Renal

• Upon completion of this problem, students should be able to discuss features and causes of urinary tract infection and types and etiology of kidney stones.
• Upon completion of this problem, students should be able to explain fluid homeostasis in the human body and apply this to clinical problems, specifically how it is disrupted in nephrotic syndrome.
• Upon completion of this problem, students should be able to explain how the renin angiotensin aldosterone system impacts blood pressure homeostasis and apply these principles to the development, manifestations, and treatment of acute hypertension in a young person.
• Upon completion of this problem, students should be able to explain and apply the mechanisms which regulate blood pressure homeostasis as well as the pathophysiology and approach to essential hypertension.
• Upon completion of this problem, students should be able to explain metabolic acid base equilibrium and be able to recognize the mechanisms leading to metabolic acid-base disorders.
• Upon completion of this problem, students will expand on the material learned in the previous case to be able to use laboratory values to calculate patients’ compensatory responses to metabolic acid-base disorders.
• Upon completion of this problem, students should be able to explain the impact of poor perfusion on kidney function and apply that to the development of acute kidney injury, and recognize the importance of Traditional Medicine Ceremonies for healing.
• Upon completion of this problem, students should summarize the causes, presentations and renal manifestations of intrinsic causes of acute kidney injury particularly an allergic reaction.
• Upon completion of this problem, the student should be able to discuss the assessment and management of the complications of chronic kidney disease and to illustrate the constraints faced by these patients recognizing the need to modify medication regimens in the face of declining renal function. Students should be able to assess the risk to relatives of a person with an autosomal dominant condition.
• Compare the incidence, etiologies and risk factors of urinary tract infection in different age groups and between different groups of people (including trans individuals).
• Describe and compare symptomatology associated with urethral, bladder and kidney inflammation.
• Demonstrate the diagnostic approach for urinary tract infection using urinalysis, microscopy and cultures.
• Identify how and when radiological investigations can help in the management of urinary tract infection.
• Explain why recurrent urinary tract infection can occur in the absence of a structural abnormality of the urinary tract.
• Describe the filtration barrier between blood and urine and explain how damage to this can lead to the nephrotic syndrome.
• Explain the physical findings expected with fluid retention.
• Explain the possibility of a contracted circulation in nephrotic syndrome with fluid retention.
• Summarize the typical biochemical abnormalities seen in blood and urine samples when the patient is "pre-renal" and apply that to clinical scenarios.
• Describe the benefits and risks of diet changes and diuretics in nephrotic syndrome.
• Describe the processes that lead to the combination of hypertension and hypokalemia.
• Describe the physiology of renal artery stenosis and understand how the treatment options interfere with these pathophysiologic mechanisms.
• Describe the diagnostic tests that can be used in this situation (hypertension in a young adult).
• Understand the adverse effects of Angiotensin Converting Enzyme (ACE) Inhibitors and Angiotensin Receptor Blockers (ARBs).
• Describe the potential mechanisms that contribute to essential hypertension
• Describe the metabolic mechanisms used to maintain normal acid-base homeostasis.
• Summarize how acid-base disorders develop when those mechanisms fail.
• Define the plasma anion gap and explain and apply how the plasma anion gap can be altered in acid-base disorders and used to solve acid-base problems.
• Summarize and predict the importance of compensation in acid-base disorders.
• Contrast the pathogenesis and approach to a non-anion gap metabolic acidosis realtive to an anion gap metabolic acidosis.
• Describe how gastrointestinal loss of bicarbonate can lead to metabolic acidosis and hypokalemia.
• Describe the determinants of glomerular filtration rate (GFR).
• Explain the role of ischemia in the development of acute kidney injury.
• Identify the metabolic consequences of acute kidney injury and demonstrate how that manifests clinically.
• Identify the indications for renal replacement therapy.
• Explain the tubuloglomerular feedback and the interaction between tubular damage and decreased glomerular filtration.
• Describe the immune response in an allergic reaction to medication.
• Describe other mechanisms of immune injury to the kidney including autoimmune disease.
• Summarize and apply the nutritional and metabolic recommendations for renal failure patients, including diet to manage complications such as vascular disease, hyperkalemia and renal metabolic bone disease.
• Identify the need to modify choice and/or dosage of medications in the face of declining renal function.
• Explain how urine is transported from the kidney to the bladder, stored in the bladder, and excreted from the body.
• Define nephrotic syndrome and describe why the consequences occur.
• Describe and contrast what scenarios would not require additional investigations investigating for secondary causes of hypertension.
• Describe lifestyle modifications for essential hypertension and explain why they would be useful.
• Contrast this case of secondary hypertension with the previous case of essential hypertension.
• Contrast the metabolic mechanisms to the respiratory mechanism reviewed in MF1 (respirology).
• Identify the symptoms associated with chronic kidney disease.
• Describe and discuss the metabolic complications of chronic kidney disease.
• Identify the indications for renal replacement therapy.
• Compare and contrast the options for renal replacement therapy (including conservative care).
• Identify the ureter, its length, division, and the sites of constriction along its course.
• Describe the anatomy of the urinary bladder and the urethra and its difference between males and females.
• Describe the anatomy and the physiology (function) of renal cortex, medulla, renal pyramids, renal papilla, and renal columns.
• Describe the renal vasculature and differentiate the layers of the blood vessels.
• Describe the potential physiologic mechanisms that maintain normal blood pressure.
• Identify common anti-hypertensive medications and describe why they lower blood pressure.
• Describe the features of autosomal dominant inheritance.
• Draw a pedigree (3 generation minimum).
• Differentiate between expression and penetrance.
• Interpret an uncomplicated genetic report.
• Upon completion of this problem, students will be able to describe the role of the kidney in electrolyte homeostasis and develop an approach to electrolyte abnormalities.
• Describe how loss of water from the body can lead to hypernatremia and the compensatory kidney mechanisms involved in maintaining or restoring intravascular volume.
• Describe the value of urine electrolytes and fractional excretion of sodium (FeNa) in distinguishing between renal and non-renal causes of hyponatremia.
• Describe the risks associated with rapid correction of hyponatremia and hypernatremia.
• Describe the function of renal tubules and mechanisms of renal absorption of main electrolytes: Na, K, Mg, Cl
• Describe the action sites of common diuretics: Furosemide, Hydrochlorothiazide and the resemblance of their action to inborn errors of tubular solute transport seen in Bartter and Gitelman syndromes.
• Identify types of kidney stones: calcium oxalate, calcium phosphate, struvite, uric acid, cystine; and review risk factors for their formation: hypercalciuria, hypocitraturia, UTIs, gout, hyperoxaluria
• Discuss the practice of Smudging and its relevance to Traditional Healing Practices of many Indigenous cultures in Canada.
• Students should review best practices for patient-centered smoking cessation counseling.
• Students will explore best practices for interpretation of eGFR values, including recent evidence highlighting that adjustments for race are unnecessary and may hinder patient care.