Low Birthweight as a Risk Factor for Non-communicable Diseases in Adults

According to studies undertaken over the past 40 years, low birthweight (LBW) is not only a significant predictor of perinatal death and morbidity, but also increases the risk of chronic non-communicable diseases (NCDs) in adulthood. The purpose of this paper is to summarize the research on LBW as a risk factor for NCDs in adults. The Barker hypothesis was based on the finding that adults with an LBW or an unhealthy intrauterine environment, as well as a rapid catch-up, die due to NCDs. Over the last few decades, terminology such as thrifty genes, fetal programming, developmental origins of health and disease (DOHaD), and epigenetic factors have been coined. The most common NCDs include cardiovascular disease, diabetes mellitus type 2 (DMT2), hypertension (HT), dyslipidemia, proteinuria, and chronic kidney disease (CKD). Studies in mothers who experienced famine and those that solely reported birth weight as a risk factor for mortality support the concept. Although the etiology of NCD is unknown, Barry Brenner explained the notion of a low glomerular number (nGlom) in LBW children, followed by the progression to hyperfiltration as the physiopathologic etiology of HT and CKD in adults based on Guyton's renal physiology work. Autopsies of several ethnic groups have revealed anatomopathologic evidence in fetuses and adult kidneys. Because of the renal reserve, demonstrating renal function in proportion to renal volume in vivo is more difficult in adults. The greatest impact of these theories can be seen in pediatrics and obstetrics practice.

Human Glucose Transporters in Renal Glucose Homeostasis

The kidney plays an important role in glucose homeostasis by releasing glucose into the blood stream to prevent hypoglycemia. It is also responsible for the filtration and subsequent reabsorption or excretion of glucose. As glucose is hydrophilic and soluble in water, it is unable to pass through the lipid bilayer on its own; therefore, transport takes place using carrier proteins localized to the plasma membrane. Both sodium-independent glucose transporters (GLUT proteins) and sodium-dependent glucose transporters (SGLT proteins) are expressed in kidney tissue, and mutations of the genes coding for these glucose transporters lead to renal disorders and diseases, including renal cancers. In addition, several diseases may disturb the expression and/or function of renal glucose transporters. The aim of this review is to describe the role of the kidney in glucose homeostasis and the contribution of glucose transporters in renal physiology and renal diseases.

Efficacy of flipped classroom method in teaching-learning physiology

Objectives: The overall goal of the study was to foster self-directed learning, critical thinking and problem-solving skills in 1st-year medical students. Another goal was to create interest in learning by making it more interactive. As per the requirement of a competency-based medical education curriculum, we tried to use a novel teaching method called Flipped classroom method to meet our goals. Hence, the objectives of this study were: (1) To compare the effect of flipped classroom method and didactic lecture on students’ performance in the topics from renal physiology by MCQ test. (2) To obtain students’ perception about flipped classroom method in learning physiology. (3) To obtain teachers’ perception about flipped classroom method in teaching physiology. Materials and Methods: Flipped classroom method was introduced for teaching two topics in renal physiology for first MBBS students. This cross-over experimental study included 112 first M.B.B.S. students, after taking their informed consent and Ethics Committee permission. They were divided into two groups according to odd and even roll numbers. In the first part of the study, Group A (odd roll numbers) attended the didactic lecture on Renal Clearance (RC) and Group B (even roll numbers) attended the didactic lecture on Glomerular Filtration Rate (GFR). These topics were taught by two different teachers in two different classrooms. They were administered pre-test and post-test in the form of case-based MCQs which tests knowledge, critical thinking, and problem-solving skills on the topic. In the second part, two groups were swapped. Group A attended flipped class for G.F.R. and Group B attended flipped class for RC. They were again administered pre-test and post-test in the form of the same MCQ test. The teacher remained the same for the particular topic. For the flipped class, students came prepared with the topic. They were provided with resource materials of the allotted topic 1 week prior, in the form of pre-recorded lectures and videos. Students’ feedback in the form of a questionnaire and teachers’ feedback in the form of the interview was obtained. Marks obtained by students after didactic teaching and flipped classroom method teaching were compared by “Student’s t-test.” Results: The post-test score of students in the flipped class was significantly higher (P < 0.05) than the post-test score of students in didactic class. More than 85% of students agreed and strongly agreed that the flipped classroom method improved their learning in renal physiology and it increased their confidence in answering the topic in the final exam. Near about 50% of students liked the flipped class method because of its interactive nature and discussion which was based on the application of knowledge. The teachers were more satisfied by flipped classroom method of teaching. Conclusion: Flipped classroom method is an effective teaching-learning method in physiology when compared with a didactic lecture.

The Glomerular Filtration Rate: From the Diagnosis of Kidney Function to a Public Health Tool

The prevalence of chronic kidney disease (CKD) continues to increase worldwide, as well as the associated morbidity and mortality and the consequences on the patients' quality of life and countries' economies. CKD often evolves without being recognized by patients and physicians, although the diagnosis is based on two simple laboratory data: the estimated glomerular filtration rate (eGFR) and urine analysis. To measure GFR, the knowledge about the physiologic processes at the nephron level, the concept of clearance, and the identification of creatinine as a suitable endogenous marker for measuring the creatinine clearance (CrCl) had to be previously developed. On those bases, different equations to calculate CrCl (Cockcroft and Gault, 1976), or estimated GFR (four variables MDRD, 1999; CKD-Epi, 2009, among others) were generated. They all include creatinine and some demographic data, such as sex and age. However, to compare results throughout life or among laboratories, the creatinine determination must be standardized. In addition, the accuracy of these equations remains controversial in certain subgroups of patients. For these reasons, other mathematical models to improve CrCl estimation have been developed, such as when urine cannot be collected, in debilitated elderly patients and patients with trauma, diabetes, or obesity. Currently, eGFR in adults can be measured and reported immediately, using isotope dilution mass spectrometry traceable creatinine-based equations. In conclusion, based on knowledge obtained from renal physiology, eGFR can be used in the clinic for the diagnosis and early treatment of CKD, as well as a public instrument to estimate the prevalence.

Kidney Cancer and Chronic Kidney Disease: Too Close for Comfort

Kidney cancer and chronic kidney disease are two renal pathologies with very different clinical management strategies and therapeutical options. Nonetheless, the cellular and molecular mechanisms underlying both conditions are closely related. Renal physiology is adapted to operate with a limited oxygen supply, making the kidney remarkably equipped to respond to hypoxia. This tightly regulated response mechanism is at the heart of kidney cancer, leading to the onset of malignant cellular phenotypes. Although elusive, the role of hypoxia in chronic kidney diseases is emerging as related to fibrosis, a pivotal factor in decaying renal function. The present review offers a perspective on the common biological traits shared between kidney cancer and chronic kidney disease and the available and prospective therapies for both conditions.

A meme-based approach for enhancing student engagement and learning in renal physiology

As educators around the world are exploring new approaches to keep students involved in remote learning during the pandemic, we investigated the utility of memes in promoting engagement in the online environment. Medical students enrolled in human physiology course at the College of Medicine and Health Sciences, Sohar, Oman were provided with an option to create memes related to the learning outcomes in renal physiology. 146 out of 280 students chose to create memes (52%) and the remaining students chose to submit either a labelled diagram or a concept map. Students uploaded their work in the discussion forum of the learning management system. All students enrolled in the course were given an opportunity for interaction with the uploaded content by commenting and upvoting thereafter. Students were requested to give anonymous feedback on their experience specifically on the activity related to memes. Feedback received from 142 out of 280 students through anonymous comments were subjected to thematic analysis. Based on the analysis of the data, we found that memes elicited interest in the topic, facilitated peer interaction, simplified complex ideas, enhanced retention of associated concepts and fostered a positive learning environment.

Interactive Retrieval Practice in Renal Physiology Improves Performance on Customized National Board of Medical Examiners Examination of Medical Students

Retrieval practice improves long-term retention. Use of interactive retrieval practice in large group, in-person and online live classes, in combination with outside resources, is unreported for medical physiology classes. The primary study purpose was to compare student cohorts' performance with or without retrieval practice in renal physiology classes, relative to the national average on customized national examinations in renal physiology, non-physiology, and all questions. The secondary purpose was to examine the students' educational experience. For the primary purpose, we used a non-equivalent group, post-test only design. For the secondary purpose, we used cross-sectional and qualitative designs. We analyzed examination results of 684 students in four academic years. For renal physiology questions, students performed significantly better in years with retrieval practice compared to years without it (P < 0.001). There was no change in non-physiology scores over the four years. Performance in all questions, too, significantly improved (P < 0.001). A large majority (86%) of students indicated retrieval practice helped them learn renal physiology. Student ratings of quality in online classes, which featured interactive retrieval practice, were higher than that of in-person classes (P < 0.001). Qualitative analysis revealed students found interactive retrieval practice, scaffolding, outside resources, and the instructor's teaching style helpful. Educators in medical physiology classes can use our findings to implement interactive retrieval practice.