Anda di halaman 1dari 39

KIDNEY AND GENITOURINARY SYSTEM

BLOCK BOOK

Faculty of Medicine
Pelita Harapan University
Karawaci – Tangerang
2016/2017
PREFACE

The Kidney and Genitourinary System block is designed to fulfill specific needs of students in
relation to the existing subject of clinical disease and problems disorders of the kidney and
genitourinary system. It is expected that student can recognize problems from the beginning and
understand how to differentiate among pre-renal, renal and post renal conditions which affect the
disease. The block is divided in weekly program comprises of lectures and laboratory practices, as well
as PBL group discussion.

Lectures include basic sciences such as anatomy, physiology, histology, biochemistry,


pathology, pharmacology, radiology in order to introduce students to basic sciences pertaining to the
kidney and genitourinary system as well as to the clinical practice, that is diagnosis and treatment of the
wide variety of problems and disease from which kidney may suffer.

An integrated laboratory practice 2 hours twice weekly is to have a three dimensional aspect of
the morphology and arrangement of macroscopic and microscopic structural components of kidney and
genitourinary system.

The selected clinical cases incorporating a multidisciplinary approach are discussed to illustrate
the meeting of different disciplines. This session is carried out in small group setting discussed three
times a week and wrapped up by an expert in the plenary session.

Lippo Karawaci, 12 Februari 2017

Margaret Merlyn, dr., SpPD

Kidney & Genitourinary System / MEU - FK Page 1


LIST OF CONTENT

I. Course info
II. Teaching and Learning method
III. Departments
IV. Standard of Medical Competencies
V. Week Objectives
VI. List of disease
VII. References
VIII. Assessment
IX. Schedule
X. Approval

Kidney & Genitourinary System / MEU - FK Page 2


CHAPTER I
COURSE INFO

o Block : Kidney and Genitourinary System


o Semester : 4 (four)
o Credits : 5 credits
o Duration : 5 weeks
o Started : February 20, 2017
o Ended : March 24, 2017
o Coordinator : Margaret Merlyn, dr., SpPD

Kidney & Genitourinary System / MEU - FK Page 3


CHAPTER II
TEACHING AND LEARNING METHODS

Lectures : 6 hours/week.
Tutorial and Plenary : 7 hours/week
Laboratory practices : 4 hours/week.
Clinical skills : 4 hours/week.
Clinical exposure : 4 hours / week
Doctor, Professionalism, Ethics and Society : 2 hours

Kidney & Genitourinary System / MEU - FK Page 4


CHAPTER III
INTEGRATED DICIPLINES IN THE BLOCK

Anatomy and Embryology


Histology
Anatomical Pathology
Clinical Pathology
Biochemistry
Physiology
Microbiology
Pharmacology
Radiology
Internal Medicine-Nephrology
Surgery-Urology
Pediatric

Kidney & Genitourinary System / MEU - FK Page 5


CHAPTER IV
STANDARDS OF MEDICAL COMPETENCY

The Indonesia Medical Council has published two standards for Medical Doctor Graduate (2012)
1. Educational Standard of Medical Doctor Profession
2. Competencies Standard of Medical Doctor

THE SEVEN AREAS OF COMPETENCE ARE


1. Professionalism
2. Self-awareness and self-development
3. Effective communication
4. Management of information
5. Scientific basis of medical knowledge
6. Clinical skills
7. Management of health problems

THE COMPETENCY OF BLOCK OF KIDNEY AND GU SYSTEM


Scientific basis of medical knowledge
Core competency
Identify, explain, and plan a scientific approach to health problem-solving, based on
current medical and health science, to get an optimal result.
The graduate is able to:
Apply the concepts and principles of biomedical, clinical, and behavioural science,
and public health, appropriate to the delivery of primary health care.
Summarize an appropriate interpretation of the history, physical examination, and
laboratory tests for Kidney and Genitourinary disorders.
Explain the Kidney and Genitourinary disorders in terms of the principles of the
basic medical sciences, pathogenesis and pathophysiology.
Explain the molecular and cellular aspects of the Kidney and Genitourinary
disorders, based on an understanding of the normal mechanisms of the human
body.
Explain the physiological and the molecular goals of treatmentinKidney and
Genitourinary disorders.

Kidney & Genitourinary System / MEU - FK Page 6


Explain the rational management of the Kidney and Genitourinary disorders, based
on clinical-epidemiology, pharmacology, physiology, diet, exercise, and behavioural
change.
Justify the chosen intervention based on pharmacology, physiology, nutrition,
exercise and behavioural change in Kidney and Genitourinary disorders.
Explain the possibility of drug interactions and side effects.
Explain the benefit of dietary therapy in the management of Kidney and
Genitourinarydisorders.
Summarize an appropriate interpretation of the history, physical examination, and
laboratory tests of Kidney and Genitourinarydisorders.
Explain the clinical and laboratory data to determine the diagnosis of Kidney and
Genitourinary disorders.

Levels of competencies expected to be accomplished at the end of Medical Doctor Degree


program:
Level of Competencies 1
A Medical Doctor is able to identify and to situate clinical features of the diseases when reading
references. In correspondences, he is able to identify these clinical features, and know how to
obtain further information. This level indicates overview level. When facing a patient with these
clinical features, and then assuming the diseases, the Medical Doctor directly refers.
Level of Competencies 2
A medical Doctor should be able to make a clinical diagnosis based on physical examination and
further examination requested (for example: basic laboratory examination or X-ray). Medical Doctor
is able to refer immediately to relevant specialist and able to manage afterward.
Level of Competencies 3
3a. A medical Doctor should be able to make a clinical diagnosis based on physical examination
and further examination requested (for example: basic laboratory examination or X-ray).
Medical Doctor is able to decide and provide initial management and refer to relevant specialist
(not an emergency case).
3b. A medical Doctor should be able to make a clinical diagnosis based on physical examination
and further examination requested (for example: basic laboratory examination or X-ray).
Medical Doctor is able to decide and provide initial management and refer to relevant specialist
(emergency case).

Kidney & Genitourinary System / MEU - FK Page 7


Level of Competencies 4
A medical Doctor should be able to make a clinical diagnosis based on physical examination and
further examination requested (for example: basic laboratory examination or X-ray). Medical Doctor
is able to decide and independently manage problem comprehensively.

Kidney & Genitourinary System / MEU - FK Page 8


CHAPTER V
WEEK OBJECTIVE

LECTURE
Week 1
Theme : GLOMERULAR DISEASE
OBJECTIVES
Student should be able to:
1. Complete medical history and physical examination, a thorough examination of the urine, blood
and urine chemistry examinations as indicated are essential initial steps in the workup of any
patient
2. Describe the physiology and hormonal regulation of :
a. Renal tubular sodium handling
b. Water loss or reabsorption
3. Describe the various body fluid compartments, specifically be able to discuss the distribution of
solutes and solvents in each and their relationships
4. Explain the mechanism of action of diuretics with particular reference to the main sites of
transport/ action
a. Proximal convoluted tubule
b. Loop of Henle
c. Distal convoluted tubule
d. Collecting duct
5. Describe the strengths and weakness of various methods of estimating renal function including:
a. Serum creatinine
b. Creatinine clearance
c. Nuclear medicine glomerular filtration
d. Prediction equation (eGFR)
6. Recognize the medical renal diseases are those that involve principally the parenchyma of the
kidney
7. Interpret common findings on urinary dipstick; including the presence of :
a. Glucose with or without ketones
b. Nitrites and/or WBC
c. Hematuria or proteinuria

Kidney & Genitourinary System / MEU - FK Page 9


8. Recognize, identify and explain the likely meaning for commonly occurring microscopic
elements, specifically :
a. Cast (RBC, hyaline, coarse/fine granular)
b. Crystals (calcium oxalate, triple phosphate, uric acid, cystine)
c. Cellular elements (WBC, RBC –eumorphic or dysmorphic)
9. Describe the major pathogenesis mechanisms of glomerular disease
10. Describe the clinical and laboratory findings, microbiologic findings, associated with diagnosis
of urinary tract infections.
11. Identify the hereditary renal disease to permit early diagnosis for detection and genetic
counseling.

LECTURE 1
Duration : 50 minutes
Topic : Histology of kidney
Lecturer : Jan Tambayong dr., PHK
Objective :
Students should be able to
1. Explain the microscopic structure of nephron

LECTURE 2
Duration : 50 minutes
Topic : Overview of Pathological aspect in Kidney diseases
Lecturer : Darti Isbandiati dr., SpPA, MS
Objective :
Students should be able to
1. Describe the Pathophysiological aspect in Glomerular disease
2. Describe morphological changes in glomerular and tubular diseases
3. Describe histological characteristic of each type glomerulonephritis
4. Describe morphological changes of glomerulus in each type of nephrotic syndrome

Kidney & Genitourinary System / MEU - FK Page 10


LECTURE 3
Duration : 50 minutes
Topic : Function of kidney
Lecturer : Robert, dr.
Objective :
Students should be able to
1. Explain the segmentation of the nephron (glomerulus, proximal tubule, intermediate tubule and
distal tubule)
2. Explain the segmentation of collecting duct system
3. Describe biochemical, structural-functional relationship between the part of the nephron and
collecting duct system

LECTURE 4
Duration : 50 minutes
Topic : Structure of the Kidney and Genitourinary system
And male reproduction system
Lecturer : Bernard Hutabarat, dr., PAK
Objective :
Students should be able to:
1. Describe the structure of kidney and Genitourinary system
2. Describe the blood supply of kidney and Genitourinary system
3. Describe the innervations of kidney and Genitourinary system
4. Describe the structure of male genitalia
Describe the blood supply and innervations of male genitalia

LECTURE 5
Duration : 50 minutes
Topic : Glomerulonephritis and Nephrotic Syndrome in Children.
Lecturer : Fransisca Handy, dr, SpA
Objective :
Students should be able to
1. Recognize the clinical manifestation of glomerular renal disease (varying degress of hematuria,
excretion of characteristic formed elements in the urine and proteinuria )

Kidney & Genitourinary System / MEU - FK Page 11


2. Describe the current classification of glomerulonephritis in children based on the mechanism,
the presence and the localization of immune aggregates in the glomeruli
3. Describe the treatment, prognosis and complication from the disease
a. Describe essential diagnostic and general considerations
b. Describe most cause of nephrosis in children
c. Describe clinical findings and labotarory findings in nephrosis
d. Determine differential diagnosis, treatment and prognosis depend on the basic
responsible for nephritic syndrome in children

LECTURE 6
Duration : 50 minutes
Topic : Glomerulonephritis and Nephrotic Syndrome in Adult
Diseases of the renal tubules and interstitium.
Lecturer : Andree Kurniawan, dr. SpPD
Objective :
Student should be able to:
1. Recognize the clinical manifestation of glomerular renal disease (varying degrees of hematuria,
excretion of characteristic formed elements in the urine and proteinuria )
2. Describe the current classification of glomerulonephritis in Adult based on the mechanism, the
presence and the localization of immune aggregates in the glomeruli
3. Describe the treatment, prognosis and complication from the disease
a. Describe essential diagnostic and general considerations
b. Describe most cause of nephrosis in Adult
c. Describe clinical findings and laboratory findings in nephrosis
d. Determine differential diagnosis, treatment and prognosis depend on the basic
responsible for nephritic syndrome in Adult
4. Recognize the characterized from interstitial nephtiris, drug induced nephropathy, uric acid
nephropathy
5. Describe the prognosis and complication of the problem
6. Explain the mechanism of all situation depend the cause of disorders
7. Describe the anomalies of the tubules
a. Proximal tubule : defects reabsorption of amino acid, reabsorption of phosphorous-
calcium, glucose absorption and bicarbonate reabsorption

Kidney & Genitourinary System / MEU - FK Page 12


b. Distal tubule : defects of hydrogen ion secretion and bicarbonate reabsorption (Renal
Tubular Acidosis), defects of water absorption (Renal Diabetes Insipidus)

Kidney & Genitourinary System / MEU - FK Page 13


Kidney & Genitourinary System / MEU - FK Page 14
LABORATORY OBJECTIVES
INTEGRATED LABORATORY (100’)
LABORATORY 1
Topic : Anatomy of the urinary tract
Instructor :
1. Bernard Hutabarat, dr., PAK
2. Stefanus Satria Sumali, dr., M.Biomed
3. Deisy Budiono, dr.
Students should be able to
1. Identify the structure of kidney
2. Identify the blood supply of kidney
LABORATORY 2
Topic : Histology of nephron (100 minutes)
Instructor :
1. Jan Tambayong dr., PHK
2. Neneng Suryadinata, dr., M.Psi
Students should be able to
1. Describe the microscopic structure and composition of the nephron
2. Describe histology of supporting tissues
LABORATORY 3
Topic : Pathology of nephron (100 minutes)
Instructor :
1. Darti Isbandiati, dr., SpPA
3. Suga Trisakti, dr., SpPA
4. Kistiandono, dr., SpPA
Students should be able to
1. Describe glomerular and tubular morphological changes in glomerular and tubular
diseases
2. Identify histological characteristic of each type glomerulonephritis
3. Demonstrate histological characteristic in each glomerulopathy type.

Kidney & Genitourinary System / MEU - FK Page 15


Week 2
Theme : ACUTE KIDNEY INJURY
Student should be able to
1. Describe the causes of Acute Kidney Injury.
a. Prerenal renal failure
b. Functional-hemodynamic
c. Vascular
d. Parenchymal (intrarenal)
e. Postrenal
2. Describe the basic classification method for AKI and the markers used in clinical medicine for
AKI
3. Describe to describe pathophysiology of Acute Tubular Necrosis (ATN)
4. Describe the approximate incidence of AKI
5. Describe the major risk factors for AKI
6. Describe clinical marker AKI
a. Serum creatinine/GFR
b. Urine microscopy (eg. RBC casts)
c. Urine chemistry (eg. Na+, FeNa+)
7. Recognize basic pathophysiology of Acute Tubular Necrosis (ATN)

LECTURE 1
Duration : 50 minutes
Topic : Pathophysiology of Acute Kidney Injury
Lecturer : Margaret Merlyn, dr., SpPD
Objective :
Students should be able to:
1. Explain Pre-renal (cause in blood supply) : hypovolemia,hepatorenal syndrome, vascular
problems, infection
2. Explain Renal (damage to kidney itself) : toxin or medication, rhabdomyolisis, hemolysis,
multiple myeloma, systemic lupus erythematosus
3. Explain Post-renal (obstructive causes in the urinary tract) : medication, prostate enlargement
(benign/cancer), kidney stones, abdominal malignancy, obstructed urinary catheter
4. Explain that acute renal failure may be reversible if treated promptly and appropriately

Kidney & Genitourinary System / MEU - FK Page 16


LECTURE 2
Duration : 50 minutes
Topic : Acute Tubular Necrosis
Lecturer : Nata Pratama, dr.,SpPD.
Objective :
Students should be able to
1. Explain acute kidney failure or acute kidney injury, is a rapid loss of renal function due to
damage to the kidneys, resulting in retention of nitrogenous (urea and creatinine) and non-
nitrogenous waste products that are normally excreted by the kidney
2. Describe the severity and duration of the renal dysfunction
3. Explain this accumulation is accompanied by metabolic disturbances, such as metabolic
acidosis (acidification of the blood) and hyperkalemia (elevated potassium levels), changes in
body fluid balance, and effects on many other organ systems
Define the characteristic by oliguria or anuria (decrease or cessation of urine production), although non-
oliguric ARF may occur and treated as a medical emergency

LECTURE 3 & 4
Duration : 100 minutes
Topic : Urine output and Osmolarity
Lecture : Herman Mulyadi, dr., Sp.KP, PFK
Objective :
Students should be able to
1. Understand of urine output – anuria, oliguria, poliuria?
2. Discuss the normal physiology of ADH
a. Stimuli for release
b. Action of tubule
c. Driving force for water reabsorption
3. Understand osmolarity and its effect on water movement between the ICF and ECF
4. Understand the physiology of ADH, role of ADH in renal water regulation and ADH response to
changes in serum osmolarity
5. Discuss how ADH affects serum Na concentration and can result in excessive urine volume
Know the relationship between plasma sodium concentration and plasma osmolarity

Kidney & Genitourinary System / MEU - FK Page 17


LECTURE 5
Duration : 50 minutes
Topic : Fundamental of Laboratory Diagnostic of Renal Diseases
Lecture : Haryanto dr., SpPK
Objective :
Students should be able to :
1. Interpretation result of urinalysis Examination.
2. Explain pathogenesis of proteinuria , hematuria, leukocyte uria
3. Explain pathogenesis and formation of renal cast and renal crystal
4. Explain and understand Creatinin clearance test
5. Understand Laboratory examination for ruling out renal diseases

LECTURE 6
Duration : 50 minutes
Topic : Management of Acute Kidney Injury
Lecturer : Theo, dr., SpPD
Objectives :
Students should be able to:
1. Describe about resuscitation to normotension and a normal cardiac output is key
administering intravenous fluids is typically the first step to improve renal function
2. Describe about metabolic acidosis and hyperkalemia, the two most serious biochemical
manifestations of acute renal failure, may require medical treatment with sodium bicarbonate
administration and antihyperkalemic measures, unless dialysis is required
3. Describe hyperkalemia, metabolic acidosis, or fluid overload may necessitate artificial support
in the form of dialysis or hemofiltration.
4. Explain the cause, a proportion of patients will never regain full renal function, thus having end
stage renal failure requiring lifelong dialysis or a kidney transplant

Kidney & Genitourinary System / MEU - FK Page 18


LABORATORY OBJECTIVE
INTEGRATED LABORATORY (100’)

LABORATORY 1: CLINICAL PATHOLOGY


Topic : Interpretation of Clinical Pathology in Acute Kidney Injury.
Instructor : Haryanto, dr., SpPK
Objectives :
Students should be able to
1. Practice laboratory examinations for Acute Kidney Injury.
2. Demonstration of ureum and creatinine examinations.

LABORATORY 2 : ANATOMICAL PATHOLOGY


Topic : Tubular Changes in Acute Kidney Injury.
Instructor :
1. Darti Isbandiati, dr., SpPA
2. Suga Trisakti, dr., SpPA
3. Kistiandono, dr., SpPA
Objectives :
Students should be able to
1. Describe the early changes in acute kidney injury.
2. Describe the advanced (late) changes in chronic kidney disease
3. Describe the difference between Acute tubular Necrosis and Acute tubular Nephrosis
4. Describe the difference between acute and chronic injury

Kidney & Genitourinary System / MEU - FK Page 19


Week 3

Theme : URINARY TRACT OBSTRUCTION AND URINARY TRACT INFECTION


OBJECTIVE
1. Understand the outline and describe the autonomic innervations of the urinary tract,
specifically the pathophysiology of referred pain
2. Outline and describe the male normal physiology of micturion
3. Describe and know the anatomy structure of lower urinary tract and male reproductive
system and leading to infection or damage to involved organ
4. Describe obstructive disorders specifically such as kidney stones, neurogenic bladder and
its classification, tumors
5. Describe about the obstruction can be congenital or acquired and understand that
obstruction can develop acutely or evolve insidiously over weeks or month
6. Know the interference of flow urine at any site along the urinary tract
7. Understand about the obstruction causes urine accumulation behind obstruction
8. Outline a clinical practice for urinary incontinence, including : overflow incontinence, stress
incontinence, total incontinence and urge incontinence
9. Know the pathophysiologic consequences of urinary tract obstruction are related to
location, side, partial or complete, duration and underlying cause
10. Understand of the complication of urinary tract obstruction include infection and renal
failure
11. Understood diagnosis and management of Urinary Tract infection

LECTURE 1
Duration : 50 minutes
Topic : Histology of Urinary Tract
Lecturer : Jan Tambayong, dr., PHK
Objective :
Students should be able to :
1. Describe the histology of ureter
2. Describe the histology of bladder and prostate
3. Describe the histology of urethra and penis

Kidney & Genitourinary System / MEU - FK Page 20


LECTURE 2
Duration : 50 minutes
Topic : Infection of Urinary Tract and Male Genitalia
Lecturer : Cucunawangsih dr., SpMK
Objective :
Students should be understand to :
1. Describe about incidence and epidemiology of urinary infections
2. Describe the inflammatory conditions of the male genitourinary tract such as prostatitis and
related conditions, orchitis and epididymitis
3. Describe the epidemiology and trends of sexually transmitted disease
4. Describe the sexually transmitted disease such as GO, Chlamydia, etc
5. Describe about tuberculosis and parasitic and fungal infections of the genitourinary system

LECTURE 3
Duration : 50 minutes
Topic : Management of Urinary tract infection
Lecturer : Andree Kurniawan, dr. SpPD
Students should be able to:
1. Describe the pathogenesis and clinical manifestations of urinary tract infections
2. Describe the classification of urinary tract infection
3. Describe the principles of antimicrobial therapy and antimicrobial prophylaxis for urinary
infections
4. Explain about bacteremia, sepsis and septic shock and related to urinary infections

LECTURE 4
Duration : 50 minutes
Topic : Urinary tract congenital disorders and Benign prostate hyperplasia and related
entities
Lecturer : Imam, dr, SpU
Objective :
Students should be able to :
1. Describe the anomalies of urinary tract and give assessment of the disorders
2. Describe the abnormalities of the genitalia in boys and give assessment of the disorders
3. Manage the prognosis and outcome of the urinary tract congenital problems

Kidney & Genitourinary System / MEU - FK Page 21


4. Manage the prognosis and outcome of the abnormalities of the genitalia in boys
5. Describe the history and symptoms of prostate enlargement specifically know as lower
urinary tract symptoms (LUTS)
6. Describe the etiology and pathophysiology of benign prostate hyperplasia
7. Describe the management and treatment of benign prostate hyperplasia with the possibility
complication of untreated disorder

LECTURE 5
Duration : 50 minutes
Topic : Pharmacology for Urinary Tract Infection and Urolithiasis
Lecturer : Nicolaski Lumbuun, dr., SpFK
Objectives
Students should be understand to :
1. Explain the drugs used for management of urinary tract infection and urolithiasis.
2. Explain the mechanisms of action of those drugs.
3. Explain the side effects of those drugs.
4. Explain the posology and dosage of those drugs.

LECTURE 6
Duration : 50 minutes
Topic : Pathophysiology and classification of voiding dysfunction
Lecturer : Edwin Tobing, dr., SpU
Objective
Students should be able to :
1. Describe the normal lower urinary tract function : filling/storage and voiding/emptying
2. List the differentiate cause of the obstruction between mechanic or neurologic problem
3. Describe about definition and classification of urinary incontinence

Kidney & Genitourinary System / MEU - FK Page 22


LABORATORY OBJECTIVE
INTEGRATED LABORATORY (100’)
LABORATORY 1
Topic : Gram staining procedure
Instructor : Cucunawangsih dr., SpMK
Objective :
Students should be able
1. Demonstrate Gram staining procedure and wet mount microscopic examination from the
clinical specimen
2. Interpret the result of Gram staining and wet mount preparation
3. Demonstratrate of urine culture (CFU count).

LABORATORY 2
Topic : Histology of Urogenital tract
Instructor : Jan Tambayong dr., PHK
Objective :
Students should be able to
1. Describe the microscopic structure and composition of the Urogenital tract
2. Describe histology of supporting tissues

Kidney & Genitourinary System / MEU - FK Page 23


WEEK 4
Theme : CHRONIC RENAL FAILURE AND DYALISIS
OBJECTIVE
Students should be able
1. Outline and describe pathophysiology of anemia of chronic renal failure
2. Describe the role of decreased renal production of erythropoietin, iron deficiency and
anemia or chronic illness
3. Describe the effects of anemia on patients with chronic renal failure, in particular effects on
cardiovascular system and quality of life
4. Describe treatment of chronic renal failure and complications
5. Describe the logical and physiology based approach to minimizing the impact of anemia in
a patient with chronic renal failure
6. Describe the very basic principles related to performance of dialysis
7. Compare the advantages and disadvantages associated with the common strategies
available for dialysis modalities, specifically ;
a. Hemodialysis
b. Peritoneal dyalisis
c. Kidney transplantation
8. Recognize and be able to describe the effects of life with chronic kidney disease,
specifically as it relates to :
a. Life long illness
b. Need for life sustaining therapy (dialysis or transplant)
c. Impacts of “daily care needs”, time requirements and dietary and life style limitations
9. Describe to the patient and family about the rationing and/or rationalization of expensive
(dialysis) or limited source (kidney transplant)
10. Describe about management of nutrition for patient with chronic renal failure

Kidney & Genitourinary System / MEU - FK Page 24


LECTURE 1
Duration : 50 minutes
Topic : Diabetic Nephropathy
Lecturer : Margaret Merlyn, dr., SpPD
Objective :
Students should be able to :
1. List the characteristically diabetic nephropathy is associated with increase proteinuria,
hypertension, and progressive loss of renal function
2. Explain the process of progressive chronic kidney disease from diabetic mellitus
3. Describe stages of diabetic nephropathy and the types of disorders
4. Describe the clinical aspects of diabetic nephropathy

LECTURE 2
Duration : 50 minutes
Topic : Hypertension disease related to deteriorations in chronic kidney disease
Lecturer : Theo Audi Yanto dr., SpPD
Objective :
Students should be able to:
1. Describe the relation between blood pressure and the kidney
2. Describe the important pathophysiologic mechanism, clinical features, and therapy of
hypertension caused by renal parenchymal disease
3. Describe the types of renal artery disease that producing renal artery stenosis related to
lead chronic kidney disease
4. Explain about pathophysiology of reno-vascular hypertension, clinical features and
diagnostic approach to renal stenosis, reno-vascular hypertension and ischemic
nephropathy
5. Describe about hypertension disease associated with endocrine disorders
6. Describe management of patients depend of the problem that related to loss of kidney
function

Kidney & Genitourinary System / MEU - FK Page 25


LECTURE 3 &4
Duration : 100 minutes
Topic : Systemic Kidney Disease
Lecturer : Stevent Sumantri, dr., SpPD
Objective :
Students should be able to:
1. List the causes of progressive chronic kidney disease which parallel the most common
causes end stage renal disease such as diabetes mellitus and hypertensive disease as the
largest cases
2. Describe the mechanism of progression that causes renal damage such as apoptosis
triggered by ischemia, toxins, or endogen mediators of damage
3. Describe the factors contributing to pathophysiology of renal failure and each
characteristics
4. Describe the systemic effect and manifestations of uremia can affect to another system
such skeletal, cardiopulmonary, neurologic, endocrine, hematologic, gastrointestinal and
the others
5. Describe about hereditary diseases which can lead to chronic kidney disease
6. Assess clinical assessment of chronic kidney disease
Function, Proteinuria, Radiology and Biopsy

LECTURE 5
Duration : 50 minutes
Topic : Dietary considerations in patients with chronic kidney disease
Lecturer :Endang Darmoutomo, dr, SpGK
Objectives
Students should be able to :
1. Describe the impact from nutritional, metabolic and inflammatory status and nutritional
requirements of chronic renal failure condition

2. Explain disorders in the intestinal absorption, urinary, intestinal and dermal excretion and/or
metabolism of a wide array of nutrients

3. Describe patients with chronic kidney disease also prone to accumulate potential toxins

4. Describe causes of wasting or malnutrition in chronic renal failure such as inadequate


nutrient intake, increased losses of nutrients and increased net catabolism
Kidney & Genitourinary System / MEU - FK Page 26
LECTURE 6
Duration : 50 minutes
Topic : Uremic Syndrome and other complication of ChronicKidneyDisease
Lecturer : Margaret Merlyn, dr, SpPD
Objective :
Students should be able to :
1. Describe the patho-physiology and nephron adaptation in chronic kidney disease
2. Describe the pathogenesis of the anemia associated with kidney disease and discusses its
therapy
3. Describe the pathogenesis of the osteo dystrophy of chronic renal failure
4. Describe about nervous system manifestations of renal failure such as uremic
encephalopathy
5. Describe the different patho-mechanism underlying endocrine disorders in chronic kidney
disease

Kidney & Genitourinary System / MEU - FK Page 27


LABORATORY OBJECTIVE
INTEGRATED LABORATORY (100’)
LABORATORY 1
Topic : Pathologic characteristic of Urinary tract infections
Instructor :
1. Darti Isbandiati, dr., SpPA
2. Suga Trisakti, dr., SpPA
3. Kistiandono, dr., SpPA
Students should be able to:
1. Describe and identify the differences between acute and chronic pyelonephritis
2. Describe and identify morphological changes of glomerular diseases
3. Describeand identify morphological changes of male genitourinary tract infections

LABORATORY 2
Duration : 100 minutes
Topic : Urine profile
Instructor : Haryanto dr., SpPK
Students should be able to
1. Examine urine macroscopic
2. Examine urine chemistry
3. Examine urine microscopic

Kidney & Genitourinary System / MEU - FK Page 28


WEEK 5
Theme : HEMATURIA AND MALIGNANCY
Should be able to
1. Describe the abnormality associated with the common congenital anomalies of the
genitourinary tract, specifically congenital obstruction, vesicoureteral reflux, cryptochidism,
hypospadias
2. Describe the differential diagnosis of the common causes of hematuria based on either
etiological or anatomic considerations
3. Describe findings on history and physical exam that may help define the source of
hematuria, specifically :
a. Upper tract vs Bladder vs Prostate vs Urethra
b. Genitourinary specific or systemic
4. Describe the most common findings on history or exam (signs) and patient complains
(symptoms) at presentation of the following clinical problems :
a. Renal tumors
b. Bladder tumors
c. Prostate cancer
d. Scrotal tumor
5. Explain the advantages and disadvantages of the various radiological imaging techniques
as applied to the urinary tract, including :
a. Non-contrast
Ultrasound
b. Contrast enhanced
IVP
Computed tomogram scan
Magnetic resonance imaging
Specific examination: anterograde pyelography, retrograde pyelography, etc
6. Recognize, identify and describe the :
a. Normal radiography anatomy of the genituourinary tract
b. Radiographic features of renal masses, including cysts
c. Radiographic features of renal or ureteral calculi (stones)
7. Describe a cost effective and differential driven diagnostic approach to the patient with
hematuria including the indications for and cautions in the use of each radiologic imaging
8. Describe and understand to evaluate and manage patient with urological trauma

Kidney & Genitourinary System / MEU - FK Page 29


9. Describe about male reproductive and sexual function
10. Describe the indications for urological consulation and possible cystoscopy/ ureteroscopy

LECTURE 1&2
Duration : 100 minutes
Topic : Pathology of genitourinary neoplasm
Lecturer : Darti Isbandiati, dr., Sp.PA
Objective :
Students should be able to:
1. Describe the classification of renal epithelial and parenchymal tumors in children and adult
2. Describe the classification of the urothelial tumors of the upper urinary tract and lower
urinary tract (especially bladder)
3. Describe the classification and morphological of male genital tract neoplasms
4. Explain the histopathological features of the specific tumors

LECTURE 3 & 4
Duration : 100 minutes
Topic : Genitourinary Trauma and Surgical Management of Neoplasm
Lecturer : Edwin RPL Tobing dr., SpU
Objective :
Students should be able to:
1. List the classification and grading of trauma genitourinary tract
2. Examine patient with genitourinary trauma
3. Describe the management of patient with genitourinary trauma
4. Describe the right diagnostic procedure for the patient with genitourinary trauma
5. Describe the surgical management of patient with genitourinary diseases
6. Explain an approach to investigation of Hematuria
7. Describe about general management of genitourinary neoplasm
8. Describe how to manage patients depend of the advance of the tumor and related to
prognosis of the disesase

Kidney & Genitourinary System / MEU - FK Page 30


LECTURE 5 & 6
Duration : 100 minutes
Topic : Urinary Tract Imaging
Instructor : Brian, dr., SpRad
Objectives :
Students should be able to:
1. Describe the modalities of Urinary tract radiography
2. Describe anatomic landmarks and indications of abdominal plain radiography
3. Describe specific uro-radiologic investigation like excretory urography, retrograde
urography, cysto-urethrography
4. Describe indications, principles and technique of urinary tract ultrasonography
5. Describe indications, principles and technique of urinary tract computed tomography and
magnetic resonance imaging
6. Describe nuclear scintigraphy and what is the function of the examination
7. Recognize the normal radiography anatomy of the genituourinary tract
8. Recognize the radiographic features of renal masses, including cysts
9. Explain the advantages and disadvantages of the various radiological imaging techniques
as applied to the urinary tract as indication, including ultrasonography, intravenous
pyelography, computed tomography scan and magnetic resonance imaging
10. Recognize a malignancy disease from imaging of the radiology

Kidney & Genitourinary System / MEU - FK Page 31


LABORATORY OBJECTIVE

INTEGRATED LABORATORY (100’)


LABORATORY 1
Topic : Pathology characteristic of genitourinary neoplasms
Instructor :
1. Darti Isbandiati, dr., SpPA
2. Suga Trisakti, dr., SpPA
3. Kistiandono, dr., SpPA
Objectives :
Students should be able to:
1. Describe and Identify the most frequent renal epithelial neoplasm in children and
adult
2. Describe and identify the most frequent parenchym of renal neoplasm
3. Describe the most frequent bladder neoplasm.
4. Desribe and indentify the neoplasm of male genitalia tract (prostat, testis, penis).

LABORATORY 2
Topic : Urinary tract and Male Genitalia
Instructor :
1. Bernard Hutabarat, dr., PAK
2. Deisy Budiono, dr.
Objectives :
Students should be able to:
1. Identify the structure of Urinary tract and Male Genitalia
2. Identify the innervations and blood supply Urinary tract and Male Genitalia.

Kidney & Genitourinary System / MEU - FK Page 32


CHAPTER VI
REFERENCES

1. Anatomy
Clinically Oriented Anatomy 6th ed. Keith L. Moore. William & Wilkins
Atlas of Human anatomy, Frank Netter. Ciba Geigy

2. Langman’s Medical Embryology, TW Sadler. William & Wilkins

3. Histology
Basic Histology. L.C. Junquira, J. Carneiro, R.O. Kelley, 9th ed., Prentice Hall Int., 2000
Color Textbook of Histology. L.P. Gardner and J.L. Hiati, 2nd ed., Saunders, 2001

4. Physiology
 Medical Physiology, 10th ed. Guyton and Hall. W. B. Saunders Company, 2001

5. Pharmacology
Basic and Clinical Pharmacology, Katzung, 10thed, 2006

6. Standar Kompetensi Dokter Indonesia, 2012

Kidney & Genitourinary System / MEU - FK Page 33


CHAPTER VII
ASSESSMENT

ATTENDANCE
Attendance requirements and eligibility to write examinations:
Problem Based learning is an important and integral component of the UPH curriculum. This
instructional method emphasizes cooperative behavior and small group learning which for many
students, is a new way of learning. Consequently for groups to function successfully, regular full
attendance at tutorials is essential.
Attendance expectations as requirements and prerequisites to sit the examinations:
i. 100% for tutorials
ii. 100 % for clinical skills
iii. 80% for all other activities
iv. Exemptions permitted with Doctor’s certificate, event of Family crisis, disaster
or extraordinary reason with prior permission from tutor. Further criteria
according to UPH criteria for exemption.
ASSESSMENT
Description of Assessment System:
The system will include assessment of block learning, mandatory courses, assessment of
clinical skills and a comprehensive “end of year” knowledge based examination. Each
component will be given a relative value in calculating a Cumulative Score.
a. Assessment will be conducted for learning in each block and will include:
i. Knowledge based MCQ
ii. Objective structured Practical Examination (OSPE)
iii. Tutorial performance
b. Clinical skills learning will be assessed at the end of each semester using the
international standard Objective Structured Clinical Examination (OSCE)
c. A comprehensive knowledge based examination (MCQ) will be conducted at the year
end. This will cover content from all components of the 2 previous semesters.
d. The Cumulative Score calculated based on the components will be the final score and
required for a successful Pass for the YEAR
e. The Cut-off score for Pass will be determined by recognized standard setting
processes.

Kidney & Genitourinary System / MEU - FK Page 34


Assessment of Student Performance
1. Tutorial performance
Students will be assessed at the end of the block on the following performance in
tutorial sessions:
- Preparation
- Participation
- Professional Behavior
2. Knowledge Assessment
Student’s applied knowledge will be assessed at the end of each block using:
Multiple Choice Questions (MCQ)
Objective Structure Practical Examination (OSPE)
3. Clinical Skills Assessment
Student’s applied clinical skills will be assessed at the end of semester using:
Objective Structure Clinical Examination (OSCE)
4. Clinical Exposure and DPES
Student’s applied Clinical Exposure and DPES will be assessed at the end of semester
incorporated into the:
Multiple Choice Questions (MCQ)
Assignments
Presentations
Essays

Relative values:
1. At the end of the block, the relative value of the block consists of each component as
follows:
Component Percentage
1. PBL tutorials 25%
2. Knowledge (MCQ) 55%
3. Lab Practice (OSPE) 20 %

Kidney & Genitourinary System / MEU - FK Page 35


2. At the end of the year, the relative value of Cumulative Score consists of the relative value as
follows:
Component Percentage
1. MCQ comprehensive (items will cover
knowledge from all blocks within the year) 20%
2. OSCE (compile value within the year) 20 %
3. Blocks (compile value within the year) 45 %
4. Longitudinal course 15%

Passing grade at UPH is 60.00% (C) and will be determined through recognized Standards
Setting processes. Relationship to the Grading system and GPA is as indicated in the table.

Range Grade Scale


90 - 100 A 4.00
85,00 - 89,99 A- 3.70
80,00-84,99 B+ 3.30
75,00-79,99 B 3.00
70,00-74,99 B- 2.70
65,00 - 69,99 C+ 2.30
60,00- 64,99 C 2.00
55,00-59,99 C- 1.50
0,00 - 54,99 F 0.00

Kidney & Genitourinary System / MEU - FK Page 36


CHAPTER VIII
TIME TABLE

Glomerular disease Week chair : dr. Andree, SpPD


Week I 20-Feb 21-Feb 22-Feb 23-Feb 24-Feb
Time Monday Tuesday Wednesday Thursday Friday
07.15 - 08.05 PBL PBL PBL
Bahasa Indonesia
08.10 - 09.00 Discussion 1 Discussion 2 Discussion 3
Clinical Exposure III
09.05 - 09.55 L1: Histology, Jan Plenary: Merlyn
Small Group/Tutor & Field DPES I
10.00 - 10.50 L5: Paed,Fransisca Lab practice
10.55 - 11.45 lunch b reak lunch b reak L2: Pathology, Darti lunch b reak Anatomy/Histology/PA
11.50 - 12.40 Lab practice lunch b reak
Clinical Skill III Clinical Skill III Faith activity
12.45 - 13.35 Anatomy/Histology/PA
13.40 - 14.30 Lab practice L3: Physiology, Robert Lab practice
14.35 - 15.25 Anatomy/Histology/PA L6: IM, Andree L4: Anatomy, Bernard Anatomy/Histology/PA
15.40 - 16.20
16.25 - 17.15 Clinical Exposure III
17.20 - 18.10 Class
L1: Histology of kidney L4: Structure of the kidney and genitourinary system
L2: Overview of pathological aspect in kidney disease L5: Glomerulonephritis and nephrotic syndrome in childreen
L3: Function of kidney L6:Glomerulonephritis and nephrotic syndrome in Adult

Acute Kidney Injury Week Chair: dr. Nata P, SpPD


Week 2 27-Feb 28-Feb 1-Mar 2-Mar 3-Mar
Time Monday Tuesday Wednesday Thursday Friday
07.15 - 08.05 PBL PBL PBL
Bahasa Indonesia
08.10 - 09.00 Discussion 1 Discussion 2 Discussion 3
Clinical Exposure III
09.05 - 09.55 L1: IM, Merlyn
Small Group/Tutor & Field DPES I
10.00 - 10.50 L2: IM, Nata Lab practice Clinical
10.55 - 11.45 lunch b reak lunch b reak L3&4: Physiology lunch b reak Pathology/PA
11.50 - 12.40 Lab practice Clinical Herman
Clinical Skill III Clinical Skill III Faith activity
12.45 - 13.35 Pathology/PA lunch b reak
13.40 - 14.30 Lab practice Clinical L5: Clin Path, Haryanto Lab practice Clinical L6: IM, Theo
14.35 - 15.25 Pathology/PA Pathology/PA Plenary: Theo
15.40 - 16.20
16.25 - 17.15 Clinical Exposure III
17.20 - 18.10 Class
L1 : Pathophysiology of acute kidney injury L5: Fundamental of laboratory diagnostic of renal diseases
L2: Acute tubular necrosis L6: Management of Acute kidney injury
L3 & L4: Urine output and osmolarity

Urinary tract obstruction and infection Week Chair: dr. Margaret Merlyn, SpPD
Week 3 6-Mar 7-Mar 8-Mar 9-Mar 10-Mar
Time Monday Tuesday Wednesday Thursday Friday
07.15 - 08.05 PBL PBL PBL
Bahasa Indonesia
08.10 - 09.00 Discussion 1 Discussion 2 Discussion 3
Clinical Exposure III
09.05 - 09.55 L1: Histology, Jan
Small Group/Tutor & Field DPES I
10.00 - 10.50 L5: Pharmacology, Nico Lab practice
10.55 - 11.45 lunch b reak lunch b reak lunch b reak Microbiology/Histology
11.50 - 12.40 Lab practice lunch b reak
Clinical Skill III Clinical Skill III Faith activity
12.45 - 13.35 Microbiology/Histology
13.40 - 14.30 Lab practice L3: IM, Andree Lab practice L6: Surgery, Edwin
14.35 - 15.25 Microbiology/Histology L2: Microbiology, Cucu L4: Surgery, Imam Microbiology/Histology Plenary: Edwin
15.40 - 16.20
16.25 - 17.15 Clinical Exposure III
17.20 - 18.10 Class
L1: Histology of urinary tract L4: Urinary tract congenital disorders and Benign prostate hyperplasia
L2: Infection of urinary tract and male genitalia L5: Pharmacology for urinary tract infection and urolithiasis
L3: Management of Urinary tract infection L6: Pathophysiology and classification of voiding dysfunction

Kidney & Genitourinary System / MEU - FK Page 37


CRF and Hemodialysis Week Chair: dr. Stevent, SpPD
Week 4 13-Mar 14-Mar 15-Mar 16-Mar 17-Mar
Time Monday Tuesday Wednesday Thursday Friday
07.15 - 08.05 PBL PBL PBL
Bahasa Indonesia
08.10 - 09.00 Discussion 1 Discussion 2 Discussion 3
Clinical Exposure III
09.05 - 09.55 L1: IM, Merlyn
Small Group/Tutor & Field DPES I
10.00 - 10.50 L2: IM, Theo L5: Nutrition, Endang Lab practice Clinical
10.55 - 11.45 lunch b reak lunch b reak lunch b reak Pathology/ PA
11.50 - 12.40 Lab practice Clinical lunch b reak
Clinical Skill III Clinical Skill III Faith activity
12.45 - 13.35 Pathology/ PA
13.40 - 14.30 Lab practice Clinical L3&L4: Internal Med Lab practice Clinical L6: IM, Merlyn
14.35 - 15.25 Pathology/ PA Stevent Pathology/ PA Plenary, Merlyn
15.40 - 16.20
16.25 - 17.15 Clinical Exposure III
17.20 - 18.10 Class
L1: Diabetic nephropathy L5: Dietary considerations in patients with chronic kidney disease
L2: Hypertension disease related to deteriorations in chronic kidney L6: Uremic syndrome and other complication of chronic kidney disease
disease
L3 & L4: Systemic kidney disease

Hematuria and malignancy Week Chair: dr. Margaret Merlyn, SpPD


Week 5 20-Mar 21-Mar 22-Mar 23-Mar 24-Mar
Time Monday Tuesday Wednesday Thursday Friday
07.15 - 08.05 PBL PBL PBL
Bahasa Indonesia
08.10 - 09.00 Discussion 1 Discussion 2 Discussion 3
Clinical Exposure III
09.05 - 09.55 L5&6: Radiology
Small Group/Tutor & Field DPES I
10.00 - 10.50 Brian
Lab practice PA/Anatomy
10.55 - 11.45 lunch b reak lunch b reak lunch b reak lunch b reak
11.50 - 12.40 L1&2: Pathology
Lab practice PA/Anatomy Clinical Skill III Clinical Skill III Faith activity
12.45 - 13.35 Darti
13.40 - 14.30 L3&4: Surgery
Lab practice PA/Anatomy Lab practice PA/Anatomy
14.35 - 15.25 Edwin Plenary: Edwin
15.40 - 16.20
16.25 - 17.15 Clinical Exposure III
17.20 - 18.10 Class
L1&L2: Pathology of genitourinary neoplasm L5&L6: Urinary tract imaging
L3&L4: Genitourinary trauma and surgical management of neoplasm

Kidney & Genitourinary System / MEU - FK Page 38