Renal

Total Contact Hours:

41 hours

Course Director:

Larry J. Ream, Ph.D., Associate Professor of Neuroscience, Cell Biology and Physiology

Course Description:

This course focuses on the role of the renal system in maintaining homeostasis of the human body, and how acute and chronic diseases impact its functioning. Through presentation, problem sets, team-based learning, and case discussions, the student solves acid/base balance problems, recognizes the signs and symptoms of renal disease, and relates the impact of renal disease on the other organ systems.

Course Objectives & Integration with the Educational Objectives:

By the conclusion of this course, the student will demonstrate an understanding of:

K1 Normal structure and function of the kidneys, including the ability to:

• Discuss the organ structure of the kidneys, ureters, bladder, and urethra
• Compare the size of the main fluid compartments, and describe renal mechanisms in body fluid homeostasis (e.g., state the principle of the indicator-dilution technique and indicators used for measuring TBW, ECF, and plasma space)
• Describe glomerular filtration, GFR, and renal blood flow
• State the pressure profile in the renal vascular bed, and explain the Starling forces of glomerular capillaries
• Describe tubular reabsorption and secretion, including tubular transport processes (e.g., isomotic water transport, solute transport mechanisms, Na⁺/H⁺ exchangers, bicarbonate transport, glucose reabsorption, amino acids and phosphate reabsorption, and transport of weak acids and bases)
• State the most important ion transport mechanisms for the different nephron segments, and identify which nephron segments have high and low water permeability
• Compare the permeabilities of the descending and ascending thin limbs
• Explain the importance of countercurrent exchange in the vasa recta
• Describe urinary concentration and reabsorption
• Describe various renal mechanisms in acid-base balance and body fluid homeostasis
• Describe the renal control of sodium and potassium balance along the nephron
• Describe the basic processes involved in renal metabolism and oxygen consumption
• Discuss the hormones produced by the kidneys and the hormones that act on the kidneys, especially ADH
• State the renin-angiotensin system, including the actions of angiotensin II
• Compare water diuresis and natriuresis, and state the mechanism of action for furosemide, thiazide, and amiloride

K2 Abnormal structure and function of the kidneys, including the ability to:

• Describe congenital anomalies of the kidneys, including autosomal dominant and autosomal recessive polycystic kidney disease
• Describe inflammatory and immunologic disorders of the glomerulus, including acute and progressive glomerulonephritis, nephrotic syndrome, minimal change disease, IgA nephropathy, and Alport's syndrome
• Describe glomerular diseases associated with systemic disease, including lupus erythematosus, Henoch-Schoenlein purpura, diabetes, bacterial endocarditis, and amyloidosis
• Describe diseases affecting the renal tubules and renal interstitium, including acute tubular necrosis, pyelonephritis, interstitial nephritis, multiple myeloma, and urate neuropathy
• Describe vascular disorders of the kidneys, including nephrosclerosis, renal artery stenosis, and hemolytic-uremic syndrome
• Describe traumatic and mechanical disorders, including obstructive uropathy
• Describe the four types of renal calculi
• Describe neoplastic disorders, including papillary adenoma, angiomyolipoma, fibroma, and oncocytoma, and metastases, including renal cell carcinoma and Wilms tumor
• Describe congenital anomalies, non-neoplastic lesions, and neoplastic disorders of the ureters
• Describe congenital anomalies, cystitis, bladder outlet obstruction, and neoplastic disorders of the urinary bladder
• Describe congenital anomalies, inflammatory conditions, and neoplastic disorders of the urethra

K3 The action, use, and adverse effects of diuretics, including the ability to:

• List the major indications for diuretic use
• List the classes of various diuretic drugs and state an example (generic name) in each class
• Describe the mechanisms of action by which each of the types of diuretics achieve their pharmacological effect
• Name the sites of diuretic actions
• Describe toxicities of each of the diuretic groups
• Recall what acetazolamide is and how it is used today
• Recall the relevant pharmacokinetics of thiazides and thiazide-like diuretics
• Compare and contrast loop diuretics and thiazide diuretics
• Name the diuretics that increase potassium secretion
• Recall how osmotic diuretics are used
• Name several of the common drug-drug interactions involving diuretics

K4 How to formulate a recommendation regarding starting hemodialysis (when given a clinical case scenario), including the ability to:

• Identify factors in the patient that would preclude offering hemodialysis
• Identify health system issues that would preclude or prevent offering the patient hemodialysis
• Based on the principles of weighing the patient's cogno-affective, social, and belief characteristics, identify patient characteristics that would preclude or prevent offering the patient hemodialysis
• Regarding starting a new treatment, identify any professional value conflicts within the scenario that would preclude or prevent offering the patient hemodialysis

K5 Disease treatment and prevention, including the ability to:

• Recognize the distinctive clinical presentation of acute post-streptococcal glomerulonephritis, acute rheumatic fever, and hemolytic uremic syndrome
• Understand the utilization of a problem list to formulate a differential diagnosis
• Understand the workup and evaluation of the pediatric patient with hematuria

C1 Work effectively in teams in the team-based learning module: the microscopic examination of urine sediment

C2 Work effectively in the three case-based clinical learning modules, in the evidence-based medicine workshop, and in the integrated clinical session

P1 Convey professionalism by:

• Being punctual and attending required events
• Completing assignments in a timely fashion
• Being truthful
• Being courteous to staff, colleagues, faculty, and other health professionals
• Demonstrating scholarship in the form of contributing to a positive learning environment, collaborating with colleagues, and performing self-assessment and self-directed learning

Learning Activities:

Presentations, team-based learning, laboratory exercise.

Assessment:

One MCQ exam, team-based learning.