Purpose Students must know

Subject 22 - Acute kidney injury, chronic kidney disease

(4 hours)

Place

Educational room, separation of nephrology or chronic haemodyalis.

Purpose

Students must know:

• 
  Principal reasons of chronic kidney insufficiency.
  
• 
  Pathogenesis of defeats of separate organs and systems, them clinical displays.
  
• 
  Classification CRI.
  
• 
  Features of clinic are on the different stages of development of CRI.
  
• 
  Instrumental and laboratory methods of diagnostics are depending on the stage of CRI.
  
• 
  Differential diagnostics.
  
• 
  Complication.
  
• 
  Treatment on the different stages.
  
• 
  Haemodyalis: essence, medical effect, testimony and contra-indication, complication.
  
• 
  A testimony to ren's transplantation.
  
• 
  Principal reasons of sharp kidney insufficiency.
  
• 
  Pathogenesis of defeats of separate organs and systems, them clinical displays.
  
• 
  Classification SRI.
  
• 
  Features of clinic and development of SRI
  
• 
  Instrumental and laboratory methods of diagnostics.
  
• 
  Differential diagnostics.
  
• 
  Complication.
  
• 
  Treatment of SRI.
  

To Able:

• 
  Based on information of inspection sick with a CRI to conduct a differential diagnosis and formulate a clinical diagnosis, define tactic and appoint treatment.
  
• 
  Based on information of inspection sick with a SRI to conduct a differential diagnosis and formulate a clinical diagnosis, define tactic and appoint treatment.
  

Professional orientation of students
SRI and CRIis investigation of most diseases pochard which considerably worsens a prognosis and is the factor of lethality at these diseases.

Base level of knowledges and abilities

№	Discipline	To know	To able
	Anatomy	Anatomic structure of rens and urinoexcretory ways	To conduct the palpation of ren
	Gistology	Structure and functioning of nephron	To analyse morphological research
	Biochemistry	Bases of nitrous exchange	To interpret biochemical blood tests
	Pathanatomy	Initially and the the second time wrinkled ren, changes in internalss and systems at CRI
	Therapy	Semiotics of diseases of rens and urinoexcretory ways	To conduct the estimation of clinical, instrumental and laboratory researches

Plan of practical employment

№	Elements of practical employments	Time(minutes)
	Verification of present's students	5
	Entrance control and his analysis	15
*	Distributing patients for Supervision ( card or clinical tasks )	10
*	Review patients or study of educational hospital chart	40
	Discussion of findings, formulation of previous diagnosis, determination of methods of additional inspection of patient, interpretation of their results, formulation of final diagnosis and plan of treatment	50
	Exercises with clinical formulations for solving clinical situation tasks	20
	Output control of knowledge and its evaluation	15
	Results and final assessment of knowledge and skills of students and tasks to self- preparation for the next lesson	5

Note: * - in the case of patients absence in clinical, practice can be made in the form of preparation and decision of situational tasks.

List of theoretical questions which are examined on employment

1. 
   Features of etiology SRI and CRI.
   
2. 
   Pathogesis of SRI and CRI.
   
3. 
   Clinical motion of CGRI is depending on stage.
   
4. 
   Classification SRI and CRI.
   
5. 
   Instrumental and laboratory methods of diagnostics
   
6. 
   Differential diagnostics.
   
7. 
   Complication.
   
8. 
   Treatment of SRI and CRI is depending on stage.
   
9. 
   Haemodyalis: essence, medical effect, testimony and contra-indication, complication.
   
10. 
    A testimony to ren's transplantation.
    

Method of leadthrough of practical employment *

On the first employment teacher hold instructing from accident (if there are such terms) which registers in the magazine of teacher's signature of student prevention.

* Students answer in writing on the tests of base knowledges entrance control. Then a teacher distributes students for kuration patients and determines them a task.

№	Task	Teasher's pointing to students	Teacher's note for students
1.	To conduct kuration of patient who has CRI : Group symptoms in syndromes, to select a leading syndrome and conduct differential diagnostics after him, to formulate a diagnosis, to appoint adequate treatment.	During an inspection to discover: Signs of disturb of rens function The reason which caused development CRI or promote it Characterised for CRI change in laboratory and instrumental information.	To turn the special attention on: signs of autointocsication and scray changes from the side of other organs and systems motion CRI, presence of disease which resulted in CRI, quality of treatment of basic diseasepresence of changes at laboratory and UZ- researches, accordance of their stage of CRI determination of tactic setting of treatment

Forms and methods of self-control

Tests

1. 
   The most frequent factor of CRI is:
   

1. 
   Glomerulonephritis
   
2. 
   Polykistos of rens.
   
3. 
   Amyloidosis of rens.
   
4. 
   Diabetic nefropatiya.
   
5. 
   Hypertensive illness.
   

1. 
   The most credible factor of bradikardia at CRI is:
   
2. 
   Hyperkaliaemia.
   
3. 
   Hypocalciaemia.
   
4. 
   Hyponatyaemia.
   
5. 
   Hypokaliaemia
   
6. 
   Hypernatyaemia.
   

Woman 48th years grumbles about a weakness, skhudnennya, decline of appetite, head pain. In youth carried a sharp glomerulonephritis. From 25-ti years is ill arterial hypertens. Did not treat oneself systematic, to the doctor applied rarely. After the conducted research found out the signs of chronic kidney insufficiency And item (kreatinine - 0,43 mmol/l). What recommendations in relation to a feed are most justified for this sick?

A. Increase of volume of liquid

B. The use of meal is with enhanceable maintenance of "alkaline" foods

C. Limitation of lipids

D. Limitation of hydrocarbons

E. Limitation of proteins*
What from the transferred reasons of sharp kidney insufficiency does belong to afterrenalic?

A. Sharp glomerulonephritis

B. Cardiac insufficiency

C. Rabdomiolis

D. Septicaemiya

E. Cholecystitis *

2. 
   The patient, 39 years appealed to the doctor with complaints about morning head pain, decline of appetite, nausea, morning vomit, periodic nose-bleeds. In 15-ti annual age carried a sharp glomerulonephritis. At an inspection the increase of arteriotony is marked to 220/130 mm of Hg., haemorragic on the skin of hands and feet, pallor of skin and mucus shells. What from the resulted biochemical indexes does have diagnostic meaningfulness in this case?
   

A. Urinary acid

B. Sodium of blood

C. Fibrinogenum

D. Bilirubin of blood

E. Kreatinine of blood *

5. 
   Patient 35 years,with a chronic glomerulonephritis 3 last years is on gemodializ, appeared interruptions in heart working, low blood pressure, growing weakness, shortbreathing. On EKG: bradicardya, atrioventricular blockage I item, high sharp indents T. The day befor - gross violation of the drinkable and dietary modes. What biochemical changes are the most reliable reason of foregoing clinical picture?
   

1. 
   Hypocalciaemia
   
2. 
   Hypernatriyaemia
   
3. 
   Hyperkaliaemia*
   
4. 
   Hypokaliaemia
   
5. 
   Hyperhydratation
   

5. 
   Woman 50 years, chronic pielonefrit, during sharpening there was decreasing combination of anti-infectives - gentamicin (80 mg 3 times on days) and biseptol (960 mg 2 times on days). Can this combination of antibiotics result in what consequences?
   

A. Glomeruloskleroz

B. Sharp adrenal insufficiency

C. CRI

D. SRI*

E. Combination of antibiotics is optimum and fully safe

A man 55 years grumbles about a general weakness, diminishing of leadingout of liquid, pain, in the area of heart of aching character. During 15 suffers on a chronic pyelonephritis, treated oneself in permanent establishments. Ob''ektivno: skin pokrovi dry, with a rather yellow tint. Ps- of 80/khv, rhythmic, AT- 100/70 mm of rt.st. During a cardiophony - tones are deaf, noise of friction of pericardium. After additional researches: kreatinine - 1,1 mmol/l, glomerular filtration 5 ml/khv. What treatment is rotined a patient?

A. Reopoliglyukin

B. Haemodialys*

C. Ksilit, Sorbitum

D. Diuretic

E. Antibiotics
9. Woman 50 years, chronic pielonefrit, during sharpening there was decreasing combination of anti-infectives - gentamicin (80 mg 3 times on days) and biseptol (960 mg 2 times on days). Can this combination of antibiotics result in what consequences?

A. Glomeruloskleroz

B. Sharp adrenal insufficiency

C. CRI

D. SRI*

E. Combination of antibiotics is optimum and fully safe

10. Patient 35 years,with a chronic glomerulonephritis 3 last years is on gemodializ, appeared interruptions in heart working, low blood pressure, growing weakness, shortbreathing. On EKG: bradicardya, atrioventricular blockage I item, high sharp indents T. The day befor - gross violation of the drinkable and dietary modes. What biochemical changes are the most reliable reason of foregoing clinical picture?

6. 
   Hypocalciaemia
   
7. 
   Hypernatriyaemia
   
8. 
   Hyperkaliaemia*
   
9. 
   Hypokaliaemia
   
10. 
    Hyperhydratation
    

11. A patient is 37 years delivered in a reanimation separation. The general state as heavy as lead. Sopor. Skin is grey, moisture. The turgor of muscles is decreased. A pulse is frequent, tense. The AP is 160/110 mm of Hg. Tone of muscles is increased. Hyperreflexia. In mid air smell of ammonia. What previous diagnosis?

A. Hypoglycemyc comma

B. Alcoholic comma

C. Cerebral comma

D. Uremic comma

E. Hyperglicaemic comma

Situational tasks

1. 
   A sick man 27 years appealed about head pain, general weakness, nausea, dryness in a company, skin itch. Considers itself a patient during 8 months, when these complaints appeared first. Treated oneself in country dwelling. Ob-no: The general state of patient is heavy. Skin and mucus turn pale. Left limit of heart + 3 see is from lin. mediaclavicularis, tones are muffled, noise of friction of pericardium in a 5 point, PS – 60'., The propulsion MODULE 175/120 mm of Hg. item A tounge is assessed. Edge of liver + 3 sm. Buds not palpation, symptom Pasternatsky doubtful. In blood: Gb – 62 grammes/l, Eras. – 1,8?109, SHOE 35 mm/god., kreatinine – 1,2 mmol/l. Glomerular filtration 15 ml. In urine of squirrel – 1, 2 grammes/l, eras. 20-25 in p/z, leyk. – 3-4 in p/z, pit. weight 1005. What is reason of the bad state? Define a prognosis.
   
2. 
   The man, 52 appealed about absence of appetite, periodically nausea, weakness, shortbreathing, at the physical loading. 20 years ago there was the proposed diagnosis of chronic glomerulonephritis. Felt good, that is why not inspection, not treat. Worked in a hot workshop, where constantly many sweats and drank plenty of water and soft drinks. Complaints began to appear the last 3 months. Ob-ve: Skin and mucus turn pale. Left limit of heart + 4 see is from lin. mediaclavicularis, tones are muffled, noise of friction of pericardium in a 5 point, PS – 58', The AP 210/130 mm Hg. Tounge is assessed. Edge of liver + 4 sm. Rena not palpation, the symptom of Pasternatvky is doubtful. In blood: Gb – 70 grammes/l, Er. – 2,0?109, SHOE 35 mm/god., kreatinine – 1, 3 mmol/l. Glomerular filtration 12 ml. In urine of squirrel – 1, 0 grammes/l, er. 20-25 in p/z, leuc. – 3-4 in p/z, pit. weight 1005. Formulate a clinical diagnosis. Does it follow to explain presence of anaemia? Are yaks factors of the protracted indemnification of violations of nitrous exchange?
   

Ilustrative material

1. 
   Tables and sliding seats with classification of CRI, charts of treatment
   
2. 
   Sets of analyses, UZ-pictures,
   
3. 
   Tests, situational tasks.
   

Information generators

Basic:

Therapy. Course of lectures. Simferopol. -2003.- 444p.

Additional:

1. Harrison's Principles of Internal Medicine 18^th edition.

.org)

2.era-edta.org

The program of preparation students to the theme

To learn:

1. 
   Features of etiology SRI and CRI.
   
2. 
   Pathogesis of SRI and CRI.
   
3. 
   Clinical motion of CGRI is depending on stage.
   
4. 
   Classification SRI and CRI.
   
5. 
   Instrumental and laboratory methods of diagnostics
   
6. 
   Differential diagnostics.
   
7. 
   Complication.
   
8. 
   Treatment of SRI and CRI is depending on stage.
   
9. 
   Haemodyalis: essence, medical effect, testimony and contra-indication, complication.
   
10. 
    A testimony to ren's transplantation.
    

To draw:

Chart of scray changes of organs and systems at CRI.

To Able:

• 
  To set the final diagnosis of CRI at the different diseases of rens, appoint a necessary inspection and treatment.
  

To pay attention on the use of modern methods of treatment of CRI.