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Last update: prof. MUDr. Jiří Horák, CSc. (03.12.2012)
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 five 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. |
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Last update: Bekime Jajová, DiS. (27.09.2021)
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Last update: Bekime Jajová, DiS. (22.09.2023)
The subject NURG is obligatory. Conditions to get the credit: 1) 80% attendance at controlled parts of the teaching, i.e. practice, seminars. 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. 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.
According to 3LF UK, all exams are held in person. The condition for admission to the oral exam is the successful completion of a written test + presentation of attendance. Attendance records must be submitted no later than on the day of the oral examination to the IK secretariat (put in the mailbox in front of the secretariat, building N, 3p). The credit will be entered in the SIS on the day of the oral examination.
Test It is possible to pass the written test in the pre-term once, in case of failure it is possible to repeat the test only in the regular examination period. Successful completion of the written test is a condition for admission to the oral exam.
The oral exam Capacity is limited, pre-term only 12 - 18 students. There are 3 resit dates, i.e. the student can take the test no more than 4 times and if he fails, he does not get credit. They must use the regular announced dates available in the SIS. In case of registration and failure to complete (without apology), this deadline expires. |
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Last update: prof. MUDr. Jiří Horák, CSc. (03.12.2012)
Robbins and Cotran - Pathologic Basis of Disease (8th edition)- Kumar, Abbas, Fausto, Aster Eds. Elsevier, Saunders ( 2010) (ISBN978-1-4160-3121-5) McCance, K. and S. Huether (2002). Pathophysiology - The Biologic Basis for Disease in Adults and Children. St. Louis, Missouri, Mosby, Inc.: 1170- 1229 RIEDER / WERNER / FREUDENBERG. Basiswissen Allgemeine und Spezielle Pathologie 1. Auflage 2009, 748 Seiten, 391 Abbildungen ISBN 9783540792130, Springer Verlag Stewens A., Lowe J, Scott I. Core Pathology - (3rd edition Elsevier), 2009, ISBN 978-0-7234-3444-3 Guyton, A. C. Textbook of Medical Physiology. Saunders (2006). Smith and Tanagho's General Urology, Eighteenth Edition, Lange, 2012 Guyton AC and Hall JE Textbook of Medical Physiology, 11th ed. 2006. pp. 1 - 42 Paulev-Zubieta: New Human Physiology Textbook in Medical Physiology and Pathophysiology: Essentials and Clinical Problems http://www.zuniv.net/physiology/book/index.htm http://www.americangeriatrics.org/files/documents/health_care_pros/JAGS.Falls.Guidelines.pdf http://www.americangeriatrics.org/files/documents/beers/2012BeersCriteria_JAGS.pdf Reide, Schaefer: Pathologie, Georg Thieme Verlag 2005 Underwood et al., General and Systemic Pathology, Elsevier 2009 H. P. Rang, et al Pharmacology 7th ed. - Churchill Livingstone 2011 B. G. Katzung Basic & clinical pharmacology - - 11th ed. - Lange Medi. Books - McGraw-Hill 2009 M. J. Neal Medical Pharmacology at a Glance -. 6th ed. Wiley-Blackwell, 2009 British National Formulary No. 62 [nebo vyšší] - BMJ Books, September 2011 [nebo novější] Howland RD, Mycek MJ, Pharmacology (Lippincott's Illustrated Reviews Series). 4th ed. Lippincott‘s Illustrated Reviews 2008 Dale NN, Haylett DG. Pharmacology Condensed 2nd ed., Churchill Livingstone, 2009 Forbes CH.D.,Jackson W.F. Colour atlas and text of Clinical Medicine, Mosby-Wolfe., 2nd ed. Joints and Bones, p.121-161 |
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Last update: Bekime Jajová, DiS. (05.10.2020)
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.
All lectures and seminars will be taught in a distance form on-line through the tool Meet 3.LF UK at least until 31.10.2020, for all students of the scheduled groups. Students will sign up to the on-line teaching exclusively under their real name so that their presence can be confirmed. Students must be physically present at practical lessons and clinical training and their attendance will be always confirmed by the assigned teacher. Students must be equipped with a face mask and perform proper desinfection of hands and stethoscopes. If the student cannot participate in clinical teaching for objective reasons (not able to come to the Czech Republic) must individually contact prof. Rychlík (int1sec@fnkv.cz) for next instructions. |
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Last update: prof. MUDr. Jiří Horák, CSc. (03.12.2012)
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. The subjects ends by a written examination in the form of multiple choice question test (120 questions, four possibilities, just one is correct). A minimum of 65% of correct answers is required to pass the test. 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. |
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Last update: Bekime Jajová, DiS. (29.09.2023)
I. Syllabus nephrology
1. Introductory seminar (prof. Rychlik, dr. Havrda) a. organization information, credit conditions, overview of the syllabus b. basic classification of the kidney diseases (prerenal x renal x postrenal, vascular, glomerular, tubulointerstitial diseases, diseases of the urinary tract) c. review of the symptomatology of the kidney diseases (subjective complains such as pain, urinary symptoms, oligoanuria, polyuria, nycturia, hematuria, proteinuria, basic nephrologic syndromes – nephrotic x nephritic, edemas, hypertension, uremic syndrome) d. basic epidemiological data of patients with kindey diseases e. basis tests review (urinary sediment, urine culture, sodium, potassium, calcium, phosphates, urea, creatinine, Astrup, ultrasonography, X-ray methods, scintigraphy, imunology, paraprotein detection, renal biopsy) f. Trajectory of patients with CKD (higher risks of CKD-early diagnosis-slowing of progression-preparation for RRT / conservative care-basic RRT methods)
2. Laboratory and other tests in nephrology (Dr. Habara, Dr. Žabka) a. Glomerular filtration tests – urea, creatinine, cystatin C, clearance, estimations, measurements with inulin, isotopes b. Differentiate between evaluation of stabilised kidney function and changing kidney function c. Proteinuria evaluation – quantitative proteinuria, PCR, ACR, proteinuria typisation, d. Hematuria evaluation – hematuria typisation,
3. Acute kidney injury (Dr. Grussmannová, Dr. Krátká) a. AKI definition, stages b. Predisposing states and factors of AKI. Hydration evaluation c. AKI caused by contrast agent, drug-associated AKI (ATN, ATIN) d. Hepatorenal syndrome e. Cardiorenal syndrome f. AKI prevention g. Tests used for differential diagnosis of the etiology, renal biopsy indications h. Treatment of the AKI, corticotherapy indications (ATIN) i. Elimination methods in AKI (HD, CRRT, PD) – indications, performing) 4. Chronic kidney disease (Dr. Bandúr, Dr. Lažanská) a. CKD definition, stages b. Differentiation of active disease, tests, indication of renal biopsy in unclear kidney disease c. Uremic syndrome (clinical-laboratory presentation) d. Complications of the CKD and their treatment – anemia, acidosis, CKD-MBD, nutrition and diet, hypertension, cardiovascular complications, specifics of pharmacotherapy
5. Differential diagnostic seminar 1 – discussion of case studies (Dr. Sýkora, Dr. Knížek Bonatto) a. Renal function evaluation in stable and unstable conditions b. Differentiation of type of the kidney disease and differentiation between acute and chronic disease according to clinical, laboratory and other tests c. Approach to the patient with AKI d. Approach to the patient with CKD
6. Kidney and the vascular diseases (Dr. Krátká, Dr. Havrda) a. Malignant hypertension, vascular nephrosclerosis, ischemic disease of the kidney b. Renovascular hypertension, secondary renal hypertension c. Vasculitis – overview, vasculitis of the large and medium-sized vessels affecting the kidney d. Thrombotic microangiopathy
7. Rapidly progressive glomerulonephritis (prof. Rychlik, Dr. Havrda) a. Symptomatology of the RPGN, overview b. Goodpasteur syndrome, anti-GBM nephritis c. ANCA-associated vasculitis d. Lupus nephritis e. RPGN as presenation of the HSP, IgAN f. Renal biopsy – indication, contraindication, performing, complications
8. Chronic glomerular diseases (Dr. Žabka, Dr. Havrda) a. GN classification according to morphology (classical) and pathophysiology (new) b. Idiopathic nephrotic syndrome (MCD, FSGS, MGN) c. IgAN, HSP
9. Chronic glomerular diseases II. (Dr. Havrda, Dr. Žabka) a. Membranoproliferative GN – morphology, clinic, basic differential diagnosis b. Diabetic kidney disease c. Lupus nephritis
10. Infections and the kidneys (Dr. Knížek-Bonatto, Dr. Sýkora) a. Bacterial infections of the kidneys and urinary tract b. Acute postinfectious GN c. Parainfectious GN d. GN in viral infections
11. Clinical-pathological seminar (Doc. Honsová) a. Acute, rapidly progressive and chronic kidney diseases focused on vascular diseases, RPGN and chronic glomerular diseases (seminars 6-9)
12. Tubulointerstitial kidney diseases (Dr. Lažanská, Dr. Bachroňová) a. Acute tubular necrosis, acute tubulointerstitial nephritis b. Damage of the kidney in myoglobinuria and hemoglobinuria, crystals induced kidney damage c. Chronic tubulointerstitial nephritis, drug associated kidney damage, chronic pyelonephritis d. Monoclonal gammopathy with renal significance (MGRS) e. Polycystic kidney disease
13. Renal replacement therapy (Dr. Tetour, Dr. Szonowská, Dr. Bandúr) a. Basic classification of the RRT, indications b. Conservative treatment of the severe CKD, palliative nephrology c. Basic classification of dialysis treatment, basic physical principles of dialysis d. Hemodialysis – technology, vascular access, dry weight, ultrafiltration, HD prescription, complications, basic diet
14. Other treatment options in nephrology (Dr. Szonowska, Dr. Lažanská, Dr. Tetour) a. Peritoneal dialysis b. Continual methods of RRT c. Home HD d. Plasmapheresis, hemoperfusion e. Kidney transplantation
15. Differential diagnostic seminar 3, final – discussion of case studies (Dr. Havrda, prof. Rychlík) a. Tubulointerstitial kidney diseases, monoclonal gammopathies b. CKD patient care, arrangement of nephrology treatment, RRT indications c. HD, PD, Tx complications, acute states d. Test and exam preparations (structure, questions, demands, conditions for the credit and exam)
B/ Seminars organized by preclinical departments 1. Pathophysiology of the kidney I 2. Pathophysiology of the kidney II 3. Pharmacology of the kidney and urinary tract I 4. Pharmacology of the kidney and urinary tract II
Lectures:
1/Basic principles of examination of a patient with kidney disease 2/Glomerulonephritis 3/Tubulointresticial nephritis 4/ RRT (renal replacement therapy) 5/ AKI (acute kidney injury) 6/Possibilities of affecting the progression of nephropathy
II. Syllabus urology Examination methods in urology Imaging procedures in urology Clinical urology Non-neoplastic diseases of the urinary bladder and urethra Tumours of the urinary bladder Endoscopic diagnostics Benign prostatic hyperplasia, prostatitis Tumours of the prostate Incontinency Diseases of external genitals TBC in urology/ non-neoplastic diseases of the kidney
III/Syllabus of rheumatology - modul NURG Seminars: A/ organized by 1st Department of Medicine 1. Basic overview of rheumatology a. Overview of rheumatic diseases (RD) b. Symptoms of rheumatic diseases ( pain, arthritis, extra-articular features ) c. Basic classification of RD d. Basic assessment of RD, basic interpretation of laboratory results ( blood biochemistry, immunology, radiography, ultrasound, densitometry)
2. Rheumatoid arthritis a. Definition and clinical manifestations b. Diagnosis and diferential diagnosis c. Treatment and management
3. Seronegative Spondarthritis a. Definition , a new classification b. Ankylosing spondylitis - clinical manifestations, diagnosis and diferential diagnosis, treatment and management
d. Psoriatic arthritis - clinical manifestations, diagnosis and diferential diagnosis, treatment and management
4. Gout a. Definition and clinical manifestations, b. Diagnosis and diferential diagnosis c. Treatment and management
B/ Seminars organized by other departments 1. Pharmacotheraphy of rheumatic diseases 2. Physical and rehabilitation treatment of rheumatic diseases 3. Radiographic examination and imaging procedures in rheumatic diseases 4. Metabolic diseases of bone (osteoporosis, osteomalacia)
Practise: 1. Clinical rheumatology (1 st Department of Medicine) – examination of the joints and spine Osteoarthritis, clinical manifestationes, examination of the patient 2. Pathology: Ligh microscopy of rheumatic diseases 3. Pathophysiology: Pathophysiology of calcium
Lectures: 1. Connective tissue diseases I. Systemic lupus erythematosus (SLE) 2. Connective tissue diseases II. Systemic sclerosis, Polymyositis and Dermatomyositis, Sjogren´s syndroma
IV. Syllabus geriatrics Ageing and old age, theory of ageing, general characteristics Old age and stress, diseases in the elderly Physiological changes during ageing, changes in structure and function of organs Specificities of clinical symptomatology in the elderly; functional geriatric assessment Geriatric syndromes: Instability, vertigo and falls in the elderly Geriatric syndromes: Impairment of cognitive functions. Caring family in the Czech Republic Pharmacotherapy in the elderly History in a geriatric patient; diagnostics of pain in patients with advanced dementia Functional geriatric assessment. Active geriatric aftercare. Functional evaluation and rehabilitation Concept of geriatric care Ethical aspects in geriatrics. Life quality. Personal distinction Unappropriate pharmacotherapy in the elderly Case report seminar: Transient cognitive impairment during acute conditions in the elderly
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Last update: prof. MUDr. Jiří Horák, CSc. (03.12.2012)
Recommendations for the evaluation of biochemichal parameters in nephrology (Dr. Granátová):
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
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)
s-creatinine (+ eGFR (MDRD, event. CKD-EPI, s-urea, albumin in urine,ACR (especially in diabetic patiens, hypertension)
(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.)
glomerular nonselective: focal segmental glomerulosclerosis (FSGS), postinfectional glomerulonefritis (GN), other GN
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 |
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Last update: prof. MUDr. Jiří Horák, CSc. (03.12.2012)
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. |
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Last update: Bekime Jajová, DiS. (22.09.2023)
The subject NURG is obligatory. Conditions to get the credit: 1) 80% attendance at controlled parts of the teaching, i.e. practice, seminars. 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. 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.
According to 3LF UK, all exams are held in person. The condition for admission to the oral exam is the successful completion of a written test + presentation of attendance. Attendance records must be submitted no later than on the day of the oral examination to the IK secretariat (put in the mailbox in front of the secretariat, building N, 3p). The credit will be entered in the SIS on the day of the oral examination.
Test It is possible to pass the written test in the pre-term once, in case of failure it is possible to repeat the test only in the regular examination period. Successful completion of the written test is a condition for admission to the oral exam.
The oral exam Capacity is limited, pre-term only 12 - 18 students. There are 3 resit dates, i.e. the student can take the test no more than 4 times and if he fails, he does not get credit. They must use the regular announced dates available in the SIS. In case of registration and failure to complete (without apology), this deadline expires. |