Nefrologia sperimentale e clinica
As sound as they may seem all living beings are mainly formed by water, reflecting the origin of life in a water environment. Indeed, life sparkled in an ancestral see that consisted of a complex solution containing numerous minerals and ionic molecules altogether contributing the fluid osmolality. Actually, from its very beginning life was tailored to its environment, and accordingly the reactions that sustained life were developed to operate in the restricted range of ion concentration, and osmolality of the native sea. Millions of years have passed from life’s origin, and life has undergone continuing evolution whose main steps can be roughly indicated as 1) the isolation of life machinery inside the cell, 2) the development of cell tools that maintain stable its internal composition, 3) the building up of complex multicellular organs forming a body and eventually 4) the adaptation to dry land. The resulting prevalent today-model of living being is that of functionally specialized cells aggregated to form organs that in turn form bodies, i.e. a model that seems far away from the self replicating sparse molecules that were the primodium of life. Instead, the distance is not as astronomical, because both our sophysticated bodies and the early life foms have a common need, that is to home in a steady fluid environment that permits the life machinery to work. The evolutionary response to such a mandatory requirement has been to facilitate the stability of the fluid where for-life reactions occur by closing it inside the cell, and bathing the cell in an internal sea to be maintained constant as well. It is moving to know from paleooceanographic studies that our intracellular fluid compositon mirros that of the ancestral sea where life originated, which means that we have a trait that has been transmitted for millions of years ! Of course this is an oversimplification, that does not mention the dependence of cell life on the ionic gradients that exist between the intracellular and extacellular fluids, nor the role of extracellular fluid volume as the determinant of circulation. The kidneys have appeared quite late in the long tale of how life has defended against environmental changes, but they have become soon the principal actors on the stage, assuming the task to maintain the omestasis of body fluid volumes and of the ionic composition of body fluids. Indeed, the kidney have developed an extraordinary ability to respond to challenges driven against the stability of total body fluid, body fluid osmolatiy, intravscular volume, and intra- and extracellular ion concentrations including that of protons.
The 2013 Class of Nephrology will be delivered for 21-hour lessons, starting from October 21st to November 28th.The contents of the lectures will include:
- A synthetic review of the adaptive mechanisms that life has developed to obviate for changes in fluid enviroment that could stop its machinery
- A description of renal evolution in phylogenesis, including renal embryogenesis
- Physiology of body fluids in man, their distribution, how they can be measured or evaluated.
- Extracellular fluid volume: its determinant, its regulation
- How sodium reabsorption in different nephron segments has been studied: renal micropuncture, free-water clearance, lithium clearance.
- The mechanisms by which the kidney attain sodium balance
- Extracellula fluid volume: clinical settings of its expansion/contraction
- Body Fluid osmolality: control of water content in the body. Countercurrent systems. Hotmones.
- On body protons. Proton handling in the kidney
- The metabolic forms of acidosis
- Metabolic alkalosis
- Appropriate use of diuretics
- Method to plan a therapeutic program to restore or maintain fluid omeostasis
Il corso si terrà, dal 21 ottobre al 28 novembre 2013, presso le Aule 1-14 e 1-15 di Palazzo Broletto, come meglio specificato nel calendario.
1° appello d'esame: venerdì 13 dicembre p.v., dalle ore 13, presso Aula 1-14 (Sede IUSS).
Semestre: Semestre I
Anno accademico: 2013-2014