8 - diabetes hypertension , APCKD and other conditions affecting the kidney

Question 1

What is the nephrotic syndrome triad?

Answer 1

proteinuria
hypoalbuminaemia
oedematous

Question 2

what are the causes of nephrotic syndrome?

Answer 2

PRIMARY RENAL DISEASE
minimal change glomerulonephritis
focal segmented glomerulosclerosis
membranous nephropathy

SECONDARY RENAL DISEASE
diabetes
SLE
amyloid

Question 3

What is the management of nephrotic syndrome?

Answer 3

oedema - diuretics. salt and fluid restriction
ACEI
hypercholesterolaemia
treat underlying condition

Question 4

what is the nephritic syndrome triad?

Answer 4

haematuria
reduction in GFR
hypertension

Question 5

what are the common causes of nephritic syndrome?

Answer 5

Goodpasture’s
ANCA - associated vasculitis
post-infectious
lupus

Question 6

what is the management of nephritic syndrome?

Answer 6

BP control 
treatment of oedema 
disease specific treatments 
CVS risk management 
dialysis

Question 7

what is systemic lupus erythematosus?

Answer 7

auto-immune systemic disease - can affect multiple systems
has different patterns of renal disease
can cause nephrotic or nephritic syndrome
treatment is dependent on pattern of lupus nephritis

Question 8

What are the pathological changes in diabetic nephropathy?

Answer 8

1. hyperfiltration/ capillary hypertension
   occurs early in disease - causes kidney to increase in size - increased GFR
2. glomerular BM thickening
3. mesangial expansion (potentially reversible at this stage)
4. podocyte injury
5. glomerular sclerosis/ arteriolosclerosis

Question 9

what are the clinical signs and symptoms in diabetic nephropathy?

Answer 9

1. hyperfiltration and hypertrophy
2. latent stage
3. microalbuminuria (potentially reversible at this stage)
4. overt proteinuria
5. ESRD
6. increased GFR
7. normal albuminuria, GBM thickening and mesangial expansion
8. variable mesangial expansion/ sclerosis, increased GBM thickening, podocyte changes. GFR normal
9. systemic hypertension, falling GFR

Question 10

what are diabetic nephropathy risk factors?

Answer 10

genetic susceptibility 
race 
hypertension
hyperglycaemia 
high level of hyperfiltration 
increasing age 
duration of diabetes
smoking

Question 11

what is the primary prevention of diabetic nephropathy?

Answer 11

tight blood glucose control

tight BP control

Question 12

what is the management of microalbuminuria and proteinuria?

Answer 12

• inhibition of RAAS
• tight BP control
• statin therapy
• CV risk management
• moderate protein intake
• tight blood glucose control (not affect progression once overt proteinuria develops)