The System Diseases 1 course takes the students into clinical medicine with the study of the "Diseases of the Kidney and Urinary System" (Nephrology) and the "Diseases of the Heart and Vessels" (Cardiology). Such studies will be dealt on a comprehensive basis, i.e. including Diagnostic Imaging, Pathology, Clinical Biochemistry and Microbiology, in relation to the diseases of the organ.
This module will focus on some relevant aspects of cardiology, which shall be discussed with a predominantly pathophysiological approach. A more clinical and therapy oriented approach will be in place at 5th year, in the exam of Translational Cariovascular Medicine and Surgery.
The purpose of this module is to provide essential knowledge of the kidney role in maintaining the body homeostasis, both in patients with renal diseases and in patients with other conditions, such as arterial hypertension and diabetes mellitus, in which kidneys play a pivotal role in the genesis and the response of the organism to the disease process. The module offers the unique opportunity to systematically explore specific renal disorders, like the glomerulopathies, and an introduction to very relevant clinical syndromes, such as acute and chronic kidney disease.
Course Relevance: The knowledge of signs and symptoms (semeiotics) in nephrology and the ability to identify the clinical presentation of renal diseases represent an essential part of the medical heritage and practice. It is of utmost importance in the everyday clinical and surgical practice, if we consider the high incidence of both acute (mostly in surgical setting) and chronic kidney injury (mostly in internal medicine). Also, the ability to detect the first signs and symptoms of a specific renal disease is crucial for an early nephrology referral. Despite the intended field of specialization in medicine, we believe that this module is very important both for the future physician and the future surgeon.
The main purpose of the module is the understanding of the role of microorganisms, as etiological agents or cofactors, in the pathogenesis of myocardial/cardiac (cardiology module) and urinary tract diseases (nephrology module).
Every lecture will focus on four main aspects: the epidemiology of the involved microorganisms, the mechanisms of pathogenesis employed by the microorganisms, the diagnostic approaches for the detection of the microorganisms, and, when available, the antimicrobial therapies.
The first part of the course will focus on the definition of Anatomic Pathology and on its contribution in modern medicine. The organization of the work flow at a Pathology Department, with particular focus on its three major sections (histology, cytology and autopsy) will be described, together with the structure and the contents of a modern pathological report. Principles, applications and clinical implications of some ancillary techniques of the anatomic pathology such as immunohistochemistry and molecular pathology will also be considered in detail.
The second part of the course will deal with the anatomic pathology of the heart. In particular, lectures will be focused on the pathogenetic mechanisms, morphologic changes, evolution and complications of the diseases involving the most important structures of the heart (myocardium, endocardium and valves, pericardium) and the blood vessels.
The module is focused on explaining the different interactions between iodizing and non iodizing radiation and matter in order to obtain diagnostic images (i.e. x rays, sonography and magnetic resonance imaging) and the use of radiopharmaceuticals in Nuclear Medicine. The course is also designed to highlight the different diagnostic capabilities of imaging techniques in detecting and characterizing pathologic conditions in the cardiovascular and urinary systems.
In particular, the course will focus on conditions such as ischemic heart disease, valvular heart disease, urinary tract stones, infections and tumors.
Expected learning outcomes
Students are expected to achieve general and specific requirements. General requirements:
-Recognize the most relevant signs and symptoms of renal and cardiovascular disease.
-Learn how to conduct a medical and anamnestic interview.
-Plan the best approach to the patient.
-Apply the correct steps of a medical examination.
-Understand the pathophysiological features of acute and chronic renal and cardiovascular diseases.
-Develop a deep knowledge of the principal renal and cardiac syndromes.
-Understand the main etiologies and the clinical features of acute injury of the kidney and the cardiovascular system.
-Understand the main etiologies and the clinical features of chronic injury of the kidney and the cardiovascular system.
-Develop a broad understanding of the role of kidneys in the pathogenesis of electrolyte disturbances
-Develop a broad knowledge of genetic abnormalities determining renal diseases
Specific requirements :
-Understand how to collect critical information about renal and cardiovascular diseases from the patient's clinical history.
-Demonstrate the ability to grade a cardiovascular disease
-Understand how to stage kidney injury upon the creatinine serum levels and the corresponding glomerular filtration rate.
-Understand how proteinuria affects severity of kidney disease and its progression.
-Understand how to put together clinical and laboratory data in order to identify: nephritic syndrome, nephrotic syndrome, urinary tract infections, acute kidney injury, chronic kidney injury.
-Demonstrate the ability in detecting the condition of body fluid overload.