Faculty of Medicine
King Abdulaziz University
THE URINARY
SYSTEM MODULE
Study Guide
Phase II, MBBS
2008
TABLE OF CONTENTS
Topic
Page
THE OUTCOMES OF THE UNDERGRADUATE CURRICULUM
4
CURRICULUM MAP
5
PHASE 2
6
STRUCTURE OF THE MODULE
6
INTRODUCTION
7
AIMS & OBJECTIVES
7
TEACHERS CONTACTS
8
ASSESSMENT
9
ICONS
11
TOPIC OUTLINES
12
NO.
LECTURES
1
Anatomy of the kidney, ureter, urinary bladder and urethra
2
Development of the kidney, ureter, urinary bladder and urethra.
3
Introduction to renal physiology.
4
Histology of the kidney, ureter, urinary bladder and urethra.
5
Congenital anomalies of the kidney, ureter, urinary bladder and urethra.
6
Renal blood flow and its control
7
Renal function: Glomerular filtration and its control.
8
10
Renal regulation of acid-base balance
Renal function: Tubular processing of the glomerular filtrate ,tubular
reabsorption and tubular secretion
Regulation of tubular functions
11
The concept of renal plasma clearance
12
Assessment of renal function
Control of sodium and water balance: Regulation of plasma volume and
osmolarity
9
13
Page
King Abdulaziz University
Faculty of Medicine
14
Urine composition and renal stones
15
Medical aspects of proteinuria and haematuria
16
Glomeular Diseases I
17
Glomerular Diseases II
18
Metabolic function of the kidney
19
Renal Tubular and Interstitial Pathology
20
Defence mechanisms of the urinary tract and urinary tract infection
21
Pathology of Renal Vascular System
22
Diabetic nephropathy
23
Pathological aspects of tumours of kidney & urinary tract
24
Clinical aspects of tumours of the urinary tract
25
Mechanisms of formation of concentrated & diluted urine
26
Principles of diuretic therapy.
27
Introduction to acute renal failure
28
Radiological aspects of obstructive uropathy
29
Physiology of Micturition
30
Surgical aspects of hematuria
31
Case studies related to urinary calcium excretion and renal stones analysis.
NO
PRACTICAL
1
Examination of prosections of urinary tract anatomy.
2
Radiological imaging techniques, e.g. x-rays, IVPs.
3
Analysis of random and 24-hour urine sample.
4
Nuclear imaging in renal diseases including renal haemodynamics.
5
Blood gas analysis.
6
The anatomy of the lower urinary tract.
7
Diagnosis, investigation and treatment of UTI.
8
Demonstration of haemodialysis, peritoneal dialysis.
9
Pathology of renal disease 1.
10
Pathology of renal disease 2.
11
The anatomy of the lower urinary tract.
12
Investigation of CRF / ARF
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Problem-Based Learning (PBL) Sessions
PBL case
Tutorials:
Number Title
Department
1
2
3
4
5
6
Pharmacology
Clinical Biochemistry
Microbiology
Anatomy
Histology/Embryology
Pathology
Case studies in diuretic use
(i) Problems on acid-base balance (ii) the anion gap.
Bacteruria in extremes of age, pregnancy, and in catheterized patients
Gross anatomy of upper and lower urinary tract
Histology / Embryology of upper and lower urinary tract
Pathology of the urinary system.
Clinical Presentations:
Lecturer
Number
Title
Department
Male
Female
1
Case studies in chronic renal failure.
Medicine
S. Shohaib
F. Beladi
2
Case studies in acute renal failure.
Pediatrics
Salah Mourshidy
J. Kari
Self-Directed Learning:
Lecturer
Number
1
2
Title
i.
ii.
Department
urinary organic acid excretion
the concept of fractional
Clinical Biochemistry
excretion of solutes
Cystic Diseases of the Kidney
The Urinary System Module
Pathology
Male
Female
A.Abdulrafae
A. Elgharib
G. Mokhtar
O.Nassif
Page 4 of 79
King Abdulaziz University
Faculty of Medicine
OUTCOMES OF THE MEDICAL UNDERGRADUATE
CURRICULUM
1) Knowledge
Graduate should have sufficient knowledge and understanding of:
a. The normal structure, function and development of the human body and
interaction between body and mind
b. The normal pregnancy and child birth, the principles of antenatal and postnatal
care
c. The aetiology, pathogenesis, clinical presentation, natural history and
prognosis of common physical and mental disease, particular those which pose
acute danger to function, life or the community.
d. Common diagnostic tests and procedures, their uses, limitations and costs
e. The management of common conditions including pharmacological,
psychological, physical and nutritional therapy
f. The principles of health education, disease prevention, rehabilitation and the
care of the suffering and dying.
g. The principles and ethics related to health care and the Islamic and legal
responsibilities of the medical profession
2) Skills
Graduate should acquire the skills of
a. Take a tactful, accurate and organised medical history
b. Perform a gentle and accurate physical and mental examination
c. Integrate history and physical examination to reach a provisional diagnosis of
differential diagnosis
d. Select the most appropriate and cost effective diagnostic procedures
e. Formulate a management plan
f. Counsel patients and families clearly regarding diagnostic and therapeutic
procedures before eliciting consent
g. Perform common life-saving procedures
h. Use information resources to obtain further knowledge and interpret medical
evidence critically and scientifically
i. Communicate clearly and considerately with other health professionals
3) Attitudes
Graduate should have the attitude of
a.
b.
c.
d.
Respect for every human being and abide by relevant Islamic ethics
A desire to ease pain and suffering
Willingness to work in a team with other health professionals
Responsibility to remain a life-long learner and maintain the highest ethical
and professional standards
e. Referring patients to other health professional when needed
f. A realization that it is not always in the interest of patients to pursue every
diagnostic or therapeutic possibility
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
CURRICULUM MAP
YOU ARE HERE…
Year 1
Phase I
Year 2
Year 3
Phase II
Year 4
Year 5
Year 6
Internship
Phase III
Phase 2 is the stage towards achieving the objectives specified in the curriculum. The aim is
to implement full-time integrated study of the MBBS program. This phase will include
knowledge, skills and attitudes, particularly attitudes toward the learning process. The
curriculum philosophy in Phase 2 is enforcing the development of a mixture of teaching
approaches. By the end of Phase 2, you should be ready for phase 3 of the learning process.
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
PHASE II
SECOND YEAR
III- SEMESTER
IV - SEMESTER
Foundation Course
Musculoskeletal System
General Anatomy
Cardiovascular System
Cells and Tissues
Respiratory System
Embryology
Renal and Urinary System
Biochemical Basis of Medicine
Immune, Blood, lymphatic System
Pathology
Basic Emergency Care
Islamic Studies (1)
Islamic Studies (2)
STRUCTURE OF THE MODULE
TIMETABLED HOURS:
31 Lectures, 12 Practicals
TEACHING
DEPARTMENTS:
Anatomy, Clinical Biochemistry, Embryology,
Histology, Medicine, Microbiology, Nuclear Medicine,
Pathology, Pediatric, Pediatric Nephrology,
Pharmacology, Physiology, Radiology, Urology
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
INTRODUCTION
WELCOME to the urinary module. This course aims to introduce you to the anatomy,
physiology, biochemistry and pathology of the urinary system and the different common
diseases that affect the system.
AIMS & OBJECTIVES
AIMS:
The aims of this module is to:
 Acquire sufficient knowledge of the macroscopic and microscopic structure of the
urinary tract in order to understand normal function and common clinical
abnormalities.
 Acquire skills and working knowledge and understanding of the principles and
concepts applicable to the Urinary System, in general.
 Appreciate the role of the kidney in controlling the volume and composition of body
fluid and the way in which they respond to departures from normal parameters of
volume, electrolyte concentration and systemic haemodynamics.
 Understand renal cellular function in order to appreciate the basis of relevant
therapeutics.
 Describe normal micturition, the reasons of oliguria, and such common conditions as
glomerulonephritis, pyelonephritis, urinary tract infection, haematuria, proteinuria,
and chronic renal failure.
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
OBJECTIVES:
By the end of this module, the student should be able to:
 Outline the structure and relations of the kidney, ureters, bladder and urethra in the
male and the female, and the ways in which these structures may be imaged and
examined
 Identify and describe the fluid compartments of the body, their electrolyte
composition, and state the normal concentrations of major electrolytes in extracellular
fluid, blood and urine.
 Describe the histological structure of the kidney, and identify the component parts of
the nephron
 Identify and describe the structure of the glomerulus and the process of glomerular
ultrafiltration, the processes underlying the formation of dilute and concentrated urine
 Describe renal responses to extracellular fluid volume depletion and other common
alterations in systematic haemodynamics.
 Understand the mechanisms of controlling sodium and potassium balance
 Understand the role of the kidney in maintaining acid base balance, and interpret
uncomplicated cases of acid base disturbances
 Identify and describe the classes of diuretics and their mode of action
 Describe the bladder and control of micrurition
 Describe
common
pathological
changes
in
the
urinary
tract,
including
glomerulonephritis, pyelonephritis, neoplasia, and prostate enlargement.
 Describe and demonstrate the features, consequences, and management of acute and
chronic renal failure.
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
TEACHERS CONTACTS
Name
Department
Prof. Mohammed Badawoud
Coordinator
Prof. Jameela Kari
Coordinator
Prof. Adil Abdelrafee
Clinical
Biochemistry
Prof. M. M. Rawas
Radiology
Dr. Fatma Albiladi
Medicine
Dr. "Sawsan Jalalah
Pathology
Dr. Khaled Ezam
Physiology
Prof. Mai abdulalim
Dr. Ahmed Saiad
The Urinary System Module
Pharmacology
Urology
E-mail
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
Page 10 of 79
King Abdulaziz University
Faculty of Medicine
ASSESSMENT
METHODS OF ASSESSMENT
Type of exam:
a) Written: 40% of total marks
b) Practical: 20% of total marks
c) Course work & continuous assessment: 40% of total marks
I.
Written Exam:

This will be used as a method of assessment for the final exam.

Total time: 2 hours.

Contributing departments: all departments involved in the teaching of the module.

Types of questions:
o MCQs
II.
Practical Exam:

This will be used as a method of assessment for the final exam.

Total time: 2 hours.

Contributing departments: Anatomy, Biochemistry and Pathology.

Types of questions:
o Spotting (50% of total exam mark):

With MCQs (pathology)

Without MCQs (anatomy).
o OSPE (50% of total exam mark).

Time given for each type of question:
o Spotting:

With MCQs: 2 minutes

Without MCQs: 45 seconds
o OSPE (50% of total exam mark): 5 minutes per station
NB: Biochemistry practical exam questions should be given the time for 3 stations (15 minutes) as the student
is usually asked to run an experiment.
The Urinary System Module
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King Abdulaziz University
III.
Faculty of Medicine
Course work and continuous assessment:

This will be used as a method of assessment throughout the course during
tutorials.

Contributing departments: all departments involved in the teaching of the module.

Types of questions:
o MCQs
o Assignments: oral presentations or written research projects, one per
student per module (this will be left for each department to be designed as
appropriate).
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Assessment Tools
Exams: Written Exams will include short answer and multiple choice questions (MCQs).
They will cover material presented in lecture, readings, and discussion. All exams must be
taken on the date scheduled. In case of an emergency, the coordinator must be notified. No
make-up exams will be provided if you fail to notify and discuss your situation with the
coordinator. Practical Exam will be in an OSPE (Objective Structured Practical Exam)
format, where you will pass through several stations representing all the subjects.
Assignment paper: The purpose of the work is to provide you with the opportunity to
explore an area of basic medical sciences or medical education in depth. The paper is to be a
10-15 page literature review of the topic will constitute 20% of your final grade. Policy:
Topics must be approved in writing by the coordinator. Directions for topic submission will
be discussed during the first week of class. Topics that have not been approved will not be
accepted.
All papers must reference a minimum of eight references from refereed journals. All papers
must be typed, double-spaced, have 1 inch margins.
Note: We will be making the journey from "womb to tomb" in weeks. Therefore, this
course requires an intensive coursework load. Class attendance and participation are
extremely important to your learning and as such are considered in the evaluation of your
course grade. This course is recommended for students that can make the required time and
energy commitment. If there is anything that the coordinator can do to assist you during the
course, please feel free to contact him.
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Icons (standards)
The following icons have been used to help you identify the various experiences
you will be exposed to.
Learning objectives
Content of the lecture
Independent learning from textbooks
Independent learning from the CD-ROM.
The computer cluster is in the 2nd floor of the medical library, building
No. 7.
Independent learning from the Internet
Problem-Based Learning
Self- Assessment (the answer to self-assessment exercises will be
discussed in tutorial sessions)
The main concepts
The Urinary System Module
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Topic Outlines
The Urinary System Module
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Lecture 1:
Anatomy of the kidney, ureter, urinary bladder and urethra.
Student Notes:
Department: Anatomy
.
Lecturer:
Dr. H.Saleh &prof. Amira Elhaggagy
At the end of the lecture you should be able to:
1) Learning the anatomy of the kidney, ureter,
urinary bladder and urethra.
1. Structure, site, arterial supply, nerve
supply, venous drainage, lymphatic
drainage and relations of the kidney.
2. Site, arterial supply, nerve supply, venous
drainage, lymphatic drainage and
relations of the ureter.
3. Site, arterial supply, nerve supply, venous
drainage, lymphatic drainage and
relations of the urinary bladder and
urethra.
Clinical anatomy for medical students (R Snell).
(Insert here handouts and additional
pages for notes if needed)
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Lecture 2:
Development of the kidney, ureter, urinary bladder and urethra.
Student Notes:
Department: Anatomy
.
Lecturer:
Dr. M. Abdulwahab & Dr. H.Saleh
At the end of the lecture you should be able to:
1) Learning the development of the kidney,
ureter, urinary bladder and urethra.
2) Learning the Congenital anomalies of the
kidney, ureter, urinary bladder and urethra.

Development of pronephros,
mesonephros, metanephros.

Development of Cloaca, urogenital sinus,
anal canal.
Langman’s medical embryology.
(Insert here handouts and additional
pages for notes if needed)
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Lecture 3:
Introduction to renal physiology.
Department: Physiology
Lecturer: Dr. H. Al-Kadi and Dr. K. Ezam
Student Notes:
.
At the end of the lecture you should be able to:
1. Describe the different functions of the kidney
and its role in homeostasis.
2. Describe the different parts of the nephron.
3. Distinguish between the 2 different types of
nephrons.
4. State the physiological significance
of the juxtaglomerular apparatus.








Role of the kidney in homeostasis, as its role
in water and electrolytes balance, regulation
of plasma volume, and acid-base balance.
Other functions of the kidney including
excretory, endocrine and metabolic
functions.
Description of the functional unit of the
kidney (nephron).
The differences between cortical and
juxtamedullary nephrons.
The structure of the glomerular membrane
(filtration barrier).
The JGA and its physiological significance.
One major function of the kidney is to
regulate excretion of substances at a rate that
exactly balances their input into the body
and, thereby, maintain total body
homeostatic balance for many substances.
A second major function of the kidney is to
regulate blood volume, blood osmolarity, and
total body sodium in a way that determines
average blood pressure.
(Insert here handouts and additional
pages for notes if needed)
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Continue … Lecture 3: Introduction to renal physiology …
Student Notes:
1) Vander’s Renal Physiology. Eaton D.C.
and Pooler J.P. 6th edition (2004), Lange
Medical Books/ McGraw-Hill Medical
Publishing Division.
2) Human Physiology from cells to systems.
Sherwood L. 6th edition (2007), Thomson
Brooks/Cole.
3) Review of Medical Physiology. Ganong
W.F., 22nd edition (2005), Lange Medical
Books/ McGraw-Hill Medical Publishing
Division.
4) Textbook of Medical Physiology. Guyton
A.C. and Hall J.E., 11th edition (2006),
Elsevier Saunders.
Interactive Physiology 9 - system suite (version
1.0) - Urinary system (Bnjamin Cummings),
ISBN 0-8053-6126-X.
http://www2.kumc.edu/ki/physiology/index.htm
http://www.kidneypatientguide.org.uk/site/HDanim.
html
Knowing the normal functions of the kidney, name 3
problems a patient with renal failure may suffer
from?
The Urinary System Module
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.
King Abdulaziz University
Faculty of Medicine
Lecture 4:
Histology of the kidney, ureter, urinary bladder and urethra.
Student Notes:
Department: Anatomy
.
Lecturer:
Dr. R.Hamdi & Dr. S.Al-Sagaaf
At the end of the lecture you should be able to:
1) Learning the histological structure of the
kidney, ureter, urinary bladder and urethra.
1. The histological structure of the kidney
(capsule, cortex, medulla, cortical
labynith, renal corpuscles, glomerulus
and juxtraglomerular apparatus).
2. The histological structure of the ureter
(different layers of the wall).
3. The histological structure of the urinary
bladder and the urethra (different layers
of the wall).
Color text book of histology (Gartner L.P. and
Hiatt J.L.)
(Insert here handouts and additional
pages for notes if needed)
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Lecture 5:
Congenital anomalies of the kidney, ureter, urinary bladder and urethra.
Student Notes:
Department: Anatomy
.
Lecturer: Dr. Dr. M. Abdulwahab & Dr. H.Saleh
At the end of the lecture you should be able to:
1) Learning the Congenital anomalies of the
kidney, ureter, urinary bladder and urethra.
Langman’s medical embryology.
(Insert here handouts and additional
pages for notes if needed)
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Lecture 6:
Renal blood flow and its control.
Department: Physiology
Lecturer: Dr. H. Al-Kadi and Dr. K. Ezam
Student Notes:
.
At the end of the lecture you should be able to:
1) Define renal blood flow (RBF), renal plasma
flow (RPF), and filtration fraction and give
normal values for each.
2) Define autoregulation of RBF and describe
the mechanisms underlying autoregulation.
3) How does the sympathetic nervous system
influence RBF?
4) Which hormones regulate renal blood flow?








Definition and normal values for renal blood
flow (RBF), renal plasma flow (RPF), and
filtration fraction.
The relation between flow, pressure and
vascular resistance in an organ.
Definition of autoregulation of RBF and its
adaptive value.
Mechanisms of autoregulation: the myogenic
and tubuloglomerular feedback.
The direct effects of the renal sympathetic
nerves on renal arterioles and how these
influence RBF.
The reflexes that cause renal sympathetic
nerve activity to increase and the adaptive
value of this increase.
The different vasoconstrictor and vasodilator
hormones and locally acting vasoactive
substances that influence RBF.
RBF is much higher than required for
metabolic needs and is regulated for
functional reasons, not metabolic demands.
(Insert here handouts and additional
pages for notes if needed)
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Continue … Lecture 6: Renal blood flow …
Student Notes:
1) Vander’s Renal Physiology. Eaton D.C.
and Pooler J.P. 6th edition (2004), Lange
Medical Books/ McGraw-Hill Medical
Publishing Division.
2) Human Physiology from cells to systems.
Sherwood L. 6th edition (2007), Thomson
Brooks/Cole.
3) Review of Medical Physiology. Ganong
W.F., 22nd edition (2005), Lange Medical
Books/ McGraw-Hill Medical Publishing
Division.
4) Textbook of Medical Physiology. Guyton
A.C. and Hall J.E., 11th edition (2006),
Elsevier Saunders.
Interactive Physiology 9 - system suite (version
1.0) - Urinary system (Bnjamin Cummings),
ISBN 0-8053-6126-X.
http://www.uhmc.sunysb.edu/internalmed/nephro/w
ebpages/Part_A.htm
Explain why the administration of nonsteroidal antiinflammatory drugs is not recommended for patients
with severe reductions in GFR and RBF.
The Urinary System Module
Page 23 of 79
.
King Abdulaziz University
Faculty of Medicine
Lecture 7:
Renal function: Glomerular filtration and its control.
Department: Physiology
Lecturer: Dr. H. Al-Kadi and Dr. K. Ezam
Student Notes:
.
At the end of the lecture you should be able to:
1. Define the basic renal processes that result in
urine formation.
2. Explain how glomerular filtrate is formed.
3. Describe the composition of the glomerular
filtrate.
4. State the main determinants of solute
filterability.
6. Define glomerular filtration rate (GFR) and
state its normal value.
7. Predict the forces involved in glomerular
filtration.
8. List the direct determinants of GFR and the
factors that influence them.







The basic renal processes that result in urine
formation: glomerular filtration, tubular
reabsorption, and tubular secretion.
Formation of the glomerular filtrate, and
forces that favor filtration and those that
oppose filtration.
The composition of the glomerular filtrate
and the factors that determine molecule
filterability (molecular size and electrical
charge).
Definition of GFR, its normal value and the
formula for the determinants of GFR
(filtration coefficient x net filtration
pressure).
How arterial pressure, afferent and efferent
arteriolar resistances determine glomerular
capillary pressure.
What factors may affect Bowman's capsule
hydrostatic pressure and plasma colloid
osmotic pressure.
How mesangial cells might alter filtration
coefficient.
The Urinary System Module
(Insert here handouts and additional
pages for notes if needed)
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King Abdulaziz University
Faculty of Medicine
GFR varies with the net filtration pressure (NFP)
and capillary filtration coefficient.
1) Vander’s Renal Physiology. Eaton D.C.
and Pooler J.P. 6th edition (2004), Lange
Medical Books/ McGraw-Hill Medical
Publishing Division.
2) Human Physiology from cells to systems.
Sherwood L. 6th edition (2007), Thomson
Brooks/Cole.
3) Review of Medical Physiology. Ganong
W.F., 22nd edition (2005), Lange Medical
Books/ McGraw-Hill Medical Publishing
Division.
4) Textbook of Medical Physiology. Guyton
A.C. and Hall J.E., 11th edition (2006),
Elsevier Saunders.
Interactive Physiology 9 - system suite (version
1.0) - Urinary system (Bnjamin Cummings),
ISBN 0-8053-6126-X.
http://www.uhmc.sunysb.edu/internalmed/nephro/w
ebpages/Part_A.htm
A drug was noted to cause a decrease in GFR.
Identify 4 possible actions of the drug that might
decrease GFR.
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Lecture 8:
Renal regulation of acid-base balance. Regulation of potassium balance.
Student Notes:
.
Department: Clinical Biochemistry
Lecturer:
Prof. A.Abdulrafae & A. Elgharib
At the end of the lecture you should be able to:
1) Describe the role of the kidneys in regulating
extracellular fluid pH.
2) Describe the renal regulation of potassium.

The sources of hydrogen ion gain and loss.

Renal handling of bicarbonate.

Addition of new bicarbonate by the kidneys.

Renal handling of hydrogen-ion.

Control of hydrogen ion secretion by the
renal tubules.

Urine buffers.

Proximal tubular production of ammonium
ion from glutamine.

Excretion of ammonium ion in urine
(addition of new bicarbonate to the blood).

Renal handling of potassium ion
(reabsorption and secretion).

Factors affecting potassium excretion:
plasma potassium level, aldosterone, and
acid-base balance.
(Insert here handouts and additional pages
for notes if needed)
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Lecture 9:
Renal function: Tubular processing of the glomerular filtrate: tubular
reabsorption and tubular secretion.
Student Notes:
.
Department: Physiology
Lecturer: Dr. H. Al-Kadi and Dr. K. Ezam
At the end of the lecture you should be able to:
1. Define the renal processes: Tubular
reabsorption & tubular secretion.
2. Define transport maximum (Tm), renal plasma
threshold and splay.
3. Describe the mode of reabsorption of different
substances (e.g. Na+, K+, Cl-, glucose, urea,
and water).
4. Describe the mode of secretion of different
substances (e.g. K+, H+ and organic ions).







Definition of the tubular processes: tubular
reabsorption and tubular secretion.
The different transport mechanisms (active
and passive) across the tubular cells.
Definition of transport maximum (Tm), renal
plasma threshold, and splay.
The cellular mechanisms for the transport of
inorganic ions e.g. sodium, chloride,
potassium, H+, calcium and phosphate ions
by the major tubular segments.
The cellular mechanisms for the transport of
organic solutes (e.g. glucose, amino acids,
urea, creatinine, drugs) by the major tubular
segments.
The cellular mechanisms for the transport of
water by the major tubular segments.
The reabsorption of water and almost all
solutes is linked, directly or indirectly to the
active reabsorption of sodium.
(Insert here handouts and additional pages
for notes if needed)
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Continue … Lecture 9: Renal function: Tubular processing of the glomerular
filtrate: tubular reabsorption and tubular secretion.
Student Notes:
1) Vander’s Renal Physiology. Eaton D.C.
and Pooler J.P. 6th edition (2004), Lange
Medical Books/ McGraw-Hill Medical
Publishing Division.
2) Human Physiology from cells to systems.
Sherwood L. 6th edition (2007), Thomson
Brooks/Cole.
3) Review of Medical Physiology. Ganong
W.F., 22nd edition (2005), Lange Medical
Books/ McGraw-Hill Medical Publishing
Division.
4) Textbook of Medical Physiology. Guyton
A.C. and Hall J.E., 11th edition (2006),
Elsevier Saunders.
Interactive Physiology 9 - system suite (version
1.0) - Urinary system (Bnjamin Cummings),
ISBN 0-8053-6126-X.
http://www.spcollege.edu/spg/science/lancraft/bsc20
86/content/worksheets/bal_reabsecretion.pdf
If the plasma concentration of substance X is 200
mg/100 ml and the GFR is 125 ml/min, the
filtered load of this substance is---------------------.
If the Tm for substance X is 200 mg/min, how
much of the substance will be reabsorbed at a
plasma concentration of 200 mg/100ml and a
GFR of 125 ml/min?--------------------------. How
much of substance X will be excreted?---------------------.
The Urinary System Module
Page 28 of 79
.
King Abdulaziz University
Faculty of Medicine
Lecture 10:
Regulation of tubular functions
Student Notes:
.
Department: Physiology
Lecturer: Dr. K. Ezam and Al-Kadi
At the end of the lecture you should be able to:
1) To describe the nervous mechanisms that
regulates tubular function (renal sympathetic
nerves.
2) To describe the hormonal mechanisms that
regulate tubular function:
a) Renin-angiotensin system.
b) Aldosterone.
c) Atrial natriuretic peptides.
d) Antidiuretic hormone.
e) Parathyroid hormone.
There are multiple local, nervous, and hormonal
control mechanisms that regulate tubular functions.
An important feature of tubular reabsorption is that
the reabsorption of some solutes can be regulated
independently of others especially through hormonal
control.
All the physiological controls in the proximal
nephron affect the excretion of sodium and water
together, whereas the actions of aldosterone and
ADH in the distal nephron regulate sodium and
water excretion independently.
(Insert here handouts and additional pages
for notes if needed)
The Urinary System Module
Page 29 of 79
King Abdulaziz University
Faculty of Medicine
Continue … Lecture 10: Regulation of tubular functions
Student Notes:
1) Vander’s Renal Physiology. Eaton D.C.
and Pooler J.P. 6th edition (2004), Lange
Medical Books/ McGraw-Hill Medical
Publishing Division.
2) Human Physiology from cells to systems.
Sherwood L. 6th edition (2007), Thomson
Brooks/Cole.
3) Review of Medical Physiology. Ganong
W.F., 22nd edition (2005), Lange Medical
Books/ McGraw-Hill Medical Publishing
Division.
4) Textbook of Medical Physiology. Guyton
A.C. and Hall J.E., 11th edition (2006),
Elsevier Saunders.
Interactive Physiology 9 - system suite (version
1.0) - Urinary system (Bnjamin Cummings),
ISBN 0-8053-6126-X.
http://www.spcollege.edu/spg/science/lancraft/bsc20
86/content/worksheets/bal_hormonecontrol.pdf
1. Conn’s syndrome is an endocrine disorder
brought about by a tumor of the adrenal
cortex that secretes excessive aldosterone in
uncontrolled fashion. Based on what you
know about the function of aldosterone,
LIST 3 prominent features of this condition.
2. What are the major renal sites of action of the
following hormones?
a. Aldosterone
b. ADH
c. Renin
d. Noradrenaline
e. Angiotensin II
The Urinary System Module
Page 30 of 79
.
King Abdulaziz University
Faculty of Medicine
Lecture 11:
The Concept of Renal Plasma Clearance
Department: Physiology
Lecturer:
Dr. H. Al-Kadi & K. Ezam
Student Notes:
.
At the end of the lecture you should be able to:
1. Define the term "renal plasma clearance".
2. Use the clearance equation and an appropriate
compound to estimate glomerular filtration rate
and renal plasma flow.
3. Distinguish between the use of inulin and
creatinine as measure of GFR.
4. Given the plasma and urine concentrations and
the urine flow rate, calculate the clearance of
any given substance.
5. Predicts whether a substance undergoes net
reabsorption or net secretion by comparison of
its clearance to that inulin.






Definition of the term clearance.
The clinical use of clearance and
significance of GFR measurement.
The criteria that must be met for a
substance in order for its clearance to be
used as a measure of GFR.
Substances that are used to measure
GFR and RBF.
Data required for clearance calculation
of any substance.
Use of renal clearance to predict the
renal handling of any substance (net
reabsorption or net secretion).
(Insert here handouts and additional
pages for notes if needed)
The Urinary System Module
Page 31 of 79
King Abdulaziz University



Faculty of Medicine
Inulin clearance is used to measure GFR
because inulin is freely filtered and neither
secreted nor reabsorbed.
Creatinine clearance is used as a practical
estimate of GFR.
PAH clearance is used as a practical
estimate of RBF.
1) Vander’s Renal Physiology. Eaton D.C.
and Pooler J.P. 6th edition (2004), Lange
Medical Books/ McGraw-Hill Medical
Publishing Division.
2) Human Physiology from cells to systems.
Sherwood L. 6th edition (2007), Thomson
Brooks/Cole.
3) Review of Medical Physiology. Ganong
W.F., 22nd edition (2005), Lange Medical
Books/ McGraw-Hill Medical Publishing
Division.
4) Textbook of Medical Physiology. Guyton
A.C. and Hall J.E., 11th edition (2006),
Elsevier Saunders.
http://glencoe.mcgrawhill.com/sites/9834092339/student_view0/chapter50/r
enal_clearance.html
List in order of decreasing renal clearance, the
following substances: glucose, urea, sodium,
inulin, creatinine, PAH.
The Urinary System Module
Page 32 of 79
King Abdulaziz University
Faculty of Medicine
Lecture 12:
Assessment of renal function
Student Notes:
.
Department: Clinical Biochemistry
Lecturer:
Prof. A.Abdulrafae & A. Elgharib
At the end of the lecture you should be able to:
1) Utilize the knowledge gained from anatomy
and physiology in assessment of renal
function.
2) Identify the laboratory procedures used to
evaluate glomerular filtration , tubular
reabsorption and secretion, and renal blood
flow
3) Discuss the advantages and disadvantages in
using urea, inulin, creatinine, beta²
microglobulin, and radionucleotides to
measure glomerular filtration
4) Given hypotet laboratory data, calculate a
creatinine clearance and determine wither the
result is normal.
5) Discuss the clinical significance of the
creatinine clearance test
6) Define osmolarity and discuss its relationship
to urine concentration
7) Given hypotet laboratory data, calculate a
free- water clearance and interprete the result
8) Given hypotet laboratory data, calculate a
PAH clearance and relate this result to renal
blood flow.
9) Describe the relationship of urinary ammonia
and titratable acidity to the production
(Insert here handouts and additional pages for
notes if needed)
The Urinary System Module
Page 33 of 79
King Abdulaziz University
Faculty of Medicine
Continue … Lecture 12: Assessment of renal …
Student Notes:
 Glomerular filtration tests
Clearance test : creatinine, insulin, B²
microglobulins
Calculation, examples and clinical
significance
 Tubular reabsorption test:
Osmolarity, osmolality and osmometers and
clinical significance
Free water excretion: calculation and clinical
significance
 Tubular secretion and renal blood flow test:
PAH test, Titrable acidity and urinary
ammonia.
 Glomerular filtration tests
Clearance test : creatinine, insulin, B²
microglobulins
Calculation, examples and clinical
significance
 Tubular reabsorption test:
Osmolarity, osmolality and osmometers and
clinical significance
Free water excretion: calculation and clinical
significance
 Tubular secretion and renal blood flow test:
PAH test, Titrable acidity and urinary ammonia.
WELL'S Biochemical basis of medicine
The Urinary System Module
Page 34 of 79
.
King Abdulaziz University
Faculty of Medicine
Lecture 13:
Control of sodium and water balance: Regulation of plasma
volume and osmolarity.
Student Notes:
.
Department: Physiology
Lecturer: Dr. H. Al-Kadi & K.Ezam
At the end of the lecture you should be able to:
1) Describes the renal mechanisms for sodium
regulation:
a) Regulation of amount filtered.
b) Regulation of amount reabsorbed.
2) Describes the renal mechanisms for
water regulation:
a) Role of osmoreceptors.
b) Role of baroreceptors.
c) Thirst.
3) Describe the role of the kidney in
long term regulation of ABP:
 through regulating ECF volume.
 role of RAAS.
Homeostasis depends on maintaining a balance
between the input and the output of all
constituents present in the ISF. Regulation of
fluid balance involves two separate components:
control of ECF volume and control of ECF
osmolarity.
The kidneys control ECF volume by
maintaining salt balance and control of ECF
osmolarity by maintaining water balance.
The kidneys maintain this balance by adjusting
the output of salt and water in the urine as
needed to compensate for variable input and
abnormal losses of these substances.


Multiple overlapping mechanisms regulate
sodium and water excretion, most are related
to blood pressure.
The kidneys are the ultimate determinant of
blood pressure in the long term via their
control of ECF volume.
The Urinary System Module
(Insert here handouts and additional pages
for notes if needed)
Page 35 of 79
King Abdulaziz University
Faculty of Medicine
Continue … Lecture 13:
Control of sodium and water balance: Regulation of plasma volume and osmolarity
Student Notes:
1. Vander’s Renal Physiology. Eaton D.C.
and Pooler J.P. 6th edition (2004), Lange
Medical Books/ McGraw-Hill Medical
Publishing Division.
2. Human Physiology from cells to systems.
Sherwood L. 6th edition (2007), Thomson
Brooks/Cole.
3. Review of Medical Physiology. Ganong
W.F., 22nd edition (2005), Lange Medical
Books/ McGraw-Hill Medical Publishing
Division.
4. Textbook of Medical Physiology. Guyton
A.C. and Hall J.E., 11th edition (2006),
Elsevier Saunders.
Interactive Physiology 9 - system suite (version
1.0) - Urinary system (Bnjamin Cummings),
ISBN 0-8053-6126-X.
http://www.spjc.edu/spg/science/lancraft/bsc2086/co
ntent/urinary.html
If the right renal artery becomes abnormally
constricted, what will happen to renin secretion by
the right kidney and the left kidney?
The Urinary System Module
Page 36 of 79
.
King Abdulaziz University
Faculty of Medicine
Lecture 14:
Urine composition and renal stones.
Student Notes:
.
Department: Clinical Biochemistry
Lecturer:
Prof. A.Abdulrafae
Dr. A. Elgharib
At the end of the lecture you should be able to:
1) Know the normal and abnormal constituents
of urine and its clinical significance.
2) Know the types of renal stones mechanism
of its formation and the role of stone
analysis inpatient management.
Urinary Composition:
Normal constituent of urine


Inorganic ions
Non-protein nitrogenous compounds:
Urea ,uric acid, creatinine, amino acids,
hippuric acid and indican

No-nitrogenous organic compound
Abnormal constituents of urine

Proteins: prerenal , renal tubular disorders
and postrenal proteinuria

Glucose: clinical significance,
Hyperglycemia and renal associated
causes of
glucosuria

Ketones and its clinical significance

Blood haematuria, hemoglobinuria and
myoglobinuria

Bilirubin and its clinical significance

Urobilinogen and its clinical significance
RENAL STONE: urinary crystal, type of stone
and stone analysis
(Insert here handouts and additional pages
for notes if needed)
The Urinary System Module
Page 37 of 79
King Abdulaziz University
Faculty of Medicine
Continue … Lecture 14: Urine composition …
Student Notes:
WELL'S Biochemical basis of medicine
The Urinary System Module
Page 38 of 79
.
King Abdulaziz University
Faculty of Medicine
Lecture 15:
Medical aspects of proteinuria and haematuria
Student Notes:
.
Department: Medicine
Lecturer:
Dr. Fatma Albeladi or
Dr. Saad Shohaib
At the end of the lecture you should be able to:
1) Definition of significant proteinuria and
haematuria
2) Understanding the pathophysiology of
proteinuria and haematuria
3) Causes of macroscopic haematuria and
microscopic haematuria
4) Classification of proteinuria: nonpathological & pathological. Significant and
nephrotic range proteinuria
5) How to diagnose haematuria and its causes
6) How to diagnose proteinuria and its causes
 Explain how to diagnose proteinuria and
haematuria.
 Discuss the methods of urine collection for
urine analysis, microscopy, 24 hours
collection
of
urine
and
urine
albumin/creatinine ratio.
 Explain the causes of causes of haematuria
and the concept of renal and systemic causes
as well as the upper renal tract causes and
lower renal tract causes.
 How to differentiate glomerular causes from
non-glomerular causes.
 Discuss the causes
nephrotic syndrome.
of
proteinuria
and
 Definition of nephrotic syndrome, its
manifestation, indicated investigation and
complication.
The Urinary System Module
(Insert here handouts and additional pages
for notes if needed)
Page 39 of 79
King Abdulaziz University
Faculty of Medicine
Continue … Lecture 17: Medical aspects of …
Student Notes:
Davidson: textbook of Medicine
Kumar: textbook of Medicine
The Urinary System Module
Page 40 of 79
.
King Abdulaziz University
Faculty of Medicine
Lecture 16:
Glomerular Diseases I
Student Notes:
Department: Pathology
Lecturer:
Dr. S. Jalalah and Dr. Taha
At the end of the lecture you should be able to:
1) Discuss the pathogenesis of glomerular injury
2) Discuss the pathogenesis of Nephrotic Syndrome
and correlate with the clinical presentation
3) Identify the glomerular causes of nephrotic
syndrome: Primary glomerular diseases and
systemic causes
4) Understand the pathogenesis of the primary
glomerular diseases presenting with nephrotic
syndrome
5) Describe
and
compare
the
glomerular
morphologic changes of these glomerular
disorders
1. Pathogenesis of glomerular injury including:
a. in situ formation of immune complexes,
deposition of circulating immune complexes,
cytotoxic antibodies, cell mediated
glomerular damage, activation of alternative
component pathway
b. mediators of glomerular injury and other
mechanisms of glomerular injury
2. Glomerular syndromes -- Nephrotic
Syndrome -- definition & pathogenesis
3. Causes of nephrotic syndrome
a. Primary glomerular diseases
b. Systemic diseases
4. Pathogenesis and morphology (light
microscopy, immunofluroscent and electron
microscopy findings) of:
a. minimal change disease
b. membranous glomerulonephritis
c. focal segmental glomrulosclerosis
d. membranoproliferative
glomerulonephritis
The Urinary System Module
Page 41 of 79
.
King Abdulaziz University
Faculty of Medicine
Continue … Lecture 16: Glomerular Diseases I
Student Notes:
Book of Basic Pathology: Kumar, Cotran,
Robbins
(Chapter 14: the kidney and its collecting system)
pp 442-451
The Urinary System Module
Page 42 of 79
.
King Abdulaziz University
Faculty of Medicine
Lecture 17:
Glomerular Diseases II
Student Notes:
.
Department: Pathology
Lecturer:
Dr. S. Jalalah and Dr. Taha
At the end of the lecture you should be able to:
1) Discuss the pathogenesis of Nephritic
Syndrome
2) Identify the glomerular causes of nephritic
syndrome: Primary glomerular diseases
and systemic causes
3) Understand the pathogenesis of the
primary glomerular diseases presenting
with nephritic syndrome
4) Describe and compare the glomerular
morphologic changes of these glomerular
disorders.
5) Discuss the causes, pathogenesis and
morphology of chronic glomerulonephritis
1. Glomerular syndromes -- Nephritic
Syndrome -- definition & pathogenesis
2. Causes of nephritic syndrome
a. Primary glomerular diseases
b. Systemic diseases
3. Pathogenesis and morphology (light
microscopy, immunofluroscent and
electron microscopy findings) of:
a. Acute proliferative (poststreptococcal,
postinfectious) glomerulonephritis
b. Rapidly progressive (cresentic)
glomerulonephritis
c. IgA nephropathy (Berger's disease)
d. Hereditary nephritis (Alport
syndrome)
4. Chronic glomerulonephritis: Causes and
morphology
(Insert here handouts and additional pages
for notes if needed)
The Urinary System Module
Page 43 of 79
King Abdulaziz University
Faculty of Medicine
Continue … Lecture 17: Glomerular Diseases II …
Student Notes:
Book of
Basic Pathology: Kumar, Cotran, Robbins
(Chapter 14: the kidney and its collecting system)
pp 451-455
The Urinary System Module
Page 44 of 79
.
King Abdulaziz University
Faculty of Medicine
Lecture 18:
Metabolic function of the kidney.
Department: Clinical Biochemistry
Lecturer:
Student Notes:
.
Prof. A.Abdulrafae & A. Elgharib
At the end of the lecture you should be able to:
1) Discuss energy provision in the kidney
2) Understand metabolic function of the
kidney
3) Know the role of the kidney in erythropoiesis

Metabolic fuel of the kidney

Glucogenesis in kidney cortex

Ammonia production in kidney

Kidney tubular transport mechanisms

Kidney and erthropoiesis
Well's Biochemical basis of medicine
(Insert here handouts and additional
pages for notes if needed)
The Urinary System Module
Page 45 of 79
King Abdulaziz University
Faculty of Medicine
Lecture 19:
Congenital anomalies of the kidney,ureter,urinarybladder and urethra.
Department: Anatomy
Lecturer:
Student Notes:
.
Dr. H.Saleh &prof. Amira Elhaggagy
TEACHING LOCATION :main auditorium
At the end of the lecture you should be able to:
1)Leaning
the Congenital anomalies of the kidney,
ureter , urinary bladder and urethra
1.
Congenital anomalies of the kidney ,
ureter, urinary bladder and urethra.
Langman,s medical embryology
(Insert here handouts and additional
pages for notes if needed)
The Urinary System Module
Page 46 of 79
King Abdulaziz University
Faculty of Medicine
Lecture 20:
Defence mechanism of the urinary tract and urinary tract infection
Student Notes:
.
Department: Pediatric / Nephrology
Lecturer:
Prof. Jameela Kari
Dr. Sharief Dousoky or Dr.Salah Murshidy
At the end of the lecture you should be able to:
1) Incidence of UTI
2) Bacterial virulence factor and host factors
which encourage UTI
3) Clinical presentation (pyelonephritis and
cystitis)
4) Method of collection of urine sample
5) How to diagnose UTI
6) Who should be investigated and with what
imaging and what follow up
7) What can be done to prevent further UTI
8) How should siblings be investigated
1) Explain how the renal tracts maintained
sterile ie regular complete bladder emptying
to wash out organisms that have ascend into
the urinary system.
2) Discuss the clinical presentation in infants
and younger age and in older age
3) Discuss the difference of the method of
collection of urine sample according the age
(MSU, SPA, Catheter, clean catch or bag
urine).
4) Who should be investigated radiologically
and why?
5) Antibiotics role in preventing further UTI
6) Siblings of children with VUR should be
investigated and why.
(Insert here handouts and additional pages
for notes if needed)
The Urinary System Module
Page 47 of 79
King Abdulaziz University
Faculty of Medicine
Continue … Lecture 20: Defence mechanism …
Student Notes:
Nelson: Pediatrics textbook
Transferable skills:
Identification of the presentation of UTI in
children and how to confirm the diagnosis.
The Urinary System Module
Page 48 of 79
.
King Abdulaziz University
Faculty of Medicine
Lecture 21:
Pathology of Renal Vascular System
Student Notes:
.
Department: Pathology
Lecturer:
Dr. O.Nassif & A.Mokhtar
At the end of the lecture you should be able to:
Discuss the effects of some systemic diseases
involving blood vessels and their complications in
the kidney
Hypertension:
1) Know the clinical classification of
hypertension and its effects on the kidney
2) Discuss the pathogenesis of Benign and
Malignant nephrosclerosis
3) Compare between the morphologic pattern
of Benign and Malignant nephrosclerosis
and correlate with the clinical presentation
Diabetes mellitus
4) Discuss the pathogenesis of diabetic
nephropathy and its complications
Thrombotic microangiopathy
5) Verify the forms of thrombotic
microngipathy, and understand the
underlying pathogenesis of childhood
hemolytic uremic syndrome
1.
2.
3.
4.
Hypertension:
Benign nephrosclerosis:
Pathogenesis & morphology
Malignant nephrosclerosis:
Pathogenesis & morphology
Diabetes mellitus
Diabetic nephropathy:
Pathogenesis & morphology
Thrombotic microangiopathy
Thrombotic microangiopathy:
Pathogenesis & morphology
(Insert here handouts and additional pages
for notes if needed)
The Urinary System Module
Page 49 of 79
King Abdulaziz University
Faculty of Medicine
Continue … Lecture 21: Pathology of renal …
Student Notes:
Book of
Basic Pathology: Kumar, Cotran, Robbins
(Chapter 14: the kidney and its collecting system)
pp 461-463
(Chapter 17: the pancreas- Diabetes mellitus)
pp570-571
The Urinary System Module
Page 50 of 79
.
King Abdulaziz University
Faculty of Medicine
Lecture 23:
Pathological aspects of tumours of the kidney &urinary tract
Student Notes:
.
Department: Pathology
Lecturer:
Dr. S.Jalalah and Dr.Taha
At the end of the lecture you should be able to:
1) Classification of Kidney tumors.
2) Classification of urinary bladder tumors.
3) Discuss the pathogenesis of kidney and
bladder carcinoma.
4) Discuss the morphology of renal carcinoma,
Wilm’s tumor & bladder carcinoma.
1) Renal cell carcinoma
a.
Pathogenesis:
- Risk factors
- Genes involved
b.
Morphology:
- Gross
- Microscopic
- Pathological variants
2) Wilm’s tumor:
a.
Pathogenesis
b.
Morphology
3) Urinary bladder carcinoma
a.
b.
Pathogenesis
Morphology
- Gross
- Microscopic
- Pathological type
(Insert here handouts and additional pages
for notes if needed)
The Urinary System Module
Page 51 of 79
King Abdulaziz University
Faculty of Medicine
Continue … Lecture 23: Pathological aspects of …
Student Notes:
Basic Pathology: Kumar, Cotran, Robbins
(Chapter 14: The kidney and its collecting
system)
pp456-469
The Urinary System Module
Page 52 of 79
.
King Abdulaziz University
Faculty of Medicine
Lecture 24:
Clinical aspects of tumours of the urinary tract
Department: Urology
Lecturer:
Student Notes:
.
Prof. H. A. Farsi
At the end of the lecture you should be able to:
1) Overview of the anatomy and cell types of
the upper and lower urinary tracts
2) Classifications of the tumors affecting the
urinary tract
3) Clinical
aspects:
epidemiology,
distribution, and risk factors
4) Clinical presentation of the tumors
affecting the urinary tract
5) Lines of methods of diagnosis and
therapeutic modalities
A brief overview of the anatomy and
cell types where the primary tumors of the
urinary tract may arise will be given. The
classification and possible origin, course, natural
history and ways of spread of the tumors of the
urinary tract are explained. The clinical aspects
including the outcome of the tumors and their
presentations are detailed along with an
introductory notes on the epidemiology,
distribution, and the possible risk factors specific
to each of the tumors of the kidney, urinary
bladder and urethra, prostate cancer, testis
tumors and penile tumors. This would include:
cigarette smoking, exposure to industrial and
other chemical products, analgesic abuse, lack of
hygiene, the presence of un-descended testis and
absent or faulty circumcision.
The diagnosis and management will be based on
the clinical presentation, screening for population
at risk, physical examination, investigations
using the different tumor markers, other
laboratory tests, imaging, endoscopic and
histopathological results.
The lines of management are either conservative,
surgical, radiotherapy or chemotherapy.
The Urinary System Module
(Insert here handouts and additional
pages for notes if needed)
Page 53 of 79
King Abdulaziz University
Faculty of Medicine
Continue … Lecture 24: Clinical aspects of …
Student Notes:
Smith’s General Urology, Lange medical book
series
The Urinary System Module
Page 54 of 79
.
King Abdulaziz University
Faculty of Medicine
Lecture 25:
Mechanisms of formation of concentrated and diluted urine
Student Notes:
.
Department: Physiology
Lecturer: Dr.H. Al-Kadi, Dr. K. Ezam
At the end of the lecture you should be able to:
1) Describe the mechanisms behind the
establishment of an osmotic gradient in the
medullary interstitium.
2) Describe the countercurrent multiplication
system.
3) Describe how urea contributes to the
hyperosmotic renal medullary interstitium
and to the urine concentration.
4) Describe the role of vasa recta as
countercurrent exchanger in maintaining the
hyperosmolarity of the renal medulla.
5) Describe how the kidneys produce dilute and
concentrated urine.
The kidneys are able to excrete urine of varying
volumes and concentrations to either conserve or
eliminate water, depending on whether the body has a
water deficit or excess respectively.
The kidneys are able to produce urine that ranges in
concentration from 50 mosm\L to 1200 mosm\L by
reabsorbing variable amounts of water from the distal
portions of the tubules.
The variable reabsorption of water is made possible
by establishment of vertical osmotic gradient ranging
from 300 mosm\L to 1200 mosm\L in the interstitial
fluid of the medulla of each kidney. This vertical
gradient remains constant regardless of the fluid
balance of the body.
The existence of the medullary osmotic gradient
depends on (1) dilution by the thick ascending limb,
(2) recycling of urea, and (3) low-volume
countercurrent blood flow in the vasa recta.
(Insert here handouts and
additional pages for notes if
needed)
The Urinary System Module
Page 55 of 79
King Abdulaziz University
Faculty of Medicine
1) Vander’s Renal Physiology. Eaton D.C. and
Pooler J.P. 6th edition (2004), Lange Medical
Books/ McGraw-Hill Medical Publishing
Division.
2) Human Physiology from cells to systems.
Sherwood L. 6th edition (2007), Thomson
Brooks/Cole.
3) Review of Medical Physiology. Ganong
W.F., 22nd edition (2005), Lange Medical
Books/ McGraw-Hill Medical Publishing
Division.
4) Textbook of Medical Physiology. Guyton
A.C. and Hall J.E., 11th edition (2006),
Elsevier Saunders.
Interactive Physiology 9 - system suite (version
1.0) - Urinary system (Bnjamin Cummings), ISBN
0-8053-6126-X.
http://www.cellphys.ubc.ca/undergrad_files/urine.swf
State whether the following statements are
True or False:
a. Complete inhibition of active sodium and
chloride transport by the thick ascending
limb of Henle's loop would virtually
eliminate the ability to excrete a
concentrated urine.
b. Active reabsorption of sodium and chloride
by the descending thin limb of Henle's loop
is a component of the countercurrent
multiplier system.
c. Block of sodium reabsorption in the
proximal tubule, loop of Henle, distal
tubule, or collecting duct will exert a
diuretic effect.
The Urinary System Module
Page 56 of 79
King Abdulaziz University
Faculty of Medicine
Lecture 26:
Principles of diuretic therapy
Department: Pharmacology
Student Notes:
.
Lecturer: Prof. O.Hassan and Prof. Mai
Abdulaleem
At the end of the lecture you should be able to:
1) Know the structure and function of the
nephron.
2) Understand renal handling of water, sodium
and other electrolytes.
3) Know definition and major classes of
diuretics.
4) Appreciate the main indications, and adverse
effects of each class of diuretics.
- Describe the structure and function of the nephron:
 Tubular function
 Acid- base balance
 Potassium balance
 Excretion of organic molecules
 Arachidonic acid metabolites and renal
function
-Appreciate different classes of diuretics: their sites
and mode of actions, classification, adverse effects
and uses in cardiac, hepatic, renal and other
conditions.
-Know possible changes of plasma electrolytes and
pH of the blood and urine caused by diuretics.
-Learn that diseases of the kidney must be taken into
account when prescribing drugs that are eliminated
by the kidney.
(Insert here handouts and additional
pages for notes if needed)
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Continue … Lecture 26: Principles of diuretic …
Student Notes:
1. Rang& Dale Pharmacology .5th edition
(2003).
2. Katzung
Basic
and
clinical
Pharmacology. 9th edition (2004).
3. Clinical Pharmacology Bennett and
Brown. 9th edition (2003).
4. Lippencott’s Illustrated Reviews
Pharmacology.3rd edition (2006).
The Urinary System Module
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.
King Abdulaziz University
Faculty of Medicine
Lecture 27:
Introduction to acute renal failure (ARF)
Department: Medicine
Lecturer:
Student Notes:
.
Dr. Fatma Albeladi or
Dr. Saad Shohaib
At the end of the lecture you should be able to:

Definition of ARF

Understanding the causes of CRF as prerenal causes, renal causes and post renal
causes

Clinical presentation

Electrolyte disturbances

Investigations required to diagnose ARF
and it's underlying cause
The lecture will cover acute renal failure from the
clinical aspect. Discussion of the pathophysiology
of underlying causes and explains the causes as
pre-renal, renal and post-renal.
Clinical presentation of pre-renal, renal and postrenal ARF. Discuss the investigations, particularly
hyperkalemia and metabolic acidosis. Give brief
idea about the management and the importance of
fluid intake adjustment according the cause if it is
pre-renal (give fluid) or renal (restrict fluid).
(Insert here handouts and additional
pages for notes if needed)
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Lecture 28:
Radiological aspects of obstructive uropathy.
Department: Anatomy / Radiology
Lecturer:
Student Notes:
.
Prof. Rawas
At the end of the lecture you should be able to:
1) Congenital anomalies anatomy
2) Congenital anomalies Radiologic diagnosis
3) Normal variants anatomy
4) Normal variants Radiologic appearance
1) Anatomical appearance and embryologic
background of congenital anomalies
2) Radiologic diagnosis by different modalities
3) Normal variants appearance and explanation
4) Normal variants appearance by radiologic
modalities to distinguish them diseases.
(Insert here handouts and additional
pages for notes if needed)
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Lecture 29:
Physiology of Micturition
Student Notes:
.
Department: Physiology
Lecturer: Dr. H. Al-Kadi and Dr.K. Ezam
At the end of the lecture you should be able to:
 Describe the functional anatomy and innervation
of the urinary bladder and its sphincters.
 Describe the relation between intravesical
pressure and volume of urine in the bladder.
 Describe the micturition reflex.
 Describe the role of higher centers in the control
of micturition.




The functional anatomy of the urinary bladder.
Autonomic supply of the urinary bladder.
Components of the micturition reflex.
Supraspinal facilitation or inhibition of micturition
by the brain.

Micturition is fundamentally a spinal reflex facilitated
and inhibited by higher brain centers,
Contraction of the circular muscle, which is called the
detrusor muscle, is mainly responsible for emptying
the bladder during micturition.

(Insert here handouts and
additional pages for notes if
needed)
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Continue... Lecture 29: Physiology of Micturition.
Student Notes:
.
1) Human Physiology from cells to systems.
Sherwood L. 6th edition (2007), Thomson
Brooks/Cole.
2) Review of Medical Physiology. Ganong W.F., 22nd
edition (2005), Lange Medical Books/ McGrawHill Medical Publishing Division.
3) Textbook of Medical Physiology. Guyton A.C.
and Hall J.E., 11th edition (2006), Elsevier
Saunders.
Interactive Physiology 9 - system suite (version 1.0) Urinary system (Bnjamin Cummings), ISBN 0-80536126-X.
http://highered.mcgrawhill.com/sites/0072495855/student_view0/chapter27/anima
tion__micturition_reflex.html
An accident victim suffers permanent damage of the
lower spinal cord and is paralyzed from the waist
down. Which of the following is true:
a. He can no longer voluntarily control micturition.
b. Bladder emptying will be controlled completely by
micturition reflex.
c. Both are true.
(Insert here handouts and
additional pages for notes if
needed)
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King Abdulaziz University
Faculty of Medicine
Lecture 30 :
Surgical aspects of hematuria
Student Notes:
Department: Urology
Lecturer:
Prof. H. A. Mosli
At the end of the lecture you should be able to:
1) Etiological (pathological) classification
2) The true and false hematuria
3) Laboratory classification: gross and
microscopic hematuria and their clinical
significance
4) Pain as a lateralizing sign
5) Clinical: initial, terminal and total
hematuria in relation to voiding
The etiological or pathological classification
includes causes of hematuria classifies hematuria as
congenital due to congenital anomalies of the
kidneys or the urinary tract, traumatic hematuria,
neoplatsic hematuria, inflammatory, metabolic and
toxic etiologies. True hematuria is defined as the
presence of blood or RBCs in the urine as verified
by dipstick or microscopic examination. False
hematuria is defined and recognized as the presence
of red dye but absence of RBCs in urine. The causes
of red discoloration of the urine will be given. The
importance of gross hematuria as an alarming sign to
the patient and the doctors sheds the light that
microscopic hematuria in the absence of gross red
discoloration of the urine may lead to reluctance in
the aggressive work-up and the false sense of
security while a serious life-threatening underlying
etiology may be present.
The presence of pain can be utilized as a lateralizing
sign. The clinical relevance for each of initial,
terminal and total hematuria is explained, the
mechanism of each and possible underlying
etiology. The diagnosis is based upon the clinical
presentation, physical examination and
investigations.
The Urinary System Module
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.
King Abdulaziz University
Faculty of Medicine
Continue … Lecture 30
Smith’s General Urology, Lange medical book
serie
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Practical 1:
Examination of prosections in urinary tract anatomy
Histology of the kidney, ureter, urinary bladder and urethra.
TUTOR: S.Al-Sagaaf and R.Hamdi
Department: Anatomy
OBJECTIVES:

Learning the histological structure of the kidney, ureter, urinary bladder and urethra.
READING:

Di Fiore’s atlas of histology with functional correlations (V.P. Eroschenko)
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Practical 2:
Radiological Diagnostic Techniques, e.g. X-rays, IVPs.
TUTOR: Radiology Registrar
Department: Radiology
OBJECTIVES:

Radiologic techniques of IVP

Radiologic techniques of ultrasound

Radiologic techniques of CT
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Practical 3:
Analysis of a random and 24-hour urine sample.
TUTOR: Prof. A.Abdulrafae and A. Elgharib
Department: Clinical Biochemistry
OBJECTIVES:

Understand the importance of preservatives in urine collection

Know the different types of urine specimens

Discuss physical and chemical examination of urine
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Practical 5:
Blood Gas Analysis
TUTOR: : Prof. A.Abdulrafae and A. Elgharib
Department: Clinical Biochemistry
OBJECTIVES:

Describe the principle involved in the measurement of pH, PCO2 and PO2.

Explain the clinical significance of the following pH and blood gas parameter: pH,
PCO2, PO2, actual bicarbonate, carbonic acid, base excess, oxygen saturation,
fractional oxyhemoglobin, hemoglobin oxygen(binding) capacity, oxygen content,
and total C02

Using the Henderson-Hasselbalch equation and blood gas data, determine wither data
are normal or represent metabolic or respiratory acidosis or metabolic or respiratory
alkalosis. Identify wither the data represent uncompensated or compensated condition

Identify some common causes of metabolic acidosis and alkalosis and respiratory
acidosis and alkalosis. State how the body attempts to compensate (kidney) for the
various condition

Discuss problem and precautions in collecting and handling samples for the pH and
blood gas analysis. Include syringes, anticoagulant, mixing, icing, and capillary and
venous sample as well as arterial samples.
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Practical 6:
Anatomy of urinary bladder and urethra.
TUTOR: A. Hajaj and H.Saleh
Department: Anatomy
OBJECTIVES:

Dissection and study of the anatomy and relations of urinary bladder and urethra.
READING:

Cunningham’s (G. Romanes).
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Practical 7:
Diagnosis, investigation and treatment of UTI
TUTOR: (Dr. Fatani)
Department: Microbiology
OBJECTIVES:

Clinical presentation of upper tract and complicated UTI

Clinical presentation of lower tract and uncomplicated (simple) UTI

Investigations on UTI: Radiological, endoscopic and recent culture methods

Management: antimicrobials, selection, hospital settings, home medications,
duration, prophylaxis

Elimination of risk factors
READING:

Smith’s General Urology, Lange medical book series
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Practical 9:
Pathology of Renal Disease I.
TUTOR: S. Jalalah and Taha
Department: Pathology
OBJECTIVES:

Gross morphology of renal carcinoma.

Gross morphology of Wilm’s tumor.

Gross morphology of Bladder carcinoma.

Gross morphology of chronic pyelonephritis.

Gross morphology of glomerulonephritis.
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Practical 10:
Pathology of Renal Diseases II
TUTOR: G. Mokhtar and O.Nassif
Department: Pathology
OBJECTIVES:

Microscopic appearance of:
-
Renal cell carcinoma.
-
Wilm’s tumor
-
Acute chronic pyelonephritis
-
T.B. kidney
-
Bladder carcinoma
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Practical 11:
Anatomy of the kidney and the ureter.
TUTOR: A. Hajaj and J. Saeed
Department: Anatomy
OBJECTIVES:

Dissection and study of the anatomy and relations of the kidney and ureter.
READING:

Cunningham’s (G. Romanes).
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Practical 12:
Investigation of CRF / ARF
TUTOR: Prof. A.Abdulrafae and Dr. A. Elgharib
Department: Clinical Biochemistry
OBJECTIVES:

Select the appropriate tests for diagnosis assessment and follow up of acute
and chronic renal failure patients.

Relate the laboratory data to the clinical findings.
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Independent learning
“Independent learning is a very essential skill for tomorrow’s doctors. We will
train you to gain this important skill by asking you to read independently about
specific topics in cardiovascular system”
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
PBL

PBL process
 The clinical scenario

Key information
 Explore the problem
 What you know
 What you need to know
 Identify learning issues
 Self/group study
 Share the knowledge
 Solve the problem
 Give feedback & reflect
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
AIMS: The aims of this module is to:

Acquire sufficient knowledge of the macroscopic and microscopic structure of the
urinary tract in order to understand normal function and common clinical
abnormalities.

Acquire skills and working knowledge and understanding of the principles and
concepts applicable to the Urinary System, in general.

Appreciate the role of the kidney in controlling the volume and composition of
body fluid and the way in which they respond to departures from normal
parameters of volume, electrolyte concentration and systemic haemodynamics.

Understand renal cellular function in order to appreciate the basis of relevant
therapeutics.

Describe normal micturition, the reasons of oliguria, and such common conditions
as glomerulonephritis, pyelonephritis, urinary tract infection, haematuria,
proteinuria, and chronic renal failure.
PRE-REQUISITES:
Before the students begin the Urinary System module, they should demonstrate the ability
to:

Describe and classify the basic histology of epithelia

Describe and understand the physical chemistry of osmotic forces, pH and buffers

Describe the factors affecting the movement of substances across cell membranes,
including the distinction between active and passive movement, and the role of
icon pumps, transporters and channels

Understand the effects of changes in blood volume upon the cardiovascular
system

Describe the basic classification of microorganisms.
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
 Learning opportunity
See before
Try to access CD-ROM series about the urinary system. The computer
cluster is in the 2nd floor of the medical library, building No. 7.
I would recommend you to use key words like hemturia the search engine
google (www.google.com). The aim is to recognize the rich resources in the
web.
. Google.com
The Urinary System Module
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King Abdulaziz University
Faculty of Medicine
Reading
The Urinary System Module
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