Syllabus
*Klinika nukleární medicíny a endokrinologie *odkaz na přednášky v Moodle - https://dl1.cuni.cz/course/view.php?id=6781 (vstup pro studenty až po zadání hesla) ----------------------------------------------------------------------------------- Syllabus of lectures and seminars of Internal Medicine II Nephrology:
1. Introduction to nephrology. History of nephrology. Kidney anatomy, nephron, loop of Henle, blood supply. Kidney physiology and pathophysiology. Hormone secretion by the kidneys: renin-angiotensin-aldosterone system, vasodilators and their significance, the kidney and vitamin D, erythropoietin. History taken in the renal patient. Physical examination in patients with the renal disease. Blood pressure and the kidney, the kidney and blood pressure. How to collect the urine for laboratory assays. Urinalysis and microscopy. The urine pH and its interpretation. Proteinuria: quantitative and qualitative classification. Erythrocyturia and hematuria: classification. Casts: typology and significance. Urine culture. The glomerular function, glomerular filtration rate, clearance methods. SNGFR - single nephron glomerular filtration rate, its clinical and pathophysiologic significance. The tubular function. The urine concentration and acidification, tubular syndromes. Ions and other substances fraction excretion and their significance. Imaging methods in nephrology. Radionuclides in nephrology. Molecular biology in nephrology. Renal biopsy. Specific clinical syndromes (asymptomatic proteinuria, the nephrotic syndrome, acute nephritic syndrome, microscopic hematuria, recurrent hematuria, hypertension, acute renal failure, chronic renal failure). Required knowledge: renal, ureter and urinary bladder anatomy and physiology; renal pathophysiology
2. Glomerulonephritis. Richard Bright, Bright´s disease. Glomerulonephritis and glomerulopathy. Glomerular capillary structure, light microscopy, electron microscopy, immunofluorescent microscopy. Size selectivity and charge selectivity of the glomerular capillary wall. Prevalence and incidence of glomerulonephritis, pathogenesis, acute serum sickness, circulating immune complexes, in situ immune complex formation, most common autoantigens of the glomerular capillary. Etiology of glomerulonephritis: bacteria, viruses, other microorganisms, tumors, drugs, ANCA, infection and glomerulonephritis. Laboratory signs of glomerulonephritis: proteinuria, erythrocyteuria and hematuria, casts, glomerular filtration rate, complement components, anti-GBM. Renal biopsy: technique, significance, complication. Urinary syndromes in glomerulonephritis (predominant proteinuria, predominant hematuria, combined proteinuria, and hematuria). Differential diagnosis of glomerulopathies according to urinary findings. Classification of glomerulonephritis: primary, secondary, systemic. Acute glomerulonephritis. Rapidly progressive glomerulonephritis: anti-GBM, pauci immune (ANCA), immune complex glomerulonephritis. Minimal change nephrotic syndrome. Focal and segmental glomerulosclerosis. Membranous, mesangial proliferative (IgA nephropathy), membranoproliferative glomerulonephritis (mesangiocapillary). Symptomatic treatment of glomerulonephritis, immunosuppressive (‘specific’) treatment of glomerulonephritis, ‘biologic’ treatment of glomerulonephritis. Pregnancy and glomerulonephritis. Transplantation and glomerulonephritis, recurrence in the graft. Required knowledge: the nephron structure; acute and chronic serum sickness; structure and physiological role of immune globulins; antiidiotopic antibodies; pathogenesis of immune mediated inflammation
3. Acute and chronic renal failure. Renal insufficiency and renal failure. Differential diagnosis between acute and chronic renal failure. Causes of acute renal failure (ARF), classification, oliguric and non-oliguric ARF. Water handling, protein handling, DNA metabolites in ARF. Ion disorders, acid-base balance disturbance in ARF. Differential diagnosis of prerenal, Reno parenchymatous and postrenal ARF. Fraction excretion of sodium and urea, sodium urine concentration, urine osmolality in ARF. Monitoring of ARF patient. ‘Pitfalls’ in patient with ARF. Treatment of ion, nitrogen, and proton disturbances in ARF. Nutrition of the patient with ARF. ARF prognosis. CVVH in treatment of ARF. Chronic renal failure (CRF) - definition, prevalence and causes, experimental models, pathogenesis, uremic ‘toxins’. Disorders of water, electrolytes, and nitrogen metabolism in CRF, acid-base balance disorders in CRF. Central and peripheral nervous system disorders, cardiac disorders, respiration system disorders, gastrointestinal system disorders, endocrine system disorders in CRF. Blood count, uremic bone disease. Pharmacological treatment of CRF. Protein and salt intake in CRF. Adjustment of drug dosage in patients with CRF. Required knowledge: renal, ureter and urinary bladder anatomy and physiology; renal pathophysiology
4. Urinary tract infections. Some other kidney diseases. Definition. Pathogenesis. Causative agents of UTI. Clinical symptomatology. Differential diagnosis. Clinical course. Predisposing factors for complicated UTI. Diagnosis. Therapeutical regiment. Required knowledge: renal, ureter and urinary bladder anatomy and physiology; renal pathophysiology
5. Fluid and electrolyte disorders. Body water content. Body fluid compartments (intracellular, extracellular, interstitial, intravascular, EABV - effective arterial blood volume. Body fluids regulation, high- and low- pressure receptors, renin a-angiotensin-aldosterone system, other hormones. Ionic composition of extra- and intracellular fluids. Ionic composition of other body fluids. Low of electroneutrality. Estimation of body fluid volumes in the organisms: history, physical exam, laboratory exam. Extracellular fluid composition in body fluid volume disturbances. Disturbances of the urine ionic composition in dehydration. Hypovolemia and hypervolemia, differential diagnosis. Dehydration - its classification. Water and sodium - osmotically inactive sodium. Hyponatremia and hypernatremia. Hypochloremia and hyperchloremia. Hypokalemia and hyperkalemia. Hypophosphatemia and hyperphosphatemia. ECG in ion composition disturbances. Commonly used substitutive solutions, their composition. Calculation of water, sodium, and bicarbonate deficit. Routinely used concentrations of substitutive solutions. Ionic content of common p.o. administered salts. Which solution to use in common disturbances of ion and water body composition. Required knowledge the role of water, sodium, potassium, calcium, phosphorus in the organism; mechanisms of water and electrolyte balance; Starling Law
6. Acid-base balance disturbances
7. Nephrotic syndrome, hypertension and kidney, urolithiasis. Nephrotic syndrome - definition, theory of edema development. Nephropathies that could cause nephrotic syndrome, differences between nephrotic and nephritic syndrome. Corticosteroids and immunosuppressive treatment used in the treatment. Hypertension and kidneys - secondary renal and renovascular hypertension, vascular nefrosclerosis. Urolithiasis - etiology, types of urolithiasis, risk factors, basic examination and treatment. Required knowledge: renal, ureter and urinary bladder anatomy and physiology; renal pathophysiology
8. Tubulointerstitial nephropathy. Definition. Histology. Pathogenesis. Trigger factors. Clinical course. Diagnosis. Therapy. Required knowledge: renal, ureter and urinary bladder anatomy and physiology; renal pathophysiology
9. Kidney disorders in diabetic patients. Dif. diagnosis of proteinuria. Definition. Epidemiology. Etiopathogenesis. Clinical course. Frequent events of acute kidney injury on diabetic kidney disease. Diabetic kidney disease screening. Definition and Classification of microalbuminuria/proteinuria. Measurement and estimation of GFR. Diagnosis of vascular nephropathy. Diabetic kidney disease therapy. Required knowledge: renal, ureter and urinary bladder anatomy and physiology; renal pathophysiology
10. Elimination methods in nephrology. Transplantation treatment. Hemodialysis, peritoneal dialysis. Renal transplant, immunosuppressive therapy. Required knowledge: renal, ureter and urinary bladder anatomy and physiology; renal pathophysiology Hematology:
10. Differential diagnosis of anemias. Short revision of clinically relevant information on hematopoiesis and basic laboratory tests in anemia diagnosis. Clinical presentation of anemias (signs and symptoms). Classifications used in differential diagnostics of anemias in clinical practice. Clinically most important types of anemia: iron deficiency anemia, anemia of chronic disease and megaloblastic anemias. Pathophysiology, differential diagnostics of causes and modern treatment of these diseases. Basic characteristics of hemolytic and aplastic anemias and principles of their diagnostic approach and treatment. Required knowledge: pathology and pathophysiology of hematopoiesis
11. Principles of hemotherapy, transfusion
12. Multiple myeloma and monoclonal gammopathies
13. CLL, myeloprolipherative and myelodysplastic syndromes. Definition, etiology, pathogenesis of chronic leukemia and myeloproliferative disorders. Laboratory and imaging methods, treatment. Required knowledge: pathology and pathophysiology of hematopoiesis
14. Differential diagnosis of lymphadenopathies. Definition, etiopathogenesis, diagnostics, clinical presentation. Required knowledge: pathology and pathophysiology of hematopoiesis
15. Disorders of coagulation. Definition, etiology, pathogenesis and clinical presentation of bleeding disorders and thrombophilia states. Laboratory and imaging methods, treatment. Required knowledge: pathology and pathophysiology of coagulation Rheumatology:
13. Diagnosis of systemic inflammatory diseases. etiology, pathogenesis, diagnostics, and therapy of systemic inflammatory dis
Annotation
Information about Internal Medicine II
The subject is composed from theoretical lectures, seminars and clinical practicals.
Practicals are run on wards of Internal Clinic.
Start of lectures and practicals is specified in time schedule.
Students may check which meeting room/ward is assigned to their class:
• SIS
• on a noticeboard on the floor 4D (in front of the secretariat of Internal clinic)