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Course description
Overview
This course is designed to complete the training of the medical undergraduate student
in nephrology within the context of general internal medicine over two rotating 8
weeks clerkships.
Prerequisite
A pass in the MB:BS Phase 1 examination.
The course covers diseases of the kidneys and the urinary system and is often called
nephrology, when the focus is on internal medicine and urology when the focus is on
surgery. Students would be expected to have been exposed to the rudiments of the
examination of the kidneys and history during Phase I training. This course is
designed for students during the final two clinical years of undergraduate medicine.
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At the end of the course, the student will be expected to diagnose and treat the
following major common renal conditions: Acute and chronic renal failure, anuria,
interstitial nephritis, rhabdomyolysis, hepatorenal syndrome, acute upper urinary
tract infections, renal stones and renovascular diseases. The student will also be
expected to understand the differential diagnosis of these conditions and how to
differentiate between these and other medical conditions by laboratory and
radiological investigations.
Contact Information
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Legs: Oedema and peripheral neuropathy.
The student is expected to characterise each of these symptoms by onset (where, when
how), duration and evolution. Common causes of each of these symptoms.
Symptom severity:
Cardiac: Cardiac failure, ECG, pericardial fremitus or murmur, hypertension
Dyspnoea: MRC dyspnoea scale, New York Heart Scale, respiration type
Consciousness: Glasgow Coma Scale
Temperature: With or without peripheral contraction.
Back pain: severity, location of pain in relation to probable cause but even pain
elsewhere.
Urine: Haematuria, protenuria.
Renal History
Past Medical History: importance of comorbidites eg anaemia, cerebrovascular
incidences, hypertension and/or cardiac problems, diabetes, liver problems, dyspnoea,
skin and even recurrent infections.
Intake/output: Importance of amount of fluid intake and loss. Eating habits.
Passing urine: How is it best described? Dysuria, strangury, urgency and frequency,
polyuria, nocturia, oliguria/anuria, incontinence, urge or stress incontinence, nocturnal
enuresis
Drug History: Drug abuse, importance of retrospective diagnosis of renal disease
from the drug history. Adverse effects– ACEIs, Angiotensin receptor antagonists,
NSAIDs. Kidney toxic, Aminoglycosides, amphotericin, lithium, ciclosporin and
tacrolimus, and in overdose paracetamol. Drug for HIV disease.
Allergy history all aspects.
Smoking – definition of a pack year as a measure of smoking burden
Family – genetic basis of some kidney diseases – polycystic kidney disease. Familial
diseases in general.
Social and occupational history: living or working in hot environment. Exposure to
organic solvents, working with aniline dye. Socio-economic status.
Ethnic or geographical situation: Nephropathia epidemica (hanta virus) mainly en
Europe and Russia. Balkan nephropathy. Systemic lupus erythematous with nephritis
in the far east, severe hypertension or diabetes mellitus with renal failure more
common in patients of African origin.
I. Urine analysis:
Macroscopic examination: appearance, odour, volume
Biochemical examination: Gravity, pH, glucose, ketones, proteinuria,
haematuria, bilirubin and urobilinogen, nitrite.
Microscopic examination: Cells (red, white, epithelial cells or malignant
cells). Casts (hyaline, granular, red cells, white cells, crystals
Microbiological examination: Morphological assessment of pathogens
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II. Biochemical assessment of renal function. Urea and creatinine, sodium and
potassium, bicarbonate, calcium, protein and albumin, phosphate, urate and
haematological status. Immunological screening.
VI. Arterial blood gases: Technique of taking ABG, technique of local anaesthetic,
Allen’s sign, Interpretation of ABG and the Henderson-Hasselbach Equation,
Biochemistry of measurement of pH, CO2, O2, HCO3. To distinguish the
degree of metabolic acidosis versus the decreased ventilation due to interstitial
lung oedema.
In the final year several further diseases will be discussed in addition to those studies
during the fourth year:
(1) through (5) – Year 4; All topics in Year 5
In the study of each of these diseases, the principles of history taking and examination
will be emphasised.
Students will be expected to be able to describe the investigation of these diseases and
the principles of management and knowledge of drugs used where applicable.
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Goals/ Aims
The knowledge base developed during the year 4 training in internal medicine will be
expanded in year 5. All diseases discussed during year 4 will be reviewed during
bedside sessions and a few other renal diseases will be discussed.
Students will be expected to attend the Medical Grand rounds at the EWMSC during
their training at EWMSC and to answer simple questions about the cases discussed
during these sessions.
By the end of their 2 years’ training in nephrology, students will expect to have
reached an internationally accepted standard in their knowledge and management of
renal diseases within general internal medicine.
General Objectives
The years 4& 5 nephrology module consists of 1 session per week for 8 weeks either
at POSGH or at EWMSC. You will be provided with a seasonal timetable at the start
of the course.
Specific Objectives
1.
Assignments
1. The student will expected to clerk at least 5 patients with renal diseases
described in the content section above and to present and discuss each case
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with any instructor. Clerking of a patient will involve
a. Presenting compliant
b. Complete history
c. Examination of all systems of the patients with special
emphasis on the renal examination
d. A description of what investigations were done and
should be done with details of results where applicable
e. Treatment and response to treatment
f. Follow-up plan for the patient including discharge
2. Students may be given a short project
Assessment/ Evaluation
The purpose of the assessment would be to help you to appreciate where you have
reached in attaining the goals set out in this syllabus and to stimulate you to continue
to study internal medicine and nephrology.
Your assessment will take the following forms
(1) A written examination based on structured questions or MCQs
(2) Evaluation of a project and coursework
(3) Grading of cases clerked
Teaching Strategies
The Department of medicine employs several teaching strategies which will include
1. guided lectures,
2. bed side teaching,
3. small group teaching,
4. non-lecture strategies: projects, group discussions, role play, co-operative learning
Resources
1. Patients on the medical and surgical wards are our most valuable resource.
2. Patients in the medical outpatients’ clinics.
Readings
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The student should use sound judgement when searching information from various
other websites. If the student has doubts on the validity of a site, the student is
encouraged to discuss the information with the instructor.