STUDY GUIDE RENAL MODULE 2nd Professional MBBS (Session 2020-21) Prepared by: Dr Sadaf Durrani 1 CONTENTS List of Abbreviations 2 Module Planning Committee 3 Distribution of Academic Activities among different Disciplines 4 Introduction to Renal Module and Themes 5 General Learning Outcomes 6 Individual Themes 7-26 o Introduction o Learning objectives o List of Practicals o List of SGDs o List of DSL / Others o List of dissection and FDTs o Timetable (with designated teachers and venues) Books and other reading resources 27 Block Assessments 28 o MCQs o OSPE 2 LIST OF ABBREVIATIONS Anat-L Anatomy Lecture MCQs Multiple Choice Questions Anat-SGD Small Group Discussion in Anatomy Neph-L Nephrology lecture Bio-L Biochemistry Lecture Path-L Pathology Lecture Bio-P Biochemistry Practical Phar-L Pharmacology Lecture Bio-SGD Small Group Discussion in Biochemistry Phy-L Physiology Lecture CMed Community Medicine Phy-P Physiology Practical DSL Directed Self Learning Phy-SGD Small Group Discussion in Physiology FDT Film/Demonstration/Tutorial SDL Self-Directed learning FMed Forensic Medicine SAQs Short Essay Questions Histo-P Histology Practical SGD Small Group Discussion IPS Islamiyat/Pak Studies Surg-L General surgery lecture OSPE Objectively Structured Practical Examination SLRC Self Learning Resource Center Professionalism and communication skills, Research, Identity formation, Management and leadership, PRIME Ethics 3 MODULE PLANNING COMMITTEE Patron Prof. Dr. Mahmood Aurangzeb Dean, KMC Chairman Prof. Dr. Farooq Ahmed Director Medical Education, KMC Course Coordinator Prof. Dr. Ubaid ur Rahman Department of Biochemistry, KMC Module Director Associate Prof. Dr. Sadaf Durrani Department of Biochemistry, KMC Member Prof. Dr. Mudassir Ahmad Khan Chairman, Department of Biochemistry, KMC Member Prof. Dr. Qaiser Inayat Chairman, Department of Anatomy, KMC Member Prof. Dr. Naila Chairman, Department of Physiology, KMC 4 DISTRIBUTION OF ACADEMIC ACTIVITIES AMONG DIFFERENT DISCIPLINES Small Group Format Large Group Format (Batches A, B, C and D) Basic and Clinical S No Practicals Sciences SGDs/FDTs/ SDLs Lectures DSLs / Dissections LGF+ SGF Skill Lab 1 General Anatomy 04 --- --- 04/02/04 2 Histology 02 01 03 --- 3 Embryology 04 01 --- --- 4 Physiology 17 01 --- 02 5 Biochemistry 04 --- 03 02 6 General Surgery 01 --- --- 07+ 3 7 Pathology 03 8 Pharmacology 01 8 IPS 02 --- --- 9 PRIME 01 --- --- 10 Mentoring 01 Sub Totals 40 03 06 13 08 Grand Total 43 + 06 + 13+ 08=71 Total Contact Hours = 43 + (08x1.5) + (10x 02) + (7 x 01) + ((01 x 1.5) (02 x 02)) = 88 hours 5 Introduction to Renal Module Renal module is a 3 weeks’ module consisting of study of anatomy, physiology and biochemistry of the urinary (renal) system, with some of their related abnormalities. This is the fourth module of 2nd year of MBBS and will be followed by a block assessment of, GIT, Hepatobiliary & Metabolism and Renal modules, at the end of this module. The contents of the module will be taught in lectures, SGDs and DSL. Similarly, this module also contains practical work which will be described later. Renal module consists of the following themes: S No Theme Duration 1 Loin pain 1 week 2 Edema 1 week 3 Urinary Retention 1 week 6 General Learning outcomes At the end of this module, the 2nd year MBBS students will be able to: 1) Describe the anatomy of structures in posterior abdominal wall in relation to kidneys and ureter 2) Describe the development, structure, and relations blood supply and venous drainage of kidneys 3) Describe the structure, functions and regulations of nephrons and tubules 4) Describe the mechanism of formation and constituents of urine 5) Describe the acid base balance and its regulation by the kidneys and lungs 6) Describe the development, structure, functions and relations of ureters, bladder and urethra 7) Describe the concept of leadership and management 7 Theme-1 (Loin Pain) Introduction This theme is one week long consisting of study of the anatomy of the posterior abdominal wall with abdominal aorta and lumbosacral plexus, the physiological anatomy of the kidney and its functions with emphasis on the glomerular filtration and tubular transport. In this theme the biochemical aspects of the acid-base balance and imbalance will also be studied. This theme consists of lectures, practicals, dissection, SGDs, DSLs, FDTs and SDLs. Specific Learning Objectives List of Lectures Subject/ Topic S. Learning Objectives Duration in No Mintes Gross Anatomy 60 Posterior abdominal wall 1. Describe1 the general features of lumbar vertebrae 2. Describe2 the special features of lumbar vertebrae 3. Enlist3 the muscles of posterior abdominal wall. Describe their origin, insertion, nerve supply and actions 4. Explain4 the course and relations of Abdominal Aorta 5. Enumerate5 and elaborate the paired branches of abdominal aorta 6. Discuss6 the formation of inferior vena cava 7. Illustrate7 the branches and distribution of lumbosacral plexus Embryology Development of kidney and excretory 8. Enlist8 the stages of development of kidneys and 60 system excretory system Physiology Physiological Anatomy 9. State major functions of the kidneys 60 of the kidneys and Overview of its 10. Define1 the gross structures and their Functions interrelationships:0 renal pelvis, calyces, renal pyramids, renal medulla (inner and outer zones), renal cortex, papilla 11. Define1 the components of the nephron and their interrelationships:1 renal corpuscle, glomerulus, nephron, and collecting-duct system. 8 12. Draw1 the relationship between glomerulus, Bowman's2 capsule, and the proximal tubule. 13. Describe1 the 3 layers separating the lumen of the glo3 merular capillaries and Bowman's space; defines podocytes, foot processes, and slit diaphragms. 14. Define1 glomerular mesangial cells and states their functions4 and location within the glomerulus. 15. List1 the individual tubular segments in order; state the5 segments that comprise the proximal tubule, Henle's loop, and the collecting-duct system; defines principal cells and intercalated cells. 16. List1 in order the vessels through which blood flows from6 the renal artery to the renal vein; contrasts the blood supply to the cortex and the medulla; defines vasa recta and vascular bundles. 17. Describe,1 in general terms, the differences among superfi7 cial cortical, midcortical, and juxtamedullary nephrons. 18. Define1 juxtaglomerular apparatus and describes its 3 cell8 types; states the function of the granular cells. 19. Define1 the basic renal processes: glomerular filtration,9 tubular reabsorption, and tubular secretion Glomerular Filtration: 20. Describe2 how molecular size and electrical charge 60 Determinants and Equation determine0 filterability of plasma solutes; states how protein binding of a low-molecular-weight substance influences its filterability. 21. State2 the formula for the determinants of glomerular filtration1 rate, and states, in qualitative terms why the net filtration pressure is positive. 22. Define2 filtration coefficient and states how mesangial cells2 might alter the filtration coefficient; states the reason glomerular filtration rate is so large relative to filtration across other capillaries in the body. 23. Describe2 how arterial pressure, afferent arteriolar resistance,3 and efferent arteriolar resistance influence glomerular capillary pressure. 24. Describe2 how changes in renal plasma flow influence average4 glomerular capillary oncotic pressure. 25. State2 the Starling forces involved in capillary filtration.5 26. State2 how changes in each Starling force affect glomerular6 filtration rate Nervous & Hormonal Control of Renal 27. Define2 renal blood flow, renal plasma flow, 60 9 Circulation glomerular7 filtration rate, and filtration fraction, and gives normal values. 28. State2 the formula relating flow, pressure, and resistance8 in an organ. 29. Describe2 the relative resistances of the afferent arterioles9 and efferent arterioles. 30. Describe3 the effects of changes in afferent and efferent0 arteriolar resistances on renal blood flow Autoregulation of GFR and renal blood flow 31. Define3 autoregulation of renal blood flow and 60 glomerular1 filtration rate 32. Describe3 the myogenic and tubuloglomerular feedback2 mechanisms of autoregulation. Review of Transport Mechanisms across 33. Define3 and state the major characteristics of 180 the Cell Membrane diffusion,3 facilitated diffusion, primary active (Transport Maximum) transport, secondary active transport (including Reabsorption /Secretion along Different symport and antiport) and endocytosis. Parts of the Nephron 34. Describe3 the major morphological components of an epithelial4 tissue, including lumen, serosa, interstitium, apical and basolateral membranes, tight junctions, and lateral spaces. 35. State3 how the mechanisms listed in Objective 1 can be5 combined to achieve active transcellular reabsorption in epithelial tissues. 36. Define3 paracellular transport and differentiates between6 transcellular and paracellular transport. 37. Define3 osmolality and osmolarity, and states why osmolarity7 is commonly used to approximate osmolality. 38. Describe3 what is meant by the expression "water follows8 the osmoles." 39. Describe3 qualitatively the forces that determine movement9 of reabsorbed fluid from the interstitium into peritubular capillaries. 40. Compare4 the Starling forces governing glomerular filtration0 with those governing peritubular capillary absorption. 41. Compare4 and contrasts the concepts of Tm and gradient1 -limited