| CODE | MDS1036 | ||||||||
| TITLE | Renal System | ||||||||
| UM LEVEL | 01 - Year 1 in Modular Undergraduate Course | ||||||||
| MQF LEVEL | 5 | ||||||||
| ECTS CREDITS | 5 | ||||||||
| DEPARTMENT | Faculty of Medicine and Surgery | ||||||||
| DESCRIPTION | Important aspects and fundamental concepts of normal renal function and anatomy provide the core material of the unit. In physiology, emphasis is placed on the role of the kidney in maintaining body fluid homeostasis, including acid-base balance. Lectures thus provide an overview of kidney function and body fluids, glomerular filtration, tubular processing of the filtrate, renal mechanisms for control of blood volume and osmolarity, renal regulation of potassium and calcium, and how the kidney is integrated in acid-base balance. The physiology of diuretic and ACE-inhibitor action is also looked into. From the pharmacological aspect, students are introduced to the role of the kidney in drug pharmacokinetics. Gross and histological anatomy of the upper and lower urinary tract is covered in detail, also through cadaver dissection session. Throughout, attention is given to the clinical relevance of important physiological and anatomical principles. Anatomy is linked to the clinical use of imaging of the urinary tract, from X-rays and IVPs, to ultrasound, CT scan, MRI, and radionuclide studies. Following the lectures, there are a number of Critical Thinking Sessions, based on carefully selected clinical cases on disorders of water and electrolyte balance, renal/ureteric pain, and common pathologies of the urinary tract, including tumours. These sessions are intended to stimulate the student to think and discuss critically the presented problems and to formulate basic scientific and clinical concepts. The study-unit also includes a Seminar held at the Renal Dialysis Unit (Mater Dei Hospital) wherein a renal physician will demonstrate on-site the dialysis procedure and discuss the indications for and problems associated with peritoneal and haemo-dialysis. Such knowledge supplements the information presented in the lectures and Critical Thinking Sessions. Study-Unit Aims: This study-unit provides a foundation for the clinical evaluation and management of patients with renal disease. It provides students in the biomedical sciences with an integrated approach to the study of the urinary system including the gross and microscopic anatomy, how the renal system functions in health and disease, and an introduction to laboratory tests of renal function, imaging of the urinary system and the relevant therapeutics. Learning Outcomes: 1. Knowledge & Understanding: By the end of the study-unit the student will be able to: - Correlate the structure and function of the renal system. - Describe the anatomical and physiological basis of common clinical conditions affecting the renal system. - Name the gross and microscopic features, blood supply and innervation of the upper and lower urinary tract and their clinical correlates. - Outline the surface projections and methods of clinical examination of the components of the renal tract. - Outline the development of the renal tract and how this relates to common developmental anomalies. - Discuss the physiology of body fluid compartments. Given the composition and osmolality of a fluid, identify it as hypertonic, isotonic, or hypotonic. - Explain the clearance principle and use the clearance equation to estimate the glomerular filtration rate. - Describe the factors determining glomerular filtration and its autoregulation. - Outline the transport mechanisms and renal transporters responsible for NaCl and water reabsorption by the nephron: primary and secondary active transport, facilitated diffusion, passive diffusion. - Describe the role of loop of Henle and vasa recta in production of a dilute and concentrated urine. - Discuss the major hormones (ADH, aldosterone) regulating NaCl and water reabsorption in the kidneys and their sites of action. Central and nephrogenic diabetes insipidus. - Describe the receptors involved in the monitoring of ECF volume. - Diagram the formation and generation of angiotensin II, beginning with renin. - Describe the regulation of Na+ reabsorption along the nephron, including the effects of sympathetic nerves, angiotensin II, aldosterone, and atrial natriuretic peptide. - Describe the pressure-diuresis mechanism and its role in urinary output. - Describe K+ distribution within the body, extrarenal K+ homeostasis, and the role insulin, epinephrine, and aldosterone play in the movement of K+ between intracellular and extracellular pools. - Describe the K+ shifts caused by acidosis and alkalosis, respectively. - Describe the factors that regulate K+ secretion in the collecting duct (i.e., aldosterone, plasma K+) - Provide an overview of the regulation of plasma Ca2+ by vitamin D, PTH and calcitonin, including the role of the kidney - Describe the role of buffers in maintaining pH (proteins, phosphate, bicarbonate), as well as the roles of the lungs and kidneys. Understand why the bicarbonate system the most powerful in the body. - Describe processes that lead to acid-base disturbances and list common causes. - Describe the role of the renin-angiotensin-aldosterone systems in the regulation of sodium balance and arterial pressure with emphasis on the actions of angiotensin II on renal hemodynamics and tubular transport. - Describe the molecular mechanisms of action of diuretics and ACE-inhibitors and name the primary nephron site where each class of diuretics (osmotic, carbonic anhydrase inhibitors, loop, thiazide, K+-sparing) acts. - Describe the major pathologies of the urinary tract. - Describe the basic ethical principles as applied to dialysis and organ transplantation. 2. Skills: By the end of the study-unit the student will be able to: - Identify on radiological, CT and MRI images the components of the renal system. - Identify factors that can promote renin release. - Identify which components of the filtration barrier whose damage would result in haematuria and proteinuria. - Identify factors that can promote renin release. - Identify the major sites of HCO3- reabsorption (and secretion) along the nephron, emphasizing the importance of H+ secretory mechanisms in this process. - identify simple and mixed metabolic and respiratory acid-base disturbances from blood values - apply proper imaging modality for the diagnoses of urinary tract pathologies. - Apply the principles of acid-base homeostasis to simple hypothetical clinical situations. - Interpret inulin and creatinine clearance to measure glomerular filtration in patients. - Perform urinalysis. - Identify the normal range of pH values, and the upper and lower limits compatible with life. - Interpret simple clinical cases involving the renal system (including oedematous states, glomerular diseases, renal failure, ureteric pain, and urinary tract infections) in terms of disordered anatomy and physiology and the basic drugs used to treat these conditions. - Predict the changes in glomerular filtration caused by increases or decreases in the capillary and Bowman's capsule hydrostatic and oncotic pressures. Main Text/s and any supplementary readings: Main Texts for Physiology Textbook of Medical Physiology. Ed. Guyton & Hall; Saunders. 14th Edition, 2021 Human Physiology – an Integrated Approach. Dee Unglaud Silverthorn; Pearson. 8th Edition, 2018 Main Texts for Anatomy & Histology Clinical Anatomy by Regions. Richard. S. Snell; Lippincott. 9th Edition, 2011 Clinical Anatomy by Systems. Richard. S. Snell; Lippincott. 1st Edition, 2006 Imaging Atlas of Human Anatomy, Weir, Jamie and Abrahams, Peter, 6th Edition,2020. Junqueira's Basic Histology: Text and Atlas; Young Lowe, Stevens, Heath and Deakin 16th Edition, 2021. CHURCHILL LIVINGSTONE T.W. Sadler. Langman's Medical Embryology. Edition: 14th Paperback, 2018 Main Text for Pathology Robbin’s Basic Pathology, 10th Edition. 2017. Elsevier. Main Text for Pharmacology Humphrey P. Rang, Maureen M. Dale, James M. Ritter BM, Rod Flower Pharmacology: with STUDENT CONSULT Online Access (Paperback) 7th Edition. 2011. Elsevier. |
||||||||
| ADDITIONAL NOTES | Pre-requisite Qualifications: Entry requirements of the MD Course Pre-requisite Study-units: All MD study-units are compulsory |
||||||||
| STUDY-UNIT TYPE | Lecture, Ind Study, Practicum, Seminar & Tutorial | ||||||||
| METHOD OF ASSESSMENT |
|
||||||||
| LECTURER/S | Ramona Camilleri Janet Mifsud Nikolai Pace Neville Vassallo (Co-ord.) |
||||||||
|
The University makes every effort to ensure that the published Courses Plans, Programmes of Study and Study-Unit information are complete and up-to-date at the time of publication. The University reserves the right to make changes in case errors are detected after publication.
The availability of optional units may be subject to timetabling constraints. Units not attracting a sufficient number of registrations may be withdrawn without notice. It should be noted that all the information in the description above applies to study-units available during the academic year 2024/5. It may be subject to change in subsequent years. |
|||||||||