Flashcards in Kidney & systemic disease Deck (63):
List the main multi-system diseases which involve the kidney
Which type of diabetes can lead to diabetic nephropathy?
Type 1 AND type 2
How can we diagnose overt diabetic nephropathy?
Persistent albuminuria >300mg on two separate occasions at least 3-6months apart
Explain the pathogenesis of diabetic nephropathy
Glucose causes the release of vasoactive mediators which dilate the afferent arterioles of the kidney -->
Increased blood flow and thus GFR -->
Glucose stimulates growth factors causing kidney hypertrophy -->
Mesangeal expansion -->
Nodule formation (diabetic glomerulosclerosis) -->
Proteinuria (podocyte dysfunction) -->
Tubulo interstitial fibrosis
What do we call the nodules found within the kidney because of diabetes?
Kimmelstiel Wilson lesions
How long does diabetic nephropathy take to develop?
Roughly 15-20 years
How is diabetic nephropathy diagnosed?
Other diabetic complications
How is diabetic nephropathy managed?
Glycaemic control (HbA1c
How do ACE/ARBs help in diabetic nephropathy?
Dilate efferent arterioles in the kidney
What renal replacement therapies are available to diabetic patients?
Kidney +/- pancreas transplant
Who cannot get a combined kidney and pancreas transplant?
Type 2 diabetics
Define renovascular hypertension
Secondary hypertension usually caused by renal artery stenosis
What are the two main causes of renovascular disease? Which age groups get each?
Fibromuscular dysplasia (young)
How does renal artery stenosis cause renovascular hypertension?
Hormonal and neuronal mechanisms increase blood pressure in response to reduced renal perfusion
Define ischaemic nephropathy
Reduced GFR associated with reduced renal blood flow beyond homeostatic correction
How does ischaemic nephropathy progress?
Renal atrophy then CKD
Which patients tend to get fibromuscular dysplasia?
Young women 15-50 y/o
In which case might you expect fibromuscular dysplasia to affect both renal arteries?
Familial fibromuscular dysplasia
List two conditions associated with fibromuscular dysplasia
Which other important arteries, apart from the renal, can be affected in fibromuscular dysplasia?
Carotid (i.e carotid artery dissection)
Which patients tend to get artherosclerotic renal disease?
Old white men with CVS risk factors
How does renovascular disease present clinically?
AKI after hypertension treatment (ACE/ARB)
CKD in elderly with vascular disease
Sudden onset pulmonary oedema
Background arterial disease
What examination finding may be present in a patient with renovascular disease?
How can ischaemic nephropathy be diagnosed?
Artery duplex scans
What is the characteristic radiological sign of fibromuscular dysplasia?
Corkscrewing of the arteries
How is renovascular disease managed?
Angioplasty +/- stenting
Which blood pressure drugs should not be given in renal artery stenosis? Which other condition should these drugs not be given in?
What is multiple myeloma?
Cancer of plasma cells (i.e antibody producing cells)
Where do abnormal plasma cells collect in multiple myeloma? What do they interfere with?
Red blood cell production
What is it that gets produced in multiple myeloma which damages the kidneys?
How does multiple myeloma present?
Who is at most risk of multiple myeloma?
Female at a younger age than males
How do renal problems manifest in multiple myeloma?
AKI secondary to hypercalcaemia
Monoclonal immunoglobulin deposition disease
What is amyloidosis?
Deposition of proteins in extracellular spaces
How can renal amyloidosis be classified?
Primary (AL) and secondary (AA) amyloid
How does amyloidosis present histologically?
Positive congo red stain
Apple green bifringence under polarised light
Apart from the kidneys where does amyloidosis tend to occur?
How is AKI due to multiple myeloma managed?
Stop nephrotoxics (NSAIDs, diuretics)
Chemotherapy for tumour (+/- dexamethasone)
How is kidney related hypercalcaemia treated?
Which type of vasculitis affects the kidney the most? Name three of these
Small vessel ANCA
GPA, eGPA, microscopic polyangiitis
Which age group typically gets vasculitis'?
How do vasculitis' present in general?
Constitutional symptoms (fever, arthralgia, weight loss, etc)
Where does GPA most commonly affect?
How does GPA present?
Which clinical sign may be present in GPA?
Saddle nose (reduced blood supply to cartilage)
How does eGPA present?
Asthma (late onset)
Palpable purpura or subcutaneous nodules
Where does eGPA most commonly affect?
What do GPA and eGPA have in common histologically?
Necrotising granulomatous inflammation
Are there granulomas in microscopic polyangiitis?
Pulmonary haemorrhages can occur in which small vessel vasculitis'? Why?
Alveolar capillary involvement
How are small vessel vasculitis' diagnosed?
Biopsy of involved sites
Which ANCAs are associated with the small vessel vasculitis'?
GPA - c-ANCA (cytoplasmic) & PR3
eGPA - p-ANCA (perinuclear) & MPO
Renal involvement is most common in which two small vessel vaculitis'? How does it present?
Biopsy showing segmental necrotising GN
Crescents on renal biopsy are characteristic of what?
How are vasculitis' treated?
Immunosuppression (IV methylpred & cyclophosamide)
Renal support (i.e dialysis)
What is the cause of SLE?
No one knows
What systems can be affected in SLE?
Which patients most commonly get SLE?
African american people
How might SLE present?
Which antibodies are positive in SLE?
What is renal disease caused by SLE called? How does it most commonly present?
Proteinuria +/- haematuria
How is lupus nephritis treated?
Immunosuppression (high dose steroids + immunosuppressant --> steroids + immunosuppressant)