notes:

.





Lecture 20: Defence mechanism of the urinary tract and urinary tract infection

Department: Pediatric / Nephrology

Lecturer: Prof. Jameela Kari Dr. Sharief Dousoky or Dr.Salah Murshidy


1) Incidence of UTI 2) Bacterial virulence factor and host factors

which encourage UTI

3) Clinical presentation (pyelonephritis and cystitis)

4) Method of collection of urine sample 5) How to diagnose UTI 6) Who should be investigated and with what

imaging and what follow up

7) What can be done to prevent further UTI 8) How should siblings be investigated

1) Explain how the renal tracts maintained

sterile ie regular complete bladder emptying

to wash out organisms that have ascend into

the urinary system.

2) Discuss the clinical presentation in infants and younger age and in older age

3) Discuss the difference of the method of collection of urine sample according the age

(MSU, SPA, Catheter, clean catch or bag

urine).

4) Who should be investigated radiologically and why?

5) Antibiotics role in preventing further UTI 6) Siblings of children with VUR should be

investigated and why.

Student Notes: .





Continue … Lecture 20: Defence mechanism …

Nelson: Pediatrics textbook

Transferable skills:

Identification of the presentation of UTI in

children and how to confirm the diagnosis.

Student Notes: .



Lecture 21: Pathology of Renal Vascular System


Lecturer: Dr. O.Nassif & A.Mokhtar


Discuss the effects of some systemic diseases

involving blood vessels and their complications in

the kidney

Hypertension:

1) Know the clinical classification of hypertension and its effects on the kidney

2) Discuss the pathogenesis of Benign and Malignant nephrosclerosis

3) Compare between the morphologic pattern of Benign and Malignant nephrosclerosis

and correlate with the clinical presentation

Diabetes mellitus

4) Discuss the pathogenesis of diabetic nephropathy and its complications

Thrombotic microangiopathy

5) Verify the forms of thrombotic microngipathy, and understand the

underlying pathogenesis of childhood

hemolytic uremic syndrome

Hypertension:

1. Benign nephrosclerosis: Pathogenesis & morphology

2. Malignant nephrosclerosis: Pathogenesis & morphology

Diabetes mellitus 3. Diabetic nephropathy:

Pathogenesis & morphology

Thrombotic microangiopathy 4. Thrombotic microangiopathy:

Pathogenesis & morphology

Student Notes: .





Continue … Lecture 21: Pathology of renal …

Book of



pp 461-463

(Chapter 17: the pancreas- Diabetes mellitus)

pp570-571

Student Notes: .



Lecture 23: Pathological aspects of tumours of the kidney &urinary tract


Lecturer: Dr. S.Jalalah and Dr.Taha


1) Classification of Kidney tumors.

2) Classification of urinary bladder tumors.

3) Discuss the pathogenesis of kidney and

bladder carcinoma.

4) Discuss the morphology of renal carcinoma,

Wilm’s tumor & bladder carcinoma.

1) Renal cell carcinoma

a. Pathogenesis: - Risk factors - Genes involved

b. Morphology: - Gross - Microscopic - Pathological variants

2) Wilm’s tumor: a. Pathogenesis b. Morphology

3) Urinary bladder carcinoma

a. Pathogenesis b. Morphology

- Gross - Microscopic - Pathological type

Student Notes: .





Continue … Lecture 23: Pathological aspects of …


(Chapter 14: The kidney and its collecting

system)

pp456-469

Student Notes: .



Lecture 24: Clinical aspects of tumours of the urinary tract

Department: Urology

Lecturer: Prof. H. A. Farsi


1) Overview of the anatomy and cell types of the upper and lower urinary tracts

2) Classifications of the tumors affecting the urinary tract

3) Clinical aspects: epidemiology, distribution, and risk factors

4) Clinical presentation of the tumors affecting the urinary tract

5) Lines of methods of diagnosis and therapeutic modalities

A brief overview of the anatomy and

cell types where the primary tumors of the

urinary tract may arise will be given. The

classification and possible origin, course, natural

history and ways of spread of the tumors of the

urinary tract are explained. The clinical aspects

including the outcome of the tumors and their

presentations are detailed along with an

introductory notes on the epidemiology,

distribution, and the possible risk factors specific

to each of the tumors of the kidney, urinary

bladder and urethra, prostate cancer, testis

tumors and penile tumors. This would include:

cigarette smoking, exposure to industrial and

other chemical products, analgesic abuse, lack of

hygiene, the presence of un-descended testis and

absent or faulty circumcision. The diagnosis and management will be based on

the clinical presentation, screening for population

at risk, physical examination, investigations

using the different tumor markers, other

laboratory tests, imaging, endoscopic and

histopathological results.

The lines of management are either conservative,

surgical, radiotherapy or chemotherapy.

Student Notes:

.





Continue … Lecture 24: Clinical aspects of …

Smith’s General Urology, Lange medical book

series

Student Notes: .



Lecture 25: Mechanisms of formation of concentrated and diluted urine


Lecturer: Dr.H. Al-Kadi, Dr. K. Ezam


1) Describe the mechanisms behind the establishment of an osmotic gradient in the

medullary interstitium.

2) Describe the countercurrent multiplication system.

3) Describe how urea contributes to the hyperosmotic renal medullary interstitium

and to the urine concentration.

4) Describe the role of vasa recta as countercurrent exchanger in maintaining the

hyperosmolarity of the renal medulla.

5) Describe how the kidneys produce dilute and concentrated urine.

The kidneys are able to excrete urine of varying

volumes and concentrations to either conserve or

eliminate water, depending on whether the body has a

water deficit or excess respectively.

The kidneys are able to produce urine that ranges in

concentration from 50 mosm\L to 1200 mosm\L by

reabsorbing variable amounts of water from the distal

portions of the tubules.

The variable reabsorption of water is made possible

by establishment of vertical osmotic gradient ranging

from 300 mosm\L to 1200 mosm\L in the interstitial

fluid of the medulla of each kidney. This vertical

gradient remains constant regardless of the fluid

balance of the body.

The existence of the medullary osmotic gradient

depends on (1) dilution by the thick ascending limb,

(2) recycling of urea, and (3) low-volume

countercurrent blood flow in the vasa recta.

Student Notes:

.

(Insert here handouts and

additional pages for notes if

needed)




th edition (2004), Lange Medical


Division.



Brooks/Cole.




Division.


th edition (2006),

Elsevier Saunders.


1.0) - Urinary system (Bnjamin Cummings), ISBN

0-8053-6126-X.

http://www.cellphys.ubc.ca/undergrad_files/urine.swf

State whether the following statements are

True or False:

a. Complete inhibition of active sodium and chloride transport by the thick ascending

limb of Henle's loop would virtually

eliminate the ability to excrete a

concentrated urine.

b. Active reabsorption of sodium and chloride by the descending thin limb of Henle's loop

is a component of the countercurrent

multiplier system.

c. Block of sodium reabsorption in the proximal tubule, loop of Henle, distal

tubule, or collecting duct will exert a

diuretic effect.

http://www.cellphys.ubc.ca/undergrad_files/urine.swf



Lecture 26: Principles of diuretic therapy

Department: Pharmacology

Lecturer: Prof. O.Hassan and Prof. Mai

Abdulaleem


1) Know the structure and function of the

nephron.

2) Understand renal handling of water, sodium

and other electrolytes.

3) Know definition and major classes of

diuretics.

4) Appreciate the main indications, and adverse

effects of each class of diuretics.

- Describe the structure and function of the nephron:

Tubular function

Acid- base balance

Potassium balance

Excretion of organic molecules

Arachidonic acid metabolites and renal function

-Appreciate different classes of diuretics: their sites

and mode of actions, classification, adverse effects

and uses in cardiac, hepatic, renal and other

conditions.

-Know possible changes of plasma electrolytes and

pH of the blood and urine caused by diuretics.

-Learn that diseases of the kidney must be taken into

account when prescribing drugs that are eliminated

by the kidney.

Student Notes:

.





Continue … Lecture 26: Principles of diuretic …

1. Rang& Dale Pharmacology .5th edition

(2003).

2. Katzung Basic and clinical

Pharmacology. 9th

edition (2004).

3. Clinical Pharmacology Bennett and

Brown. 9th

edition (2003).

4. Lippencott’s Illustrated Reviews

Pharmacology.3rd edition (2006).

Student Notes: .



Lecture 27: Introduction to acute renal failure (ARF)

Department: Medicine

Lecturer: Dr. Fatma Albeladi or

Dr. Saad Shohaib


Definition of ARF

Understanding the causes of CRF as pre-

renal causes, renal causes and post renal

causes

Clinical presentation

Electrolyte disturbances

Investigations required to diagnose ARF

and it's underlying cause

The lecture will cover acute renal failure from the

clinical aspect. Discussion of the pathophysiology

of underlying causes and explains the causes as

pre-renal, renal and post-renal.

Clinical presentation of pre-renal, renal and post-

renal ARF. Discuss the investigations, particularly

hyperkalemia and metabolic acidosis. Give brief

idea about the management and the importance of

fluid intake adjustment according the cause if it is

pre-renal (give fluid) or renal (restrict fluid).

Student Notes:

.





Lecture 28: Radiological aspects of obstructive uropathy.

Department: Anatomy / Radiology

Lecturer: Prof. Rawas


1) Congenital anomalies anatomy

2) Congenital anomalies Radiologic diagnosis

3) Normal variants anatomy

4) Normal variants Radiologic appearance

1) Anatomical appearance and embryologic

background of congenital anomalies

2) Radiologic diagnosis by different modalities

3) Normal variants appearance and explanation

4) Normal variants appearance by radiologic

modalities to distinguish them diseases.

Student Notes:

.





Lecture 29: Physiology of Micturition


Lecturer: Dr. H. Al-Kadi and Dr.K. Ezam


Describe the functional anatomy and innervation of the urinary bladder and its sphincters.

Describe the relation between intravesical pressure and volume of urine in the bladder.

Describe the micturition reflex.

Describe the role of higher centers in the control of micturition.

The functional anatomy of the urinary bladder.

Autonomic supply of the urinary bladder.

Components of the micturition reflex.

Supraspinal facilitation or inhibition of micturition

by the brain.

Micturition is fundamentally a spinal reflex facilitated

and inhibited by higher brain centers,

Contraction of the circular muscle, which is called the

detrusor muscle, is mainly responsible for emptying

the bladder during micturition.

Student Notes:

.



needed)



Continue... Lecture 29: Physiology of Micturition.



Brooks/Cole.

2) Review of Medical Physiology. Ganong W.F., 22nd edition (2005), Lange Medical Books/ McGraw-

Hill Medical Publishing Division.


th edition (2006), Elsevier

Saunders.

Interactive Physiology 9 - system suite (version 1.0) -

Urinary system (Bnjamin Cummings), ISBN 0-8053-

6126-X.

http://highered.mcgraw-

hill.com/sites/0072495855/student_view0/chapter27/anima

tion__micturition_reflex.html

An accident victim suffers permanent damage of the

lower spinal cord and is paralyzed from the waist

down. Which of the following is true:

a. He can no longer voluntarily control micturition.

b. Bladder emptying will be controlled completely by

micturition reflex.

c. Both are true.

Student Notes:

.



needed)

http://highered.mcgraw-hill.com/sites/0072495855/student_view0/chapter27/animation__micturition_reflex.htmlhttp://highered.mcgraw-hill.com/sites/0072495855/student_view0/chapter27/animation__micturition_reflex.htmlhttp://highered.mcgraw-hill.com/sites/0072495855/student_view0/chapter27/animation__micturition_reflex.html



Lecture 30 :

Surgical aspects of hematuria

Department: Urology

Lecturer: Prof. H. A. Mosli


1) Etiological (pathological) classification 2) The true and false hematuria 3) Laboratory classification: gross and

microscopic hematuria and their clinical

significance

4) Pain as a lateralizing sign 5) Clinical: initial, terminal and total

hematuria in relation to voiding

The etiological or pathological classification

includes causes of hematuria classifies hematuria as

congenital due to congenital anomalies of the

kidneys or the urinary tract, traumatic hematuria,

neoplatsic hematuria, inflammatory, metabolic and

toxic etiologies. True hematuria is defined as the

presence of blood or RBCs in the urine as verified

by dipstick or microscopic examination. False

hematuria is defined and recognized as the presence

of red dye but absence of RBCs in urine. The causes

of red discoloration of the urine will be given. The

importance of gross hematuria as an alarming sign to

the patient and the doctors sheds the light that

Documents

THE URINARY SYSTEM MODULE - kaukau.edu.sa/files/140/subjects/9941_urinary_module_-_january_2009[1].pdf · 4 Gross anatomy of upper and lower urinary tract Anatomy 5 Histology / Embryology