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