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

5: Kidneys in systemic disease Flashcards

(49 cards)

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1
Q

What endocrine disease causes nephropathy?

A

Diabetes mellitus

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2
Q

What causes the nephropathy seen in diabetes?

A

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

  1. Growth factors causes inflammation, leading to vasoconstriction and renal hypoperfusion > renal hypertension, inflammation, proteinuria…
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3
Q

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

A

Focal segmental glomerulosclerosis

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4
Q

What happens to GFR in diabetic nephropathy?

A

Increases

to everything, causing proteinuria

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5
Q

What is an early marker of kidney disease?

A

Microalbuminuria

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6
Q

What decreases in late diabetic nephropathy?

A

Renal function

i.e eGFR, A/C ratio…

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7
Q

What happens to GFR in

a) early
b) late

diabetic nephropathy?

A

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

b) Decreases (as kidneys fail)

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8
Q

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

A

increases

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9
Q

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

A

No

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10
Q

What measurements are used to quantify proteinuria?

A

24h urine protein

Albumin/creatinine ratio

Protein/creatinine ratio

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11
Q

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

A

Glycaemic control (HbA1c < 48)

Blood pressure (< 130/80 mmHg)

Cholesterol - statin

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12
Q

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

A

ACE inhibitors

ARBs

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

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13
Q

What is the treatment for end-stage diabetic nephropathy?

A

Renal replacement therapy

or Supportive

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14
Q

What are three types of renal replacement therapy?

A

Haemodialysis

Peritoneal dialysis

Kidney transplant

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15
Q

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

A

Joint kidney-pancreas transplant

to replace their beta cells

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16
Q

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

A

Lots of co-morbidities

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17
Q

What urinary sign is a marker of diabetic nephropathy progression?

A

Proteinuria

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18
Q

What is renovascular disease?

A

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

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19
Q

What is ischaemic nephropathy?

A

Decrease in kidney function caused by reduced blood flow

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20
Q

What happens when renal perfusion is reduced?

Study These Flashcards
A

RAAS activation

Sympathetic vasoconstriction

Renal hypertension

Further ischaemia

repeat

21
Q

What are the renal consequences of ischaemic nephropathy?

Study These Flashcards
A

Atrophy

Chronic kidney disease

22
Q

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

Study These Flashcards
A

Renal artery stenosis

23
Q

What are the risk factors for renal artery stenosis?

Study These Flashcards
A

Age

Male

Ethnicity

Alcohol

Smoking

Poor exercise

Poor diet

Hyperlipidaemia

24
Q

What process causes renal artery stenosis?

Study These Flashcards
A

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**
31
When are ACE inhibitors contraindicated in renal artery stenosis?
**Bilateral** causes severe AKI as blood supply reduced further
32
What is a rare genetic condition causing renal artery narrowing? Who tends to get it? What condition, causing hypermobility and blue sclera, is it associated with? How is it treated?
**Fibromuscular dysplasia** **Young women** **Ehlers-Danlos syndrome** **Stenting**
33
Renal disease exacerbates ___ failure.
**heart failure**
34
What are terminally differentiated B cells called? What is their function?
**Plasma cells** Produce antibodies
35
What disease causes **abnormal production** of **plasma cells**?
**Myeloma**
36
How does plasma cell function go to pot in myeloma?
**Abnormal proteins produced** (Accumulate in bone marrow, stopping it from producing normal blood cells) **Abnormal proteins also cause renal dysfunction**
37
If someone presents with **back pain** and **renal failure**, what do they probably have?
**Myeloma**
38
What are some symptoms of myeoma?
**Bone pain** **Weakness** **Fatigue** **WL**
39
What is a renal sign of **myeloma**?
Elevated **BENCE JONES PROTEIN** in urine
40
How is myeloma treated?
**Chemotherapy** **Stem cell transplant**
41
takayasu - aorta, large vessels, radial radial delay etc kawasaki - kids, rash GCA - jaw claud, headache, visual loss, assoc PMR henoch schonlein - kids, posterior rash, abdo pain GWP - nosebleeds, central midline stuff, ANCA (PR3) EGWP - GWP with eosinophils, late onset asthma, ANCA (MPO) Behcets - mouth, genital ulcers
42
How do patients with **vasculitis** present?
**Fever** **Weight loss** **Anorexia** **Arthralgia**
43
After constitutional symptoms, how do patients with vasculitis present?
**Organ damage**
44
How is vasculitis treated?
**Immunosuppression** - your standards, cyclophosphamide
45
How is late-stage renal disease, caused by vasculitis, treated?
**Dialysis**
46
What CTD is notorious for causing kidney disease?
**SLE**
47
What investigation should be done for anyone with suspected lupus?
**Urinalysis** **Antibodies** - ANA, anti-dsDNA
48
What are you trying to detect with urinalysis in someone with SLE?
**Proteinuria**
49
How do you classify the severity of glomerulonephritis caused by SLE?
**Renal biopsy**

Renal Week 2 2017/18 (11 decks)

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