Lecture 19: The Kidneys in Systemic Disease Flashcards
pathophysiology of diabetes effect on kidneys
increasing proteinuria is usually associated with…
declining GFR
what is the most common cause of end stage renal disease (ESRD) leading to the need for dialysis or transplantion?
diabetic nephropathy
what % of Lupus patients will develop lupus nephritis?
a form of glomerulonephritis
upwards of 60%
characteristics of lupus nephritis?
- proteinuria: nephrotic syndrome
- haematuria: red cell casts
- elevated creatinine
what is a multiple myeloma?
- a monoclonal proliferation of plasma cells producing excess of immunoglobulins and light chains.
what is the clinical presentation of myeloma?
- markedly elevated ESR
- anaemia
- weight loss
- fractures
- infections
- back pain/cord compression
myeloma diagnostic investigations
- bone marrow aspirate > 10% clonal plasma cells
- serum paraprotein +/- immunoparesis
- urinary Bence-Jones protein (BJP)
- skeletal survey - lytic lesions
what type of nephropathy does myeloma cause?
cast nephropathy
light chain nephropathy
when first diagnosed with multiple myeloma, what % range of patients will have some amount of kidney failure?
20-40%
how does myeloma affect the kidneys?
- cast nephropathy
- light-chain nephropathy
- amyloidosis
- hyperuricaemia
- hypercalcaemia
what symptoms would make you suspect a systemic disease with renal involvement?
- fever
- malaise
- weight loss
- arthralgia
- myalgia
- skin rash
- gritty eyes
- breathlessness
- haemoptysis
- epistaxis
- haematuria
- oedema
what signs would make you suspect a systemic disease with renal involvement?
Hands:
- splinter haemorrhages
- purpura
- Raynaud’s
Face:
- scleritis
- uveitis
- nasal cartilage deformity
- retinal vasculitis
- hypertensive retinopathy
Skin:
- vasculitic rash
- scleroderma
CV:
- hypertension
- murmur
Respiratory:
- crepitations
- haemoptysis
MS:
- joint swelling
- tenderness
Neurological:
- stroke
- encephalopathy
abnormal urinalysis
