MC/0165 - INTERNAL MEDICINE I AND NEPHROLOGY
Academic Year 2021/2022
Free text for the University
QUIRICO MELA (Tit.)
GIANFRANCA SUSANNA CABIDDU
- Teaching style
- Lingua Insegnamento
|[40/39] MEDICINE AND SURGERY||[39/00 - Ord. 2015] PERCORSO COMUNE||10||145|
Integrated Course Internal Medicine and Nephrology
TRAINING GOALS:The course is composed of a part of Internal Medicine that is oriented to study "major syndromes", multidisciplinary pathologies, that provide the knowledge of specific specialist pathologies. The purpose of the course is to teach diagnostic approach to particular syndrome. The course has a clinical orientation through therapeutic protocols. Course is intended to provide to the students knowledge and skills to interpret clinical signs, laboratory tests, and instrumental exams related to "major syndromes". Students will also have to acquire adequate knowledge of the main therapeutic protocols in use. Nephrological part is more systematic because analyzes individual nefrologic pathologies teaching the clinical-diagnostic parts and the therapeutic protocols.Training goal is to provide students adeguate knowledge of etiopathogenesis, physiopathology and systematic nosography of major nephrological diseases, moreover the course provide students to use symptoms and signs in clinical diagnosis of renal diseases. Students will also have to became expert with the laboratory and instrumental diagnostic procedures in nephrology.
KNOWLEDGE AND UNDERSTANDING: the student should: i) know the semeiology and clinical methodology in order to evaluate and asses a patient with internal medicine and renal diseases; ii) know the epidemiology of internal medicine and nephrology syndromes (primary and secondary nephropathies and chronic kidney disease and what interventions are available to prevent and treat them); iii) be able to discuss how to deal with patients who have acid-base and electrolyte balance disorders and the main therapeutic interventions that can be adopted, iv) define the goals and management of arterial hypertension and of diabetic nephropathy in the internistic and renal patient; v) acquire strategies for the diagnosis and management of acute kidney injury and the progression of chronic kidney damage, vi) know how to evaluate and assess patients with tubulointerstitial and vascular nephropathies, with genetic diseases and with rare kidney diseases, vii) acquire immunological and clinical knowledge regarding kidney transplantation, viii) be familiar with the main renal replacement therapies. The student must also be knowledgeable with regard to the main tools for the diagnosis and treatment of internal and renal diseases.
APPLIED SKILLS: the student will acquire the ability to deal with the diagnostic and therapeutic pathways of renal diseases and hydro-electrolyte and acid-base disorders learning to distinguish between alternative hypotheses and differential diagnoses. In this context, the student will acquire the ability to rationally and accurately choose which diagnostic tools to use so as to reach a diagnosis and establish the most appropriate therapy.
AUTONOMY OF JUDGEMENT: The student will learn to acquire and integrate anamnestic and instrumental data in order to make a diagnostic evaluation in the field of internal and renal disease.
COMMUNICATION SKILLS: The student will learn to present relevant data from a given clinical case and appropriately report the development and outcome of diagnostic procedures and therapeutic interventions.
LEARNING SKILLS: The student will learn to acquire new information and how to implement their own cultural background through consultation and critical interpretation of recent scientific literature.
Prerequisites: students must have gained adequate knowledge of the pathophysiology of the main internal diseses.
Students must be able to perform anamnesis and general physical examination.
Propedeutic courses: Pathology, Physiopathology and Clinical Methodology
Good basic knowledge of the anatomy and pathophysiology of the urinary apparatus and the renal excretory system, the hydro-electrolyte and acid-base control system, the immune system, and the pathological anatomy of the kidney and of the urinary tract.
Internal Medicine Frontal Lessons
Clinical approach to the patient with:
2. Chest pain
4. Sistemic arterial hypertension
5. Pulmonary hypertension
7. Abdominal pain
11. Musculoskeletal pain
12. Recent onset arthritis
16. Alterations of hemostasis
Nephrology - Frontal Lessons
1. Clinical Nephrology
- Approach to the patient with renal disease (clinical history: urine examination, evaluation of kidney failure, renal ultrasound, immunological study) (2 hours)
- Clinical nephrology syndromes (isolated urinary abnormalities, acute nephritic syndrome, nephrotic syndrome, acute kidney failure, rapidly progressive renal failure, chronic renal failure) (2 hours)
- Glomerulopathies: clinical picture, pathogenesis, primary glomerulopathies (2 hours)
- Secondary glomerulopathies (with detailed information on lupus nephritis, amyloidosis,
essential mixed cryoglobulinemia type II, and monoclonal gammopathy of renal significance [MGRS]) (2 hours)
- Acute and chronic kidney damage
AKI (Acute Kidney Injury) including the topic ‘COVID-19 and AKI’ (2 hours)
CKD (uremic syndrome: epidemiology, pathophysiology, diagnosis and therapy;
Secondary factors of renal damage progression and pathophysiology of adaptation to renal damage) (3 hours)
- Tubulointerstitial nephropathies and tubulopathies (Fanconi’s syndrome) (2 hours)
- Renal damage of vascular origin (with emphasis on rapidly progressive renal failure; ANCA-related vasculitis, hemolytic uremic syndrome, renal disease and pregnancy) (2 hours)
- Kidney and hypertension (2 hours)
- Kidney and diabetes (1 hour)
- Kidney and myeloma (1 hour)
- Clinical and metabolic aspects of kidney stones (1 hour)
2. Hydro-Electrolyte and Acid-Base Disorders
- Mechanisms of renal excretion and effects of nephron loss on these mechanisms: pathophysiology of loss of renal excretion mechanisms (1 hour)
- Hydro-Electrolyte alterations (hyponatremia, hypokalemia, hyperkalemia) (1 hour)
- Acid-base alterations (interpretation of blood gas analysis; metabolic acidosis; lactic acidosis; anion gap; metabolic alkalosis) (1 hour)
3. Genetically Determined Kidney Diseases and Rare diseases
- Polycystic kidney disease, Alport syndrome, and other hereditary and rare diseases (2 hours)
4. Immunology and clinical features of kidney transplantation (1 hour)
5. Fundamentals of Renal Replacement Therapies: Hemodialysis, peritoneal dialysis, kidney transplantation and overview of pharmacology and medication use in the renal patient (2 hours)
Discussion of clinical cases related to hospitalized patients in the internist and nephrological hospital departments
The course consists of frontal lessons in the second semester IV year and practical exercises (Internal Medicine: one week; Nefrology: one week) carried out in the Department Internal Medicine of Cagliari AOU, in the Department of Nefrology of Azienda Ospedaliera G. Brotzu Cagliari,
Verification of learning
The exam registrations will take place through ESSE3 platform.The exam could be sustained by all the students who attended at least 70% of the total frontal lectures hours and at least 50% of each lesson module and after a complete attendance of all hours required for the practical professionalizing activity.The assessment involves a final oral exam during which the student must demonstrate that he has acquired theoretical and practical knowledge in the management of the diagnostic process of the major syndromes treated during the course. In order to overcome the integrated course it is necessary to have sufficient judgment in both Internal Medicine and Nephrology
The final exam will be based on oral test.
The oral exam will include open questions on different topics present on the program that could be also presented as clinical cases. In both cases, the maximum final grade that could be achieved is 30. The exam will be considered as passed if at least a grade of 18/30 has been achieved.
The comprehension of course covered topics, as well as the ability to formulate valid diagnostic hypothesis and to verify them through an opportune and valuable diagnostic planning, will be evaluated. The knowledge of non specialistic therapies for the examinated pathologies will also be evaluated. Finally, the expression capacity, the use of appropriate scientific language and the ability to synthetize information will be assessed. The final grade will take into account:
Manifested quality of the knowledge, capacities and competences: a) Knowledge pertinence, accuracy and consistency b) Capacity pertinence, accuracy and consistency
c) Competences pertinence, accuracy and consistency
Expository modalities: a) Expressive capacity.
b) Appropriate and correct use of specific discipline-related language. c) Logic reasoning capabilities in contents connection. e) Ability to create links between different topics focusing on common points, and to make a general coherent speech, taking care of the structure, organization and logic connections of the speech. f) Ability to synthetize information.
Harrison’s: Principi di Medicina Interna Ed. Mc Graw Hill
Cecil: Medicina Interna Ed. Saunders
Rugarli: Medicina Interna sistematica Edizione EDRA
Brenner and Rector's The Kidney, 2-Volume Set 11th Edition, Oct. 2019
LOCATIONS OF INTERACTIVE TEACHING AND PROFESSIONAL TRAININGS
AOU di Cagliari
Policlinico Universitario - Presidio di Monserrato
Units of Internal Medicine
Azienda Ospedaliera G. Brotzu Cagliari
• SS Trinità Cagliari
Azienda Ospedaliera G. Brotzu Cagliari
Dipartiment of Renal Disease
S.C. Nefrologia e Dialisi
- Department of Internal Medicine
- Azienda Ospedaliera G. Brotzu Cagliari
Dipartiment of Renal Disease
S.C. Nefrologia e Dialisi
Prof. Quirico Mela
Prof.ssa Gianfranca Cabiddu mail:firstname.lastname@example.org