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Systems - Urinary > The Kidneys In Systemic Disease > Flashcards

The Kidneys In Systemic Disease Flashcards

1
Q

What are the systemic diseases affecting the kidney?

A

Cardiovascular disease (cardiac failure, atheroembolism, hypertension, atherosclerosis)

Infection (sepsis, post infective GN, Infective endocarditis)

Inflammation in blood vessels (SLE, vasculitis, scleroderma)

Myeloma

Amyloidosis

Drugs

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2
Q

What is the progression of diabetic nephropathy?

A
  1. Silent sub-clinical phase

Hyperfiltration

Increased GFR

  1. Microalbuminuria

[20 - 200ug/d]

  1. Clinical nephropathy

[proteinuria > 0.5g/d]

  1. Established renal failure

Increasing proteinuria is usually assocaited with a declining GFR

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3
Q

Does diabetic nephropathy depend on the type of diabetes you have?

A

No, it just depends on glycaemic control

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4
Q

What is the commonest single cause of ESRF?

A

Diabetes

Leading to the need for dialysis or transplantation

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5
Q

What are the classifications of renal disease?

A
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6
Q

What are the common causes of atheroembolic disease?

A

Eosinophilia

Peripheral Skin lesions

Warfarin Therapy

Vascular Procedures

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7
Q

What is vasculitis?

A

Inflammatory reaction in the wall of any blood vessel

Defined by size of vessel involved - can affect single or multiple organs, wide spectrum of clinical presentations

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8
Q

What are the vasculitic conditions that affect large arteries?

A

Takayasu arteritis

Giant cell arteritis

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9
Q

What are the vasculitic conditions that affect medium arteries?

A

Polyarteritis nodosa

Kawasaki disease

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10
Q

What are the vasculitic conditions that affect the small vessels?

A

–Wegener’s granulomatosis

–Microscopic polyarteritis

–Churg-Strauss syndrome (eosinophilic polyarteritis)

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11
Q

What type of glomerulonephritis does Wegner’s cause?

A

Focal necrotising glomerulonephritis with crescents

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12
Q

What are the manifestations of wegners?

A

Upper respiratory tract

–Epistaxis, nasal deformity, sinusitis, deafness

Lower respiratory tract

–Cough, dyspnoea, haemoptysis

–Pulmonary haemorrhage

Kidney - glomerulonephritis

Joints - arthralgia, myalgia

Eyes - scleritis

Heart - pericarditis

Systemic - fever, weight loss, vasculitic skin rash

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13
Q

Microscopic polyarteritis

A

Similar clinical spectrum to Wegener’s granulomatosis

Can present with systemic disease, renal and pulmonary involvement

More commonly renal limited disease

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14
Q

How do we make a diagnosis of vasculitis?

A

Urine

–Blood/protein

Renal function

–Raised urea/creatinine

Biochemistry

–Raised alk phos, CRP, low albumin

Haematology

–Anaemia, thrombocytosis, leukocytosis

Immunology

–Hyperglobulinaemia

–Positive ANCA

Renal biopsy

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15
Q

What immunostaining test do you use for Wegners and microscopic polyangitis?

A
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16
Q

What is infective endocarditis and what are the typical infections?

A

Endocarditis: a result of bacterial (or fungal) infection on cardiac valves

–Staphylococcus aureus

–Viridans streptococci

–Enterococci

17
Q

Why does infective endocarditis cause glomerulonephritis with or without small vessel vasculitis?

A

Due to immune complex formation

18
Q

What are clues that there is renal involvement in glomerulonephritis?

A

Renal involvement suggested by

–Abnormal urea/creatinine

–Haematuria, red cell casts

–Reduced complement levels

Renal disease should recover when underlying infection treated

19
Q

What is multiple myeloma?

A

A monoclonal proliferation of plasma cells producing an excess of immunoglobulins and /or light chains

Light chain is part of an immunoglobulin

20
Q

What are the clinical features of multiple myeloma?

A

–Markedly elevated ESR

–Anaemia

–Weight loss

–Fractures

–Infections

–Back Pain /Cord compression

21
Q

How is multiple myeloma diagnosed?

A

–Bone marrow aspirate >10% clonal plasma cells

–Serum paraprotein ± immunoparesis

–Urinary Bence-Jones protein (BJP)

–Skeletal survey - lytic lesions

22
Q

What are the causes of renal failure in myeloma?

A

Cast nephropathy - ‘myeloma kidney’

Light chain nephropathy

Amyloidosis

Hypercalcaemia

Hyperuricaemia

23
Q
A

Systems - Urinary (28 decks)

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