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Objectives

  • The student will learn how the kidneys adapt to extra-renal disturbances.
  • The student will explore disorders that arise from primary defects in kidney function.
  • The student will explore the pathogenesis and therapy of chronic kidney disease, and the consequences of kidney failure.

Lectures

The lectures will introduce each of the pathophysiologic concepts. They will provide a framework upon which you can expand your understanding with readings and small group problem-based discussions. Lectures will begin with a concise review of pertinent normal physiology, and proceed to specific pathophysiologic conditions. Many times, cases at the end of the lecture will highlight the concepts discussed. The syllabus is designed to complement the lectures. It is not a comprehensive treatment of the subject, but a guide to the lecture. It is in outline form, with reproductions of key figures and tables. You should use the syllabus as a notebook and study guide.

Readings

An assigned text has been selected for this course. It is Renal Pathophysiology - the Essentials, by Burton Rose and Helmut Rennke (Lippincott, Williams, & Wilkins, 1994). This text has been chosen because of its clarity and conciseness. The readings will expand on many of the principles introduced in lecture. You are responsible for material covered in the assigned readings. Several other books have been made available and are on reserve in the Library. These books will provide additional depth of understanding. They include: 1. Rose BD, Post T, Clinical Physiology of Acid-Base and Electrolyte Disorders, McGraw-Hill, 2001. 2. Schrier RW, Renal and Electrolyte Disorders, Little, Brown and Company, 1992. 3. Black R, Rose B, Rose & Black's Clinical Problems in Nephrology, Little, Brown and Company, 1996. More comprehensive texts of the kidney and kidney disease include: 1. Schrier RW, Gottschalk CW, Diseases of the Kidney, Little, Brown and Company, 1996. 2. Brenner B, et al, The Kidney, W.B. Saunders, 1996.

Small Groups

Due to the complexity of the material, the importance of the small group sessions cannot be overemphasized. They are designed to complement the lectures and readings. Clinical cases will be discussed which highlight, reinforce, and extend your understanding of the material. This is also the setting where concepts from different lectures will be integrated. The small group format has been very popular with students in the past, and students have consistently identified this experience as essential to their understanding of the course material. However, to be successful it is important that everyone prepares, attends, and participates. Attendance for the small groups is MANDATORY. These sessions require group participation, and you are expected to have prepared by attending lectures and reviewing the cases beforehand

Student Guidelines

Renal Pathophysiology is a difficult course. The material is challenging, and the concepts are complex. Many times, adaptive responses to one physiologic disturbance affect other functions of the kidney, producing secondary disturbances. As a result, a solid understanding of the early material in the course may not occur until some of the later subjects have been presented.

To address the challenges of the material, the course has three important components that complement and build on each other. These are lectures, readings, and small group discussions. By attending lectures, reading the assigned chapters, and preparing for and participating in the small group discussions, you will gain a mastery of renal pathophysiology.

Renal Pathophysiology is a course of concepts, not details. As such, it lends itself very well to group studying. The complicated concepts and intricate pathways can be best mastered by reviewing them over and over with classmates. Tutors are available to help individuals or groups organize themselves.

Grading

Renal Pathophysiology is a section of the Pathophysiology Course. The Pathophysiology Course is graded on an Honors/Pass/Fail scale.

The Pathophysiology Course evaluation consists of the student's performance in each Section and a cumulative final exam. Ten questions on the cumulative final exam will be from the Renal Section.

The Renal Section is evaluated with a 25-question Section Exam. Student attendance, preparation, and participation in Small Groups will account for 10% of the Section grade.

Lecture Schedule

Week 1
Lecture Kidney Structure and the Nephron - S. Gilbert, M.D.
Lecture Introduction to Glomerular Filtration - S. Gilbert, M.D.
Week 2
Lecture Introduction to Homeostasis - S. Gilbert, M.D.
Lecture Water Handling and Osmolality - Dan Weiner, M.D.
Week 3
Lecture Introduction to Acid/Base - Nicolaos Madias, M.D.
Lecture Respiratory Acidosis/Alkalosis - Nicolaos Madias, M.D.
Small Group 1 GFR and Clearance
Week 4
Lecture Sodium Handling and Volume Regulation - Mark Sarnak, M.D.
Lecture Metabolic Acidosis - Bertrand Jaber, M.D.
Small Group 2 Volume Status and Sodium Balance
Week 5
Lecture Metabolic Alkalosis - James Strom, M.D.
Week 6
Lecture Potassium Handling - Ronald Perrone, M.D.
Week 7
Lecture Stages of Chronic Kidney Disease: Progression - Andrew Levey, M.D.
Lecture Stages of Chronic Kidney Disease: Adaptation - Lesley Stevens, M.D.
Small Group 3 Osmolality and Water Balance
Week 8
Lecture Hypertension - Scott Gilbert, M.D. and Angelo Ucci, M.D., Ph.D.
Small Group 4 Metabolic Acidosis
Week 9
Lecture Acute Renal Failure and the Urinalysis - Amy Kuhlik, M.D.
Small Group 5 Metabolic Alkalosis and Potassium Disorders
Week 10
Small Group 6 Chronic Kidney Disease
Week 11
Small Group 7 Acute Renal Failure
Week 11
Final Exam