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Systems: Urinary AB > The Kidney in Systemic Disease > Flashcards

The Kidney in Systemic Disease Flashcards

1
Q

What organ receives more blood flow per unit volume than any other organ in the body?

A

Kidneys

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2
Q

What can the glomeruli do to proteins?

A
  • The glomeruli may filter proteins which are then reabsorbed by the tubule epithelial cells
  • The glomeruli may trap proteins or immune complexes
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3
Q

What types of systemic disease can affect the kidneys?

A

Diabetes mellitus

Cardiovascular disease

  • Cardiac failure
  • Atheroembolism
  • Hypertension
  • Atherosclerosis

Infection

  • Sepsis
  • Post-infectious GN
  • Infective endocarditis

Inflammation in blood vessels

  • SLE
  • Vasculitis
  • Scleroderma and other connective tissue diseases
  • Cryoglobulinaemia

HUS/TTP

Myeloma

Amyloidosis

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4
Q

What drugs can affect the kidneys?

A
  • Aminoglycosides
  • ACEI
  • Penicillamine
  • Gold
  • NSAIDs
  • Radiocontrast
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5
Q

Describe the natural history of diabetic nephropathy.

A
  • Silent sub-clinical phase. Hyper filtration. Increased GFR
  • Microalbuminaemia [20-200ug/d]
  • Clinical nephropathy [proteinuria >0.5g/d]
  • Established renal failure
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6
Q

What percentage of those with diabetic nephropathy will progress to ESRF?

A

30%

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7
Q

What is the long term risk of nephropathy for T1DM and T2DM patients?

A
  • 4% with Type 1 DM will develop nephropathy within 10 years
  • 25% with Type 1 DM will develop nephropathy within 25 years
  • 10% with Type 2 DM will have nephropathy by 5 years
  • 30% with Type 2 DM will have nephropathy by 20 years
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8
Q

What is the commonest single cause of ESRF?

A

Diabetic nephropathy

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9
Q

What is increasing proteinuria usually associated with?

A

Declining GFR

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10
Q

What is classification of chronic kidney disease based on?

A

Kidney function

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11
Q

What classification system is used for chronic kidney disease?

A

NKF K/DOQI classification system

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12
Q

What are the 5 stages of chronic kidney disease?

A
  • 1 Kidney damage/ normal or high GFR (GFR >90)
  • 2 Kidney damage/ mild reduction in GFR (GFR 60-89)
  • 3 Moderately impaired (GFR 30-59)
  • 4 Severely impaired (15-29)
  • 5 Advanced or on dialysis (GFR<15)
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13
Q

What is a common cause of renal failure in older patients?

A

Renal vascular disease

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14
Q

What is indicative of atheroembolic disease?

A
  • Eosinophilia
  • Peripheral skin lesions
  • Warfarin therapy
  • Vascular procedures
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15
Q

What is vasculitis?

A

Inflammatory reaction in the wall of any blood vessel

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16
Q

How is vasculitis defined?

A

By the size of vessel involved

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17
Q

What can vasculitis affect?

A
  • Can affect single or multiple organs

- Wide spectrum of clinical presentations

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18
Q

What types of vasculitis affect large arteries/aorta?

A
  • Takayasu arteritis

- Giant cell arteritis

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19
Q

What kind of vasculitis affects medium arteries?

A
  • Polyarteritis nodosa

- Kawasaki disease

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20
Q

What kind of vasculitis affects small vessels?

A
  • Wegener’s granulomatosis
  • Microscopic polyarteritis
  • Churg-Strauss syndrome
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21
Q

Who does Wegener’s granulomatosis affect?

A
  • Slightly more common in males

- Affects all age groups, most common 40-60 y

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22
Q

What is Wegener’s granulmatosis?

A
  • Granulomatous inflammation in respiratory tract

- Focal necrotising glomerulonephritis with crescents

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23
Q

How can Wegener’s granulomatosis present in the upper respiratory tract?

A
  • Epitaxis
  • Nasal deformity
  • Sinusitis
  • Deafness
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24
Q

How can Wegener’s granulamosis present in the lower respiratory tract?

A
  • Cough
  • Dyspnoea
  • Haemoptysis
  • Pulmonary haemorrhage
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25
Q

How can Wegener’s granulomatosis present in systems other than the respiratory system?

A

Kidney
-Glomerulonephritis

Joints

  • Arthralgia
  • Myalgia

Eyes
Scleritis

Heart
-Pericarditis

Systemic

  • Fever
  • Weight loss
  • Vasculitis skin rash
26
Q

What condition has a similar clinical spectrum to Wegener’s granulomatosis?

A

Microscopic polyarteritis

27
Q

How can microscopic polyarteritis present?

A
  • Can present with systemic disease, renal and pulmonary involvement
  • More commonly renal limited disease
28
Q

How is vasculitis diagnosed?

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

29
Q

What is C-ANCA?

A

Cytoplasmic

30
Q

What is P-ANCA?

A

Perinuclear

31
Q

What antibodies are associated with P-ANCA?

A

Myeloperoxidase

32
Q

What antibodies are associated with C-ANCA?

A

Proteinase-3

33
Q

Give an example of when ANCA can give a false positive.

A

IBD

34
Q

What form of ANCA is associated with microscopic polyarteritis?

A

P-ANCA

35
Q

What form of ANCA is associated with Wegener’s granulomatosis?

A

> 90% C-ANCA

36
Q

What is endocarditis a result of?

A

A bacterial (or fungal) infection on cardiac valves

37
Q

What are the typical infections associated with infective endocarditis?

A
  • Staphlococcus aureus
  • Viridans streptococci
  • Enterococci
38
Q

What can infective endocarditis lead to?

A

Leads to glomerulonephritis ± small vessel vasculitis due to immune complex formation

39
Q

In infective endocarditis, what is renal involvement suggested by?

A
  • Abnormal urea/creatinine
  • Haematuria, red cell casts
  • Reduced complement levels
40
Q

When should renal disease get better in infective endocarditis?

A

Renal disease should recover when underlying infection treated

41
Q

What is multiple myeloma?

A

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

42
Q

Who is multiple myeloma common in?

A

Elderly

43
Q

What are the clinical features of multiple myeloma?

A
  • Markedly elevated ESR
  • Anaemia
  • Weight loss
  • Fractures
  • Infections
  • Back Pain /Cord compression
44
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
45
Q

What can cause renal failure in myeloma?

A
  • Cast nephropathy - ‘myeloma kidney’
  • Light chain nephropathy
  • Amyloidosis
  • Hypercalcaemia
  • Hyperuricaemia
46
Q

What is there deposition of in light chain disease?

A

TBM Ig deposition

47
Q

What is there deposition of in amyloid?

A

Deposition of abnormal fibrillary proteins that persist. [AA /AL

48
Q

What history may suggest a systemic disease with renal involvement?

A
  • Fever
  • Malaise
  • Weight loss
  • Arthralgia
  • Myalgia
  • Skin rash (vasculitis)
  • Gritty eyes
  • Breathlessness
  • Haemoptysis
  • Epistaxis
  • Haematuria
  • Oedema
49
Q

How common is systemic disease with renal involvement?

A

Relatively rare but frequently missed

50
Q

What does the outcome of systemic disease with renal involvement depend on?

A

Prompt diagnosis and treatment

51
Q

What signs may be present on the hands in systemic disease with renal involvement?

A
  • Splinter haemorrhages
  • Purpura
  • Raynaud’s
52
Q

What signs may be present on the face in systemic disease with renal involvement?

A
  • Scleritis
  • Uveitis
  • Nasal cartilage deformity
  • Retinal vasculitis
  • Hypertensive retinopathy
53
Q

What signs may be present on the skin in systemic disease with renal involvement?

A
  • Vasculitic rash

- Scleroderma

54
Q

What CVS signs may be present in systemic disease with renal involvement?

A
  • Hypertension

- Murmur

55
Q

What chest signs may be present in systemic disease with renal involvement?

A
  • Crepitation’s

- Haemoptysis

56
Q

What locomotor signs may be present in systemic disease with renal involvement?

A
  • Joint welling

- Tenderness

57
Q

What CNS signs may be present in systemic disease with renal involvement?

A
  • Stroke

- Encephalopathy

58
Q

What initial investigations should be carried out for systemic disease with renal involvement?

A

Urine

  • Blood/protein on urinalysis
  • Microscopy - red cell casts

FBCs

  • Elevated urea/creatinine
  • Raised CRP
  • Thrombocytosis, anaemia
  • Raised alkaline phosphatase
59
Q

What can further investigation of the blood show in systemic disease with renal involvement?

A
  • ANCA (anti-MPO/anti-PR3 antibodies)
  • ANA, dsDNA antibodies
  • Complement levels C3, C4
  • Blood cultures
  • Immunoglobulins and electrophoresis
60
Q

What radiological investigations could be carried out for investigating systemic disease with renal involvement?

A
  • CXR
  • USS abdomen (Renal size)
  • CT thorax (Pulmonary granulomas, interstitital disease)
  • Echocardiography
61
Q

What biopsies may you consider taking in systemic disease with renal involvement?

A
  • Kidney
  • Nasal mucosa
  • Lung
  • Skin

Systems: Urinary AB (26 decks)

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