Unit 1634: Comprehensive Nephrology and Renal Care

1. Anatomy and Physiology of the Kidneys

1.1 Overview of Kidney Structure

• Macroscopic anatomy: renal cortex, medulla, pelvis
• Blood supply: renal artery, vein, microcirculation

1.2 Nephron Anatomy

• Components: glomerulus, Bowman's capsule, proximal tubule, loop of Henle, distal tubule, collecting duct
• Types of nephrons: cortical vs juxtamedullary

1.3 Kidney Functions

• Filtration processes at the glomerulus
• Reabsorption mechanisms in tubules
• Secretion processes and urine concentration
• Regulation of fluid, electrolyte balance, and acid-base homeostasis

2. Acute Kidney Injury (AKI)

2.1 Definition and Classification

• KDIGO criteria for AKI
• Stages of AKI

2.2 Causes of AKI

• Pre-renal: hypovolemia, decreased perfusion
• Intrinsic: acute tubular necrosis, glomerulonephritis
• Post-renal: obstruction

2.3 Pathophysiology

• Mechanisms of injury in different AKI types

2.4 Clinical Manifestations

• Oliguria/anuria, fluid overload, electrolyte disturbances

2.5 Diagnosis and Investigations

• Laboratory tests, imaging

2.6 Management

• Supportive care, fluid management, addressing underlying cause
• Indications for renal replacement therapy

3. Chronic Kidney Disease (CKD)

3.1 Definition and Staging

• GFR-based stages 1-5

3.2 Etiology and Risk Factors

• Diabetes, hypertension, glomerulonephritis, polycystic kidney disease

3.3 Pathophysiology

• Progressive nephron loss, fibrosis

3.4 Clinical Features

• Uremic symptoms, anemia, bone mineral disorders

3.5 Diagnostic Criteria

• Lab markers, imaging, biopsy indications

3.6 Treatment Options

• Blood pressure control, glycemic control, diet modifications
• Pharmacotherapy: ACE inhibitors, ARBs
• Preparation for renal replacement therapy

4. Renal Replacement Therapies

4.1 Hemodialysis

• Principles, vascular access, complications

4.2 Peritoneal Dialysis

• Types, procedure, benefits, and drawbacks

4.3 Kidney Transplantation

• Indications, donor types, immunosuppression, complications

5. Glomerular Diseases

5.1 Nephrotic Syndrome

• Definition, causes, pathophysiology
• Clinical features and management

5.2 Glomerulonephritis

• Types (e.g., post-infectious, IgA nephropathy)
• Presentation and treatment

5.3 Diabetic Nephropathy

• Pathogenesis, prevention, and treatment

6. Electrolyte and Acid-Base Disorders

6.1 Common Electrolyte Imbalances

• Hyperkalemia: causes, ECG changes, treatment
• Hyponatremia: types, management
• Other imbalances: hypocalcemia, hyperphosphatemia

6.2 Acid-Base Disturbances

• Metabolic acidosis/alkalosis, respiratory acidosis/alkalosis
• Compensation mechanisms
• Management strategies

7. Hypertension and the Kidneys

7.1 Relationship Between Hypertension and Kidney Disease

• Pathophysiology of hypertensive nephrosclerosis

7.2 Mechanisms of Kidney Damage

• RAAS activation, endothelial dysfunction

7.3 Clinical Implications and Management

• Blood pressure targets
• Pharmacologic agents with renal protective effects

8. Renal Stones (Nephrolithiasis)

8.1 Types of Renal Stones

• Calcium oxalate, uric acid, struvite, cystine

8.2 Risk Factors

• Dietary, metabolic, genetic

8.3 Clinical Presentation

• Pain, hematuria, infection

8.4 Diagnostic Evaluation

• Imaging modalities: ultrasound, CT scan

8.5 Treatment Options

• Medical management, lithotripsy, surgical interventions
• Dietary and lifestyle modifications

9. Pediatric Nephrology

9.1 Congenital Abnormalities

• Renal agenesis, dysplasia, obstructive uropathies

9.2 Hereditary Kidney Conditions

• Polycystic kidney disease, Alport syndrome

9.3 Management Approaches

• Growth considerations, medication dosing, family counseling

10. Geriatric Nephrology

10.1 Impact of Aging on Kidney Function

• Decline in GFR, changes in tubular function

10.2 Common Kidney Problems in the Elderly

• Increased risk of AKI, CKD, electrolyte disturbances

10.3 Management Considerations

• Polypharmacy, comorbidities, individualized care plans