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Course, academic year 2024/2025
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Nephrology, urology, rheumatology and geriatrics - C4VL006
Title: Nefrologie, urologie, revmatologie a geriatrie (KPZM V)
Guaranteed by: Department of Internal Medicine 3FM CU and UHKV (12-2INK)
Faculty: Third Faculty of Medicine
Actual: from 2024
Semester: both
Points: 6
E-Credits: 6
Examination process:
Hours per week, examination: 20/116, C+Ex [HS]
Capacity: winter:unknown / unknown (unknown)
summer:unknown / unknown (unknown)
Min. number of students: unlimited
4EU+: no
Virtual mobility / capacity: no
Key competences:  
State of the course: taught
Language: Czech, English
Teaching methods: full-time
Level:  
Note: you can enroll for the course in winter and in summer semester
Guarantor: prof. MUDr. Ivan Rychlík, CSc.
Examination dates   Schedule   
Annotation -
Information about subject (by Department of radiodiagnostics) is in application Vyuka (http://vyuka.lf3.cuni.cz).
Last update: Kubánek Ondřej (30.09.2013)
Aim of the course -

 

The aim of the subject NURG (nephrology, urology, rheumatology and geriatrics) is to teach students the approach to patients suffering from these illnesses and conditions, to take properly the patient´s history, to master relevant physical examination, to devise a plan of auxilliary diagnostic procedures and to evaluate corrrectly the acquired information by fomulating a working diagnosis. Finally, according to the circumstances, to recommend changes in the lifestyle, appropriate diet and both pharmacologic and non-pharmacologic therapy.

The subject NURG lasts for four weeks. In the first two weeks, nephrology is taught followed by one week each of urology, rheumatology and geriatrics. The study is integrated, i.e. it starts with relevant pathophysiology and pathology followed by clinical presentation, diagnostics, treatment and prevention. Social aspects are dealt with esp. in geriatrics.

Last update: Krátká Karolína, MUDr., Ph.D. (19.09.2024)
Course completion requirements -

The subject NURG is obligatory.

In order to improve the quality of practical teaching, students will be divided into individual groups according to the instructions they will receive by email.

 

Conditions to get the credit:

1) 80% attendance at the controlled parts of the course from each part of the course (internships 80%, seminars 80%).

2) Successful completion of a credit test.

Topics to be tested: in agreement with topics of seminars and lectures in following parts of the subject NURG: Syllabus of rheumatology, Syllabus of urology, Syllabus of geriatrics, Syllabus of nephrology - only pre-clinical subjects (pathology, pathophysiology, pharmacology).

Test will be managed as a multiple choice test, 90 questions/90 minutes, 4 answers, 0-4 correct. Minimal required success: >75% in total and >70% in each subtopics. 

 

Preterm WS + SS

The number of test pre-dates is unlimited

The number of pre-dates for the oral examination is 20 places in both semesters

 

 

The assessment period for resits are 3, ie. the student can take the exam up to 4 times and if he or she fails, no credits will be given. The student must take advantage of the assessment period, otherwise he or she loses this option and thus may not receive credits even though he did not take the exam 4 times.

 

 

 

Last update: Krátká Karolína, MUDr., Ph.D. (19.09.2024)
Literature -

Daugirdas T. J., Blake G.P., Ing S.T. - Handbook of dialysis, Wolters Kluwer, 2015

Smith and Tanagho's General Urology, Eighteenth Edition, Lange, 2012

Johnson J. R., Feehally J., Floege J. - Comprehensive Clinical Nephrology, ISBN: 978-1-4557-5838-8

 

 

 

Last update: Jajová Bekime, DiS. (11.12.2019)
Teaching methods -

The subject NURG is taught by means of seminars, practicals and lectures. Teaching is integrated, i.e. it comprises pathophysiological mechanisms of the disease, pathological findings, physical examination, auxilliary diagnostic methods and both pharmacologic and non-pharmacologic treatment.

Last update: Rychlík Ivan, prof. MUDr., CSc. (20.11.2019)
Requirements to the exam -

Knowledge of anatomy, physiology, pathophysiology and pathology of the kidney, the urinary tract and locomotion apparatus including connective tissue.

Basic diseases in nephrology, urology and rheumatology, their pathogenesis, clinical presentation, diagnostics and management.

The approach to the elderly patients, specifics of diseases in the elderly, changes in clinical presentation, changes of drug pharmacokinetics in the old age, ethical and social aspects of caring for the elderly.

A precondition for the student to be allowed to sit for the examination is successful passing the exam General Foundations of Pathology and Pathophysiology in the third year.

NOTICE! Since the academic year 2016/17, the subject ends by an oral examination of nephrology.

Topics to be tested: in agreement with topics of seminars and lectures of nephrology (see: Syllabus of nephrology)

Terms of the oral exams:

1/ during regular examination period

2/ for those who are interested - preterms (limited number of participants): during the week following the end of subject NURG

 

             

 

 

 

Exam questions:

1st set of questions (clinical nephrology):

  1. nephrotic syndrome - definition, clinical symptoms, complications

  2. nephritic syndrome - definition, clinical symptoms

  3. nephrotic syndrome - definition, diseases that cause it (examples, characteristics)

  4. nephritic syndrome - definition, diseases that cause it (examples, characteristics)

  5. proteinuria – classification by intensity, prognostic importance, renal consequesnces

  6. hematuria – classification by type, diagnostic methods, examples of diseases

  7. proteinuria – individual types of proteinuria with examples of diseases

  8. evaluation of renal function – diagnostic methods

  9. edemas - differential diagnostics, characteristics of different causes of edema

  10. glomerulonephritis - classification, clinical symptoms, prognosis

  11. minimal change disease – clinical symptoms, diagnostic methods, treatment, prognosis

  12. acute glomerulonephritis – clinical symptoms, prognosis, principles of treatment

  13. prerenal, renal and postrenal disorders of kidney function - classification, examples of diseases

  14. rapidly progressive glomerulonephritis - classification, clinical symptoms, examination methods

  15. focal and segmental glomerulosclerosis- clinical symptoms, diagnostic methods, treatment, prognosis

  16. Goodpasture’s syndrome - classification, clinical symptoms, diagnostic methods, treatment, prognosis

  17. membranous nephropathy – clinical symptoms, diagnostic methods, treatment, prognosis

  18. ANCA-associated vasculitides - classification, clinical symptoms, diagnostic methods, treatment, prognosis

  19. gammopathy of renal significance – clinical symptoms, diagnostic methods, treatment, prognosis

  20. IgA nephropathy - epidemiology, clinical symptoms, diagnostic methods, treatment, prognosis

  21. diabetic kidney disease - epidemiology, mechanisms of kidney damage, characteristical clinical findings

  22. chronic glomerulonephritis - classification, clinical symptoms, diagnostic methods

  23. diabetic kidney disease – diagnostic methods, treatment, prognosis

  24. kidney damage in arterial hypertension – mechanisms of kidney damage, diagnostic methods, treatment, prognosis

  25. acute urinary infection - classification, clinical symptoms, diagnostic methods, treatment

  26. non-infectious tubulointerstitial kidney diseases- classification, clinical symptoms, diagnostic methods, treatment, prognosis

  27. thrombotic microangiopathy with renal involvement - classification, clinical symptoms, diagnostic methods, treatment, prognosis

  28. kidney damage in infectious diseases primary affecting other organs or systems

  29. stenosis of the renal arteries – clinical symptoms, diagnostic methods, treatment, prognosis

  30. hereditary kidney diseases – basic types of diseases, clinical symptoms, diagnostic methods, prognosis

2nd set of questions (RRT):

  1. renal transplantation – basic description and key principles

  2. vascular access for hemodialysis

  3. renal transplantation - methods, indication and contraindication

  4. conservative treatment of chronic kidney disease

  5. renal replacement therapy – how to choose the method

  6. diet and nutritional disorders in patients with chronic kidney disease

  7. hemodialysis - principle, description of the method

  8. cardiovascular complications of the chronic kidney disease

  9. hemodialysis - complications, impact on life of the patient

  10. pharmacotherapy in patients with the impairment of renal function – changes in pharmacokinetics and its consequences, examples of high risk drugs, consequences for the clinical practice

  11. peritoneal dialysis - principle, description of the method

  12. specifics of usage of a RTG contrast agents in a patient with impairment of renal function

  13. peritoneal dialysis - complications, impact on life of the patient

  14. antibiotic therapy in patient with an imparment of renal function

  15. acute kidney injury (AKI) - classification, examples of diseases, main principles of treatment

  16. chronic kidney disease - definition, staging

  17. acute kidney injury (AKI) – predisposing factors

  18. chronic kidney disease – clinical importance, prognosis, main principles of treatment

  19. acute kidney injury (AKI) – types of inducing insults, prevention

  20. uremic syndrome - definition, clinical characteristics

  21. acute kidney injury (AKI) – diagnostic methods, differential diagnostics

  22. renal anemia - patogenesis, clinical characteristics, main principles of treatment

  23. acute tubular necrosis - classification, examples of diseases, clinical symptoms, main principles of treatment

  24. metabolic bone diseases in chronic kidney disease - pathogenesis, clinical characteristics, main principles of treatment

  25. hemoelimination methods in acute kidney injury – indication, methods

  26. arterial hypertension in chronic kidney disease

  27. renal replacement therapy - indication, clinical importance

  28. hyperkalemia in chronic kidney disease – causes, clinical symptoms, main principles of treatment

  29. renal replacement therapy – classification of the methods and their differences

  30. acid-base balance disorders in chronic kidney disease - patogenesis, clinical characteristics, main principles of treatment

 

Choice of questions:

Each student will randomly choose a question number. He will get one question from the 1st set and one question from the 2nd set.

Last update: Jajová Bekime, DiS. (01.10.2024)
Syllabus -

I/ Syllabus nephrology

 1)    Introductory seminar 

 2)    Laboratory and other tests in nephrology 

 3)    Acute kidney injury 

 4)    Chronic kidney disease 

 5)    Differential diagnostic seminar 1 – discussion of case studies 

 6)    Kidney and the vascular diseases 

 7)    Rapidly progressive glomerulonephritis 

 8)    Chronic glomerular diseases I. 

 9)    Chronic glomerular diseases II.

10)    Infections and the kidneys 

11)   Clinical-pathological seminar 

12)   Tubulointerstitial kidney diseases 

13)   Renal replacement therapy 

14)   Other treatment options in nephrology 

15)   Differential diagnostic seminar 3, final – discussion of case studies 

 

 

    II/ Syllabus urology

 

  1. Examination methods in urology

  2. Imaging procedures in urology

  3. Clinical urology

  4. Non-neoplastic diseases of the urinary bladder and urethra  

  5. Tumours of the urinary bladder

  6. Endoscopic diagnostics

  7. Benign prostatic hyperplasia, prostatitis

  8. Tumours of the prostate

  9. Incontinency

  10. Diseases of external genitals

  11. TBC in urology/ non-neoplastic diseases of the kidney

 

III/Syllabus of rheumatology

  

  1. Symptoms of rheumatic diseases  ( pain, arthritis, extra-articular features )

  2. Basic classification of RD

  3. Basic assessment of RD, basic interpretation of laboratory results ( blood biochemistry, immunology, radiography, ultrasound, densitometry)

  4. Rheumatoid arthritis

  5. Seronegative Spondarthritis

  6. Gout

  7. Connective tissue diseases

  8. Pharmacotheraphy of rheumatic diseases

  9. Physical and rehabilitation treatment of rheumatic diseases

  10. Radiographic examination and imaging procedures in rheumatic diseases

  11. Metabolic diseases of bone (osteoporosis, osteomalacia)  

 

     

IV/ Syllabus geriatrics

 

  1. Ageing and old age,  theory of ageing, general characteristics

  2. Old age and stress, diseases in the elderly

  3. Physiological changes during ageing, changes in structure and function of organs 

  4. Specificities of clinical symptomatology in the elderly; functional geriatric assessment 

  5. Geriatric syndromes: Instability, vertigo and falls in the elderly 

  6. Geriatric syndromes: Impairment of cognitive functions. Caring family in the Czech Republic 

  7. Pharmacotherapy in the elderly

  8. History in a geriatric patient; diagnostics of pain in patients with advanced dementia  

  9. Functional geriatric assessment. Active geriatric aftercare. Functional evaluation and rehabilitation 

  10. Concept of  geriatric care

  11. Ethical aspects in geriatrics. Life quality. Personal distinction 

  12. Unappropriate pharmacotherapy in the elderly

  13. Case report seminar: Transient cognitive impairment during acute conditions in the elderly

  

 

 

Last update: Jajová Bekime, DiS. (23.09.2024)
Learning resources
Recommendations for the evaluation of biochemichal parameters in nephrology  (Dr. Granátová):
 
  1. What kidney function has my patient in a daily praxis?
  • Usual patient: s-creatinine (+ eGFR - estimated glomerular filtration (MDRD, event. CKD-EPI)
  • Muscle atrophy (dystrophy, malnutrition, immobilization, elderly) / big amount of muscles: s- cystatin C (+ estimated GFR based on cystatin  C)
  • Pregnant woman: s-cystatin C
  • Extremely obese: s-cystatin C

           Remember: -  to know thyroid function (TSH)  - if uncompensated hyperfunction -

                                    falsely worse eGFR (and falsely better if uncompensated hypofunction)

     -   in corticoid therapy falsely worse eGFR based on cystatin C   

         (dependence on the corticoid dose) - eGFR based on s-creatinine is

          more appropriate
  • Drug administration: s-cystatin C (+ estimated GFR based on cystatin  C)
  • Children: s-cystatin C  (small, thin, slight, low amount of muscles)

              s-creatinine (+ estimated GFR based on Schwartz formula,

                                   MDRD/CKD-EPI not recommended),

              estimation for a daily praxis: maximal s-creatinine = body height (cm) x 0,54

                  the upper normal value of s-creatinine that fits to still undecreased GFR 1,5 ml/s)


  1. Kidney deterioration suspected:

     s-creatinine (+ eGFR (MDRD, event. CKD-EPI, s-urea,

     albumin in urine,ACR (especially in diabetic patiens, hypertension)


  1. Worsening kidney function, acute kidney injury (AKI) suspected:

    • In outpatient department: trend in s-creatinine for 3- 4 days

                                                  (event. s-cystatin C, see above)

          If  the rising trend continues, then admission to hospital

          Remember: -   Biological + analytical variability in creatinine concentration

                                   day to day about 15%

                              -    Changes in s-creatinine are delayed in 24 - 48 hours after the cause       

                                   (hypoxia, hypoperfusion, toxins etc.)


    • In hospital: s-cystatin C (event. NGAL)


  1. Type of proteinuria (PU):

    • Children:glomerular selective: minimal change disease (MCD)

                             glomerular nonselective: focal segmental glomerulosclerosis (FSGS),

                                                                        postinfectional glomerulonefritis (GN), other GN

  • Adults:   glomerular selective: minimal change disease (MCD)

                           glomerular nonselective: idiopatic membranous glomerulopathy (IMG),

                                                                      focal segmental glomerulosclerosis (FSGS),  

                                                                      diabetic nefropathy,

                                                                      monoclonal protein("paraprotein")  - to perform

                                   serum electrophoresis (event.+ immunofixative electrophoresis if

                                   paraprotein is present,  serum free light chains (FLC); if systemic

                                   amyloidosis (AL) is suspected, these tests are necesasary in serum + in urine

                           glomerulo-tubular nonselective: advanced disease
Last update: Rychlík Ivan, prof. MUDr., CSc. (20.11.2019)
Entry requirements -

Student entering the subject NURG must have working knowledge not only of anatomy and physiology of the kidney, the whole urogenital system and the mobility apparatus but also of general pathology, pathophysiology, pharmacology, and intermediary metabolism. Further, he must understand principles of physician´s attitude to the patient including principles of medical ethics and be able to take patients´history and to perform physical examination.

Condition for the attendence of the subject is a completed exam from general foundations of pathology and pathophysiology.

Another condition is to have passed the Internal Propaedeutics Exam (UKM III) before enrolling in the course.

 

 

 

Last update: Jajová Bekime, DiS. (01.10.2024)
 
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