THE URINARY SYSTEM MODULE -...
Transcript of THE URINARY SYSTEM MODULE -...
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THE URINARY
SYSTEM MODULE
Study Guide
Faculty of Medicine
King Abdulaziz University
Phase II, MBBS
2008
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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
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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
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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
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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
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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.
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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
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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.
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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.
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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
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]
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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.
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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).
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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.
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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
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Topic Outlines
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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)
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Lecture 2: Development of the kidney, ureter, urinary bladder and urethra.
Department: Anatomy
Lecturer: Dr. M. Abdulwahab & Dr. H.Saleh
At the end of the lecture you should be able to:
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:
.
(Insert here handouts and additional
pages for notes if needed)
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Lecture 3:
Introduction to renal physiology.
Department: Physiology
Lecturer: Dr. H. Al-Kadi and Dr. K. Ezam
At the end of the lecture you should be able to:
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:
.
(Insert here handouts and additional
pages for notes if needed)
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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
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Lecture 4: Histology of the kidney, ureter, urinary bladder and urethra.
Department: Anatomy
Lecturer: Dr. R.Hamdi & Dr. S.Al-Sagaaf
At the end of the lecture you should be able to:
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:
.
(Insert here handouts and additional
pages for notes if needed)
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Lecture 5: Congenital anomalies of the kidney, ureter, urinary bladder and urethra.
Department: Anatomy
Lecturer: Dr. Dr. M. Abdulwahab & Dr. H.Saleh
At the end of the lecture you should be able to:
1) Learning the Congenital anomalies of the kidney, ureter, urinary bladder and urethra.
Langman’s medical embryology.
Student Notes:
.
(Insert here handouts and additional
pages for notes if needed)
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Lecture 6:
Renal blood flow and its control.
Department: Physiology
Lecturer: Dr. H. Al-Kadi and Dr. K. Ezam
At the end of the lecture you should be able to:
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:
.
(Insert here handouts and additional
pages for notes if needed)
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Continue … Lecture 6: Renal blood flow …
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://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: .
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Lecture 7:
Renal function: Glomerular filtration and its control.
Department: Physiology
Lecturer: Dr. H. Al-Kadi and Dr. K. Ezam
At the end of the lecture you should be able to:
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:
.
(Insert here handouts and additional
pages for notes if needed)
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GFR varies with the net filtration pressure (NFP)
and capillary filtration coefficient.
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://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.
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Lecture 8: Renal regulation of acid-base balance. Regulation of potassium balance.
Department: Clinical Biochemistry
Lecturer: Prof. A.Abdulrafae & A. Elgharib
At the end of the lecture you should be able to:
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)
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Lecture 9:
Renal function: Tubular processing of the glomerular filtrate: tubular
reabsorption and tubular secretion.
Department: Physiology
Lecturer: Dr. H. Al-Kadi and Dr. K. Ezam
At the end of the lecture you should be able to:
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: .
(Insert here handouts and additional pages
for notes if needed)
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Continue … Lecture 9: Renal function: Tubular processing of the glomerular
filtrate: tubular reabsorption and tubular secretion.
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://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: .
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Lecture 10:
Regulation of tubular functions
Department: Physiology
Lecturer: Dr. K. Ezam and Al-Kadi
At the end of the lecture you should be able to:
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: .
(Insert here handouts and additional pages
for notes if needed)
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Continue … Lecture 10: Regulation of tubular functions
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://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: .
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Lecture 11: The Concept of Renal Plasma Clearance
Department: Physiology
Lecturer: Dr. H. Al-Kadi & K. Ezam
At the end of the lecture you should be able to:
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:
.
(Insert here handouts and additional
pages for notes if needed)
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The Urinary System Module Page 32 of 79
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.
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.
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.
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Lecture 12: Assessment of renal function
Department: Clinical Biochemistry
Lecturer: Prof. A.Abdulrafae & A. Elgharib
At the end of the lecture you should be able to:
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)
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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: .
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Lecture 13: Control of sodium and water balance: Regulation of plasma
volume and osmolarity.
Department: Physiology
Lecturer: Dr. H. Al-Kadi & K.Ezam
At the end of the lecture you should be able to:
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: .
(Insert here handouts and additional pages
for notes if needed)
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The Urinary System Module Page 36 of 79
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
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://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: .
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Lecture 14:
Urine composition and renal stones.
Department: Clinical Biochemistry
Lecturer: Prof. A.Abdulrafae
Dr. A. Elgharib
At the end of the lecture you should be able to:
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: .
(Insert here handouts and additional pages
for notes if needed)
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Continue … Lecture 14: Urine composition …
WELL'S Biochemical basis of medicine
Student Notes: .
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Lecture 15:
Medical aspects of proteinuria and haematuria
Department: Medicine
Lecturer: Dr. Fatma Albeladi or
Dr. Saad Shohaib
At the end of the lecture you should be able to:
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: .
(Insert here handouts and additional pages
for notes if needed)
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Continue … Lecture 17: Medical aspects of …
Davidson: textbook of Medicine
Kumar: textbook of Medicine
Student Notes: .
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Lecture 16:
Glomerular Diseases I
Department: Pathology
Lecturer: Dr. S. Jalalah and Dr. Taha
At the end of the lecture you should be able to:
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: .
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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: .
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Lecture 17: Glomerular Diseases II
Department: Pathology
Lecturer: Dr. S. Jalalah and Dr. Taha
At the end of the lecture you should be able to:
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: .
(Insert here handouts and additional pages
for notes if needed)
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Continue … Lecture 17: Glomerular Diseases II …
Book of
Basic Pathology: Kumar, Cotran, Robbins
(Chapter 14: the kidney and its collecting system)
pp 451-455
Student Notes: .
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Lecture 18:
Metabolic function of the kidney.
Department: Clinical Biochemistry
Lecturer: Prof. A.Abdulrafae & A. Elgharib
At the end of the lecture you should be able to:
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:
.
(Insert here handouts and additional
pages for notes if needed)
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Lecture 19: Congenital anomalies of the kidney,ureter,urinarybladder and urethra.
Department: Anatomy
Lecturer: Dr. H.Saleh &prof. Amira Elhaggagy
TEACHING LOCATION :main auditorium
At the end of the lecture you should be able to:
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:
.
(Insert here handouts and additional
pages for notes if needed)
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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
At the end of the lecture you should be able to:
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: .
(Insert here handouts and additional pages
for notes if needed)
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The Urinary System Module Page 48 of 79
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: .
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Lecture 21: Pathology of Renal Vascular System
Department: Pathology
Lecturer: Dr. O.Nassif & A.Mokhtar
At the end of the lecture you should be able to:
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: .
(Insert here handouts and additional pages
for notes if needed)
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Continue … Lecture 21: Pathology of renal …
Book of
Basic Pathology: Kumar, Cotran, Robbins
(Chapter 14: the kidney and its collecting system)
pp 461-463
(Chapter 17: the pancreas- Diabetes mellitus)
pp570-571
Student Notes: .
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Lecture 23: Pathological aspects of tumours of the kidney &urinary tract
Department: Pathology
Lecturer: Dr. S.Jalalah and Dr.Taha
At the end of the lecture you should be able to:
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: .
(Insert here handouts and additional pages
for notes if needed)
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The Urinary System Module Page 52 of 79
Continue … Lecture 23: Pathological aspects of …
Basic Pathology: Kumar, Cotran, Robbins
(Chapter 14: The kidney and its collecting
system)
pp456-469
Student Notes: .
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The Urinary System Module Page 53 of 79
Lecture 24: Clinical aspects of tumours of the urinary tract
Department: Urology
Lecturer: Prof. H. A. Farsi
At the end of the lecture you should be able to:
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:
.
(Insert here handouts and additional
pages for notes if needed)
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The Urinary System Module Page 54 of 79
Continue … Lecture 24: Clinical aspects of …
Smith’s General Urology, Lange medical book
series
Student Notes: .
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Lecture 25: Mechanisms of formation of concentrated and diluted urine
Department: Physiology
Lecturer: Dr.H. Al-Kadi, Dr. K. Ezam
At the end of the lecture you should be able to:
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)
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King Abdulaziz University Faculty of Medicine
The Urinary System Module Page 56 of 79
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://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
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Lecture 26: Principles of diuretic therapy
Department: Pharmacology
Lecturer: Prof. O.Hassan and Prof. Mai
Abdulaleem
At the end of the lecture you should be able to:
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:
.
(Insert here handouts and additional
pages for notes if needed)
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The Urinary System Module Page 58 of 79
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: .
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Lecture 27: Introduction to acute renal failure (ARF)
Department: Medicine
Lecturer: Dr. Fatma Albeladi or
Dr. Saad Shohaib
At the end of the lecture you should be able to:
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:
.
(Insert here handouts and additional
pages for notes if needed)
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Lecture 28: Radiological aspects of obstructive uropathy.
Department: Anatomy / Radiology
Lecturer: Prof. Rawas
At the end of the lecture you should be able to:
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:
.
(Insert here handouts and additional
pages for notes if needed)
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The Urinary System Module Page 61 of 79
Lecture 29: Physiology of Micturition
Department: Physiology
Lecturer: Dr. H. Al-Kadi and Dr.K. Ezam
At the end of the lecture you should be able to:
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:
.
(Insert here handouts and
additional pages for notes if
needed)
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The Urinary System Module Page 62 of 79
Continue... Lecture 29: Physiology of Micturition.
1) Human Physiology from cells to systems. Sherwood L. 6
th edition (2007), Thomson
Brooks/Cole.
2) Review of Medical Physiology. Ganong W.F., 22nd edition (2005), Lange Medical Books/ McGraw-
Hill Medical Publishing Division.
3) 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://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:
.
(Insert here handouts and
additional pages for notes if
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
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King Abdulaziz University Faculty of Medicine
The Urinary System Module Page 63 of 79
Lecture 30 :
Surgical aspects of hematuria
Department: Urology
Lecturer: Prof. H. A. Mosli
At the end of the lecture you should be able to:
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