5: Kidneys in systemic disease Flashcards Preview

Renal Week 2 2017/18 > 5: Kidneys in systemic disease > Flashcards

Flashcards in 5: Kidneys in systemic disease Deck (49)
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1

What endocrine disease causes nephropathy?

Diabetes mellitus

2

What causes the nephropathy seen in diabetes?

1. Hyperglycaemia causes endothelial damage (oxidative stress etc.) predisposing to atherosclerosis

2. Growth factors causes inflammation, leading to vasoconstriction and renal hypoperfusion > renal hypertension, inflammation, proteinuria...

3

What will be seen on biopsy of a glomerulus from someone with diabetic nephropathy?

Focal segmental glomerulosclerosis

4

What happens to GFR in diabetic nephropathy?

Increases

to everything, causing proteinuria

5

What is an early marker of kidney disease?

Microalbuminuria

6

What decreases in late diabetic nephropathy?

Renal function

i.e eGFR, A/C ratio...

7

What happens to GFR in

a) early

b) late

diabetic nephropathy?

a) Increases (mesangial proliferation, more permeable to protein)

b) Decreases (as kidneys fail)

8

As diabetic nephropathy progresses, the protein leak (increases/decreases).

increases

9

Does a urine dipstick pick up any particular type of protein?

No

10

What measurements are used to quantify proteinuria?

24h urine protein

Albumin/creatinine ratio

Protein/creatinine ratio

11

What should be controlled to limit the progression of diabetic nephropathy?

Glycaemic control (HbA1c < 48)

Blood pressure (< 130/80 mmHg)

Cholesterol - statin

12

Which drugs are used to manage blood pressure in those with kidney disease?

ACE inhibitors

ARBs

dilate efferent arterioles (by acting on RAAS), reducing renal blood pressure

13

What is the treatment for end-stage diabetic nephropathy?

Renal replacement therapy

or Supportive

14

What are three types of renal replacement therapy?

Haemodialysis

Peritoneal dialysis

Kidney transplant

15

What surgical procedure are fit Type 1 diabetics with end-stage renal failure offered?

Joint kidney-pancreas transplant

to replace their beta cells

16

Why is long-term survival quite low for diabetics on dialysis?

Lots of co-morbidities

17

What urinary sign is a marker of diabetic nephropathy progression?

Proteinuria

18

What is renovascular disease?

Poor blood supply to kidneys (for loads of reasons) causes disease

19

What is ischaemic nephropathy?

Decrease in kidney function caused by reduced blood flow

20

What happens when renal perfusion is reduced?

RAAS activation

Sympathetic vasoconstriction

Renal hypertension

Further ischaemia

repeat

21

What are the renal consequences of ischaemic nephropathy?

Atrophy

Chronic kidney disease

22

What is the main cause of ischaemic nephropathy, caused by secondary hypertension?

Renal artery stenosis

23

What are the risk factors for renal artery stenosis?

Age

Male

Ethnicity

Alcohol

Smoking

Poor exercise

Poor diet

Hyperlipidaemia

24

What process causes renal artery stenosis?

Atherosclerosis

Can also be caused by AAA

25

Is renal artery stenosis unilateral or bilateral?

Usually unilateral

26

People with renal artery stenosis will be systemically ___.

hypertensive

27

What happens when you treat someone with hypertension, secondary to renal artery stenosis, with antihypertensive drugs?

AKI

28

What is a rare respiratory presentation of renal artery stenosis?

Flash pulmonary oedema

29

How is renal arterty stenosis diagnosed?

CT / MRI angiography

30

How is renal artery stenosis treated with drugs?

ACE inhibitor / ARB

Statin - secondary prevention

Anti-platelets