RENAL HEALTH PROBLEM
Dear Learner,
Mabuhay!
Welcome to the course on The Renal Problem!
WHY STUDY RENAL PROBLEM?
Renal Problem affects the biopsychosocial well-being of any person who has it. It frequently leads to disability and death.
Worldwide, renal problem is a leading cause of morbidity and mortality, usually within the top ten in the national census.
In the Philippines, as of latest statistics (1992), every year there are about 6,500 deaths secondary to various kidney diseases. Death from renal diseases is now the tenth leading cause of death in the country.
The first four major causes of end-stage renal disease in the country are chronic glomerulonephritis, chronic pyelonephritis, diabetic nephropathy, and hypertensive nephrosclerosis. These diseases are potentially preventable if diagnosed early in the course of illness, obviating the need of expensive treatment modalities such as dialysis and transplantation.
Every primary health care physician should know how to manage any patient with or with possible renal problem. He should also know how to handle the renal problem in the community as well as to deal with issues associated with the renal problem, such as bioethical, psychosocial, medicolegal and research issues.
GENERAL COURSE OBJECTIVES
At the end of the course, the student must be able to:
1. Write an overview and a personal perspective on the renal health problem in the community.
2. Manage any patient presenting with renal problem.
2.1 Demonstrate skills in
2.1.1 Establishing rapport
2.1.2 Clinical diagnostic process
2.1.3 Paraclinical diagnostic process
2.1.4 Treatment process
2.1.5 Giving advice
2.1.6 Making referrals
2.2 Demonstrate qualities of an effective, efficient, and humane physician
2.3 Discuss/explain the biological foundation and basis of the clinical management of a patient with renal problem.
3. Discuss the following issues on renal problem.
3.1 Clinical management issues
3.2 Psychosocial or behavioral issues
3.3 Bioethical issues
3.4 Medicolegal issues
4. Conduct a public health education program on the prevention and management of renal problem.
5. Perform a research activity on the renal problem.
6. Formulate a community health plan on the renal problem.
7. Pass examinations on the renal problem.
CONTENT
I. Overview and Perspective of Renal Health Problem in the Community
Concept of Renal Problem
Common Types of Renal Problem
Common Causes of Renal Problem
Magnitude of the Renal Health Problem at the Global, National, and Local Levels
Personal Perspective on Possible Solutions of the Renal Health Problem in the Local
Community
II. Generalities on Renal Problem - Concept and Principles and Basic Sciences
A. Biomedical/Individual Domain
1. Pathophysiology
Concept of Renal Problem
Anatomy of the Urinary System
Physiology of the Urinary System
Epidemiology of Renal Problem
Types of Renal Problem
Causes of Renal Problem
Natural History of Renal Problem (Untreated and Failure of
Treatment)
Prognosis (Recovery, Disability, and Death)
2. Diagnosis
Clinical Cues (Signs and Symptoms)
Cues for the Different Renal Problems
Parenchymal and Tract Disorders
Obstructive and Non-obstructive Disorders
Urine Flow and Urine Constituent Disorder
Flow - anuria, oliguria, polyuria
Constituents - hematuria, pyuria,
bacteriuria, proteinuria,
glucosuria
Localized and Systemic Effects
Fluid and Electrolyte Imbalance
Azotemia
Clinical Diagnostic Process
Pattern Recognition and Prevalence
Paraclinical Diagnostic Procedures
Urine Analysis
Blood Analysis
Imaging Procedures
Biopsy
Paraclinical Diagnostic Process
Indication
Selection
Benefit, Risk, Cost, Availability
Interpretation
Diagnostic Algorithm
Severity and Staging
3. Treatment
Goals in Treatment
Preventive, Curative, and Palliative
Forms of Treatment
Nonoperative and Operative
Parenchymal and Tract Disorder Treatment
Dialysis
Transplantation
Selection of Treatment
Benefit, Risk, Cost, Availability
Palliative Care
Hospice Care
Follow-up Care
B. Social/Population Domain
1. Community Health Management
Epidemiology
Management Approach to the Renal Health Problem in the
Community (Primary Health Care)
Community Health Program
Renal Problem Control Program
Preventive Nephrology Project
Public Health Education
Psychosocial Issues
Prevention
Early Detection (Screening)
Research
2. Issues
Psychosocial Issues
Bioethical Issues
Organ Transplantation
Medicolegal Issues
Legal Medicine
Organ Donation Act of 1991 (R.A. 7170)
Medical Jurisprudence
Approach to Issues (Prevention and Solution)
III. Specifics on Renal Problems and Clinical Sciences
Common Renal Problems in the Philippines (male and female/young and old)
Parenchymal and Tract Disorders
Problems of the Kidney, Ureter, Bladder, Urethra
Congenital Disorders
Inflammations/Infections
Metabolic Disorders
Tumors
Trauma
Neurogenic Disorders
Other Degenerative Disorders
Problems of the Kidney
Glomerular Diseases
Acute Glomerulonephritis
Rapidly Progressive (Crescentic) Glomerulonephritis
Nephrotic Syndrome
Membranous Glomerulonephritis
Focal Segmental Glomerulosclerosis
Membranoproliferative Glomerulonephritis
Berger’s Disease
Focal Glomerulonephritis
Chronic Glomerulonephritis
Glomerular Lesions Associated with Systemic Diseases
Systemic Lupus Erythematosus, Henoch-Schonlein
Purpura, Bacterial Endocarditis, Diabetic
Glomerulosclerosis, Amyloidosis
Hereditary Nephritis
Problems Affecting Tubules and Interstitium
Acute Tubular Necrosis
Tubulointerstitial Nephritis
Pyelonephritis, Urinary Tract Infections, Tubulointerstitial Nephritis Induced by Drugs and Toxins, Urate Nephropathy, Hypercalcemia and Nephrosclerosis
Problems of Renal Blood Vessels
Benign Nephrosclerosis
Malignant Nephrosclerosis
Renal Artery Stenosis
Thrombotic Microangiopathies
Adult and Childhood Hemolytic-Uremic Syndrome, Thrombotic Thrombocytopenic Purpura
Congenital Problems
Cystic Diseases
Cystic Renal Dysplasia, Autosomal Dominant and Recessive Polycystic Kidney, Cystic Diseases of the Renal Medulla, Simple Cysts
Tumors/Cancers
Benign Tumors/Cancers
Malignant Tumors/Cancers
Inflammations/Infections
Pyenephritis
Metabolic Disorders
Stones
Trauma
Problems of the Ureter
Inflammations/Infections
Ureteritis
Obstructive Lesions
Stones
Tumors/Cancers
Congenital Anomalies
Double and Bifid Ureters, Diverticula
Trauma
Problems of the Urinary Bladder
Inflammations/Infections
Acute Cystitis, Chronic Cystitis, Hunner’s Ulcer, Malakoplakia
Congenital Anomalies
Diverticula, Exstrophy, Vesicoureteral Reflux, Congenital Vesicouterine Fistulas, Urachus
Tumors/Cancers
Trauma
Neurogenic Disorder
Problems of the Urethra
Inflammations/Infections
Gonococcal Urethritis
Nongonococcal Urethritis
Trauma
Hypospadias
Overview and Perspective of the Specific Renal Health Problem in the Community
Concept of the Specific Renal Problem
Common Types of the Specific Renal Problem
Common Causes of the Specific Renal Problem
Magnitude of the Specific Renal Health Problem at the Global,
National, and Local Levels
Personal Perspectives on Possible Solutions of the Specific Renal
Health Problem in the Local Community
For Each Specific Renal Problem -
A. Biomedical/Individual Domain
1. Pathophysiology
Concept of the Specific Renal Problem
Anatomy and Physiology of the Specific Renal Organ/Tissue
Epidemiology of Specific Renal Problem
Types of the Specific Renal Problem
Causes of the Specific Renal Problem
Natural History of the Specific Renal Problem (Untreated and Failure
of Treatment)
Prognosis (Recovery, Disability, and Death)
2. Diagnosis
Clinical Cues (Signs and Symptoms)
Clinical Diagnostic Process
Pattern Recognition and Prevalence
Paraclinical Diagnostic Procedures
Paraclinical Diagnostic Process
Indication
Selection
Benefit, Risk, Cost, Availability
Interpretation
Diagnostic Algorithm
Severity and Staging
3. Treatment
Goals in Treatment
Forms of Treatment
Selection of Treatment
Palliative Care
Follow-up Care
B. Social/Population Domain
1. Community Health Management
Epidemiology
Management Approach to the Specific Renal Health Problem in the
Community (Primary Health Care)
Community Health Program
Specific Renal Problem Control Program
Public Health Education
Psychosocial Issues
Prevention
Early Detection (Screening)
Research
2. Issues
Psychosocial Issues
Bioethical Issues
Medicolegal Issues
Legal Medicine
Medical Jurisprudence
Approach to Issues (Prevention and Solution)
IV. Special and Related Topics
Problems of the Prostate
Anatomy and Physiology of the Prostate
Pathology, Diagnosis, and Treatment
Inflammatory/Infectious Disorder
Benign Prostatic Hypertrophy
Prostatic Cancers
Sexually Transmitted Diseases
Fluid and Electrolyte Balance
(See also Folder 4 on Learning Objectives)
LEARNING STRATEGIES
PROBLEM-BASED LEARNING
Hypothetical Patient Management
Actual Patient Management
Demonstration-Return Demonstration
Projects
Discussion
Debates
Role Play
Independent Study
(See Schedule below and Details and Formats in Folder 7)
EVALUATION
LEARNING OBJECTIVES-REFERENCED EVALUATION
A student must pass the following assessment tools:
I. Academic
Written examination
Posttest - MPL of 75%
Practical examinations
Presentation in a Symposium (PASS)
Clinical Examination - MPL of 75%
Written Reports
Overview and Personal Perspectives (PASS) - individual output
Reports on Symposium (PASS) - group output
Case Presentation and Discussion of 3 Actual Patient Management (PASS)
- individual output
II. Attitude (PASS)
III. Attendance (PASS)
(See Schedule below, Folder 6 on Evaluation, and Details and Formats on Folder 7)
DURATION OF COURSE: 3 WEEKS
SCHEDULE OF LEARNING-EVALUATING ACTIVITIES
Week 1
Week 2
Week 3
Legend of Superscript:
1 There will be 12 Hypothetical Patient Management (HPM) in the entire course. Each HPM session will be for 2 hours. See Details and Formats on HPM.
2 There will be at least 3 Actual Patient Management (APM) in the entire course. Each APM session will be for 2 hours. See Details and Formats on APM.
3 There will be at least 3 Consultation with Resource Persons (CRP) in the entire course. Each CRP session will be for 1 hour. See Details and Formats on CRP.
4 During the Independent Study, the students shall do the following, but not limited to:
1. Take the pretest on the first day, then formulate learning issues and learning plan, then implement the plan.
2. Formulate own learning issues during the HPM sessions, then learning plan, then implement.
3. Formulate own learning issues during the APM sessions and learning plan and then implement the plan.
4. Take note of the learning objectives and expected output of the course and then make an action plan, and then implement.
5. Prepare for the discussion of the APM, symposium, and posttest.
6. Prepare for the submission of required written reports (using the prescribed formats):
Overview and Personal Perspective on ................. one per student
Reports on the Symposium group report
Discussion on Actual Patient Management one per student
(a total of 3 APM discussion per student)
5 There will be at least one discussion of issues (DI), either bioethical, psychosocial, or medicolegal, per week. Each DI session will be for 2 hours.
6 The Overview of Renal Health Problem and the Orientation and Introduction to the Course shall be held on the first day of the course, Monday, 2 hours, such as 7:30 - 9:30 am.
PLS. SEE DETAILS AND FORMATS ON
SPECIFIC LEARNING AND EVALUATING ACTIVITIES IN FOLDER 7.
BEST WISHES IN YOUR LEARNING JOURNEY!
Program Director: Dr. Reynaldo O. Joson
Course Coordinator:
Co-Course Coordinator:
ROJ@17nov6