What endocrine disease causes nephropathy?
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...
What will be seen on biopsy of a glomerulus from someone with diabetic nephropathy?
Focal segmental glomerulosclerosis
What happens to GFR in diabetic nephropathy?
to everything, causing proteinuria
What is an early marker of kidney disease?
What decreases in late diabetic nephropathy?
i.e eGFR, A/C ratio...
What happens to GFR in
a) Increases (mesangial proliferation, more permeable to protein)
b) Decreases (as kidneys fail)
As diabetic nephropathy progresses, the protein leak (increases/decreases).
Does a urine dipstick pick up any particular type of protein?
What measurements are used to quantify proteinuria?
24h urine protein
What should be controlled to limit the progression of diabetic nephropathy?
Glycaemic control (HbA1c < 48)
Blood pressure (< 130/80 mmHg)
Cholesterol - statin
Which drugs are used to manage blood pressure in those with kidney disease?
dilate efferent arterioles (by acting on RAAS), reducing renal blood pressure
What is the treatment for end-stage diabetic nephropathy?
Renal replacement therapy
What are three types of renal replacement therapy?
What surgical procedure are fit Type 1 diabetics with end-stage renal failure offered?
Joint kidney-pancreas transplant
to replace their beta cells
Why is long-term survival quite low for diabetics on dialysis?
Lots of co-morbidities
What urinary sign is a marker of diabetic nephropathy progression?
What is renovascular disease?
Poor blood supply to kidneys (for loads of reasons) causes disease
What is ischaemic nephropathy?
Decrease in kidney function caused by reduced blood flow
What happens when renal perfusion is reduced?
What are the renal consequences of ischaemic nephropathy?
Chronic kidney disease
What is the main cause of ischaemic nephropathy, caused by secondary hypertension?
Renal artery stenosis
What are the risk factors for renal artery stenosis?
What process causes renal artery stenosis?
Can also be caused by AAA
Is renal artery stenosis unilateral or bilateral?
People with renal artery stenosis will be systemically ___.
What happens when you treat someone with hypertension, secondary to renal artery stenosis, with antihypertensive drugs?
What is a rare respiratory presentation of renal artery stenosis?
Flash pulmonary oedema
How is renal arterty stenosis diagnosed?
CT / MRI angiography
How is renal artery stenosis treated with drugs?
ACE inhibitor / ARB
Statin - secondary prevention