Lecture 23 Kidneys in Systemic Disease Flashcards

1
Q

Why is the kidney to target for many systemic diseases

A

Large volume of blood flow
Protein reabsorption
Ability to trap protein complexes and immunoglobulins
Metabolises and excretes drugs

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2
Q

Name cardiovascular diseases that affect the kidneys

A

Cardiac failure
Atheroembolism
Hypertension
Atherosclerosis

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3
Q

Name infectious diseases that effect the kidneys

A

Sepsis
Post strep GN
Infective endocarditis

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4
Q

Name inflammation in the blood vessels hat affect the kidneys

A

Vasculitis
Scleroderma
SLE
Cryoglobulinemia

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5
Q

Name other systemic diseases that affect the kidneys

A

DM
Haemolytic-Uremic Syndrome/ Thrombotic thrombocytopenic purpura
Myeloma
Amyloidosis

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6
Q

What drugs can affect the kidneys

A
–	Aminoglycosides		
–	NSAIDs
–	ACE inhibitors			
–	Radiocontrast
–	Penicillamine, gold
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7
Q

What is the commonest cause of ESRF

A

Diabetes mellitus (type I and II)

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8
Q

Increasing proteinuria is associated with what

A

Declining GFR

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9
Q

Stage 1 CKD

A

GFR >90

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10
Q

Stage 2 CKD

A

GFR 60-89

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11
Q

Stage 3 CKD

A

GFR 30-59

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12
Q

Stage 4 CKD

A

15-29

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13
Q

Stage 5 CKD

A

<15

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14
Q

Name common causes of renal failure in older patients

A
  • Glomerulonephritis
  • Diabetes
  • Polycystic Kidney
  • Pyelonephritis
  • Renal Vascular Disease
  • Hypertension
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15
Q

What is vasculitis?

A

Inflammatory reaction in the wall of any blood vessel

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16
Q

Vasculitis in the aorta/large artery s referred to as

A

– Takayasu arteritis

– Giant cell arteritis

17
Q

Vasculitis in medium arteries are referred to as

A

– Polyarteritis nodosa

– Kawasaki disease

18
Q

Vasculitis in small vessels are referred to as

A

– Wegener’s granulomatosis
– Microscopic polyarteritis
– Churg-Strauss syndrome

19
Q

What are pathological features of Wegener’s Granulomatosis (Granulomatosis with polyangiitis)

A
  • Granulomatous inflammation in respiratory tract

* Focal necrotising glomerulonephritis with crescents

20
Q

What group does Granulomatosis with polyangiitis commonly affect

A

40-60 years

More common in males

21
Q

What are the symptoms of Granulomatosis with polyangiitis (Wegener’s Granulomatosis) in the URT

A

Epstaxis
Nasal deformity
Sinusitis
Deafness

22
Q

What are the symptoms of Granulomatosis with polyangiitis (Wegener’s Granulomatosis) in the LRT

A

Cough
Dyspnoea
Haemoptysis

23
Q

What are the symptoms of Granulomatosis with polyangiitis (Wegener’s Granulomatosis) not seen in the respiratory tract

A
  • Kidney- Glomerulonephritis
  • Joints- arthralgia, myalgia
  • Eyes- scleritis
  • Heart- pericarditis
  • Systemic- fever, weight loss, vasculitic skin rash
24
Q

What tests can be done to diagnose vasculitis

A
  • Urine- Blood/protein
  • Renal function- Raised urea/creatinine
  • Biochemistry- Raised alk phos, CRP, low albumin
  • Haematology- Anaemia, thrombocytosis, leukocytosis
  • Immunology- Hyperglobulinaemia, Positive ANCA (can be cytoplasmic or perinuclear)
  • Renal biopsy
25
Q

What are the main organisms that cause infective endocarditis

A

– Staphylococcus aureus
– Viridan streptococci
– Enterococci

26
Q

Why does infective endocarditis lead to vasculitis

A

Small vessel vasculitis due to immune complex formation

27
Q

Renal involvement in infective endocarditis would be detected through what signs

A
  • Abnormal urea/creatinine
  • Haematuria, red cell casts
  • Reduced complement levels
28
Q

How is renal disease causes by infective endocarditis resolve

A

• Renal disease should recover when underlying infection treated

29
Q

What is multiple myeloma

A

• Monoclonal proliferation of plasma cells producing an excess of immunoglobulin and light chains

30
Q

What age group is multiple myeloma common in

A

The elderly

31
Q

What are the clinical features of multiple myeloma

A
–	Markedly elevated ESR
–	Anaemia
–	Weight loss
–	Fractures
–	Infections
–	Back pain/cord compression
32
Q

How is multiple myeloma diagnosed

A
Bone marrow aspirate 
Serum paraprotein
Bence-Jones protein
Lytic lesions
Immunofluorescence 
PAS stain
33
Q

Name features of renal failure in myeloma

A

Cast nephropathy
Amyloidosis
Hypercalcaemia
Hyperuricaemia

34
Q

Presence of ANCA (anti-MPO/anti-PR3 antibodies) in the blood

A

Crescentic Glomerulonephritis

35
Q

Presence of ANA, dsDNA antibodies

A

SLE

36
Q

Presence of Viridan streptococci, Enterococci, staphylococcus aureus in blood cultures

A

Infective Endocarditis