Syllabus - Kidney and urinary tract segment in health (96204)

Course/Module Content:
I. Anatomy of the Kidney and Urinary Tract – 3 hours
A. General Anatomy of the kidney (Topographical screening of the kidney structure including the renal fascia and perirenal fat).
B. General Anatomy of the urinary bladder and track (Topographical, structural and functional description of the path of the Ureter, Urinary Bladder, Description of the male and female urethra, Topographical and structural description of the Prostate).
C. Imaging of the kidney in the healthy subject.

Anatomy Dissection Laboratory, 3 hours: One laboratory, 3 hours, of the urogenital system.

II. Histology – Most of the material will be given by Dr. Yonatan Kupchik along with the physiology, in addition there will beone hour of preparation for the histology laboratory (Michal Moyal-1 hour).
Functional structure of the kidney and Nephron; Bowman’s Capsule; Glomerulus; the Nephron tubules; Loop of Henle; Juxtaglomerular apparatus and its function; Cortex; Inner and outer Medulla; Macula Densa; Collecting Tubules; Blood supply to the kidney; Vasa Recta; Cilia in in kidney epithelial cells; Histological structure of the ureter; bladder and urethra.
Histology Laboratory – 2 hours. Examination of histological preparation of the kidney, bladder and ureter. Identification of different cellular and tissue structures (including blood vessels) in different regions of the kidney.

III. Kidney Physiology – 23 hours lectures, 4 hours self-study, 5 hours exercise. Lecturers – Dr. Yonatan Kupchik (21 hours), Dr. Ofer Gofrit (2 hours)

1. Introduction to the physiology of the kidney – functions of the kidney, the nephron and its parts, blood supply to the kidney, the basic process in the kidney (filtration, reabsorption and secretion), regulation of renal processes, overview of the functions of the different parts of the nephron.

2. Renal blood flow and the glomerular filtration – blood flow in the different blood vessels in the kidney, the connection between flow, resistance and blood pressure in the kidney and particularly the glomerulus, glomerular filtration (the anatomy and physics of the filtration, calculation of glomerular filtration rate (GFR) using the Starling equation, the role of oncotic and hydrostatic pressures, changing the GFR by dilation/constriction of glomerular blood vessels, filtered load), auto-regulation of the GFR.

3. Renal clearance and measurement of kidney function – the concept of renal clearance, calculation of the renal clearance for various substances, calculation of the GFR using the renal clearance of inulin, calculation of the renal plasma flow (RPF) using the renal clearance of para-amino hippuric acid, filtration fraction, measuring the GFR in practice (using creatinine).

4. Basic transport mechanisms in the kidney – trans-epithelial transport in the cortex and medulla of the kidney, trans-cellular and para-cellular transport, diffusion mechanisms, transport through channels, transporters, transport through endocytosis, the importance of the tight junctions, osmotic diuresis, concentration gradient-dependent transport, transport-max-limited transport, glucose transport in the kidney.

5. Kidney handling of organic solutes – reabsorption of organic molecules in the proximal tubules, reabsorption of proteins and peptides in the proximal tubules, secretion of organic anions and cations in the proximal tubule, the dependence of passive secretion or reabsorption on pH, renal handling of uric acid, renal handling of urea.

6. Renal handling of salts and water – overview of the electrolytes, body fluids and fluid compartments in the body, differential handling of water and salts in the different parts of the nephron (proximal tubule, loop of Henle, early distal tubule, late distal tubule and collecting duct), molecular mechanisms in each part of the nephron, diuretics and their function in different parts of the nephron, hormonal regulation of water and salt reabsorption.

7. Urine concentration – the mechanisms that enable the osmotic gradient in the kidney, countercurrent exchange, countercurrent multiplier, the development of the osmotic gradient in the kidney, the importance of the thick ascending limb of the loop of Henle in the process, urea recycling, hormonal regulation of water/salt/urea reabsorption, the role of the vasa recta in the maintenance of the osmotic gradient, handling of water and salts by the vasa recta.

8. Regulation of water and salts excretion in the kidney – goals of renal regulation of fluid volume and composition, the role of the kidney in the context of the cardio-vascular system, sensing sodium levels by the brain, blood vessels and the kidney and sending the signal to the kidney, the role of the autonomic nervous system, the renin-angiotensin-aldosterone system, the importance of the macula densa, function of angiotensin 2, function of aldosterone, the atrial natriuretic peptide, the role of the anti-diuretic hormone in controlling plasma osmolarity.

9. Renal regulation of potassium balance – potassium transport between intracellular and extracellular compartments, the role of muscle cells, molecular mechanisms of potassium reabsorption and secretion in the kidney, regulation of potassium excretion, opposing roles of aldosterone and angiotensin 2, regulation of potassium and sodium in different situations’ potassium-related pathology (hyperkalemia, hypokalemia).

10. Renal handling of acid-base balance – basic terms in acid-base balance, determining the pH in a Buffer-based system (Henderson-Haselbalch equation), bicarbonate handling by the proximal tubule, the role of the enzyme carbonic anhydrase, the role of the intercalated cells in regulation of plasma pH, defense mechanisms against changes in plasma pH, generation of new bicarbonate by the kidney, the role of titratable acids and ammonia in the excretion of hydrogen ions, regulation of renal handling of acid-base balance, pathology in acid-base balance (acidosis, alkalosis) and renal compensation.

11. Renal handling of calcium, phosphate and magnesium – basic physiology of calcium, phosphate and magnesium and the connection between them, differential handling of calcium in different parts of the nephron, cellular mechanisms of calcium reabsorption, the link between calcium and vitamin D, the role of calcitriol in the regulation of calcium reabsorption, the role of the para-thyroid hormone in the regulation of calcium reabsorption, mechanisms of renal reabsorption of phosphate, regulation of phosphate reabsorption by calcitriol and the parathyroid hormone, the role of FGF23 in the regulation of calcium and phosphate levels, phosphate-related pathology (parathyroidisms), magnesium balance, magnesium reabsorption mechanisms, regulation of magnesium reabsorption, magnesium-related pathology.

12. Kidney regulation of red blood cell production (self-study) – the role of erythropoietin, kidney reaction to hypoxia, the kidney as the ideal organ for erythropoietin synthesis.

13. Renal physiology of pregnancy (self-study) – changes in the GFR, changes in RPF, changes in renal handling of water and electrolytes.

14. Physiology of urination: The ureter as an active tubule for urine flow; The urinary bladder in filling and emptying out. Filling- sophisticated reservoir, which allow increase in filling without a corresponding increase in pressure of reabsorption; Emptying out- without residual volume. Neuronal coordination of sphincters; Female (simple) ureter and male (complicated) ureter and sex systems.

15. Functional imaging: (Nuclear Medicine) of the kidney and urinary track. The different imaging methods and their results will be described including those that permit evaluations of kidney function.