Kidney's and Systemic Disease

Question 1

List some various systemic disease affecting kidneys.

Answer 1

DM
CV disease
Infections and inflammation
Drugs

Question 2

Give a summary of Diabetic Nephropathy.

Answer 2

Diabetic nephropathy develops over many years

Type I and Type II patients are equally at risk

Increasing proteinuria is usually associated with declining GFR

Diabetic nephropathy is the single commonest cause of ESRF

Question 3

Review the NKF-DOQI staging of chronic kidney disease?

Answer 3

National Kidney Foundation Dialysis Outcome Quality Initiative.

1 - Kidney damage but GFR >90 
2 - GFR 60-89 
3 - GFR 30-59 (has a stage abc)
4 - GFR 15-29 
5 - GFR <15

Question 4

What is the commonest cause of renal failure in older patients?

Answer 4

Renal vascular disease

Question 5

What is vasculitis?

Answer 5

Inflammatory reaction in the wall of any blood vessel

Question 6

What is wegner’s granulomatosis?

Answer 6

Granulomatous inflammation in respiratory tract

Focal necrotising glomerulonephritis with crescents

Question 7

What is microscopic polyarteritis?

Answer 7

Similar clinical spectrum to Wegener’s granulomatosis

Can present with systemic disease, renal and pulmonary involvement

Question 8

How do we diagnose vasculitis?

Answer 8

Urine - blood/protein levels

Renal function - raised urea/creatinine

Biochemistry - raised alkaline phosphate, CRP, low albumin

Haematology - anemia, thrombocytosis, leukocytosis

Immunology - Hyperglobulinemia

Renal biopsy

Question 9

What does infective endocarditis lead to in terms of renal disease?

Answer 9

Glomerulonephritis ± small vessel vasculitis due to immune complex formation

Question 10

What is multiple myeloma?

Answer 10

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

Common in elderly

Question 11

Multiple myeloma clinical features?

Answer 11

Elevated ESR
Anemia
Weight loss
Fractures
Infections
Back pain/cord compression

Question 12

What does a “myeloma” kidney look like?

Answer 12

Cast and light change nephropathy = amyloidosis, hypercalcaemia and hyperuricemia

Question 13

What symptoms suggest renal failure is being caused by a systemic disease?

Answer 13

Weight loss
Fever and malaise
Myalgia and arthralgia
Skin rash
Breathlessness
Haemoptysis
Haematuria
Oedema

Question 14

What is myalgia and arthralgia?

Answer 14

Pain in muscle and joints respectively

Question 15

What is the basis of this lecture trying to get across?

Answer 15

Renal failure can be primary but can on rarer occasions be caused by a 2y systemic disease

Be sure to watch out for other signs which might suggest something else is going on