Kidney & systemic disease Flashcards Preview

Year 2 > Kidney & systemic disease > Flashcards

Flashcards in Kidney & systemic disease Deck (63):
1

List the main multi-system diseases which involve the kidney

Diabetes
Vasculitis'
Renovascular disease
Myeloma
Lupus

2

Which type of diabetes can lead to diabetic nephropathy?

Type 1 AND type 2

3

How can we diagnose overt diabetic nephropathy?

Persistent albuminuria >300mg on two separate occasions at least 3-6months apart

4

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) -->
Inflammation -->
Proteinuria (podocyte dysfunction) -->
Tubulo interstitial fibrosis

5

What do we call the nodules found within the kidney because of diabetes?

Kimmelstiel Wilson lesions

6

How long does diabetic nephropathy take to develop?

Roughly 15-20 years

7

How is diabetic nephropathy diagnosed?

Proteinuria
Other diabetic complications
Renal impairment

8

How is diabetic nephropathy managed?

Glycaemic control (HbA1c

9

How do ACE/ARBs help in diabetic nephropathy?

Dilate efferent arterioles in the kidney

10

What renal replacement therapies are available to diabetic patients?

Dialysis
Kidney +/- pancreas transplant

11

Who cannot get a combined kidney and pancreas transplant?

Type 2 diabetics

12

Define renovascular hypertension

Secondary hypertension usually caused by renal artery stenosis

13

What are the two main causes of renovascular disease? Which age groups get each?

Fibromuscular dysplasia (young)
Artherosclerotic (old)

14

How does renal artery stenosis cause renovascular hypertension?

Hormonal and neuronal mechanisms increase blood pressure in response to reduced renal perfusion

15

Define ischaemic nephropathy

Reduced GFR associated with reduced renal blood flow beyond homeostatic correction

16

How does ischaemic nephropathy progress?

Renal atrophy then CKD

17

Which patients tend to get fibromuscular dysplasia?

Young women 15-50 y/o

18

In which case might you expect fibromuscular dysplasia to affect both renal arteries?

Familial fibromuscular dysplasia

19

List two conditions associated with fibromuscular dysplasia

Marfan's syndrome
Ehlers Dantos

20

Which other important arteries, apart from the renal, can be affected in fibromuscular dysplasia?

Carotid (i.e carotid artery dissection)

21

Which patients tend to get artherosclerotic renal disease?

Old white men with CVS risk factors

22

How does renovascular disease present clinically?

Hypertension
AKI after hypertension treatment (ACE/ARB)
CKD in elderly with vascular disease
Sudden onset pulmonary oedema
Microscopic haematuria
Background arterial disease

23

What examination finding may be present in a patient with renovascular disease?

Abdominal bruit

24

How can ischaemic nephropathy be diagnosed?

USS
Artery duplex scans
CT/MR angiography
Angiogram

25

What is the characteristic radiological sign of fibromuscular dysplasia?

Corkscrewing of the arteries

26

How is renovascular disease managed?

BP control
Angioplasty +/- stenting

27

Which blood pressure drugs should not be given in renal artery stenosis? Which other condition should these drugs not be given in?

ACE/ARB
Fibromuscular dysplasia

28

What is multiple myeloma?

Cancer of plasma cells (i.e antibody producing cells)

29

Where do abnormal plasma cells collect in multiple myeloma? What do they interfere with?

Bone marrow
Red blood cell production

30

What is it that gets produced in multiple myeloma which damages the kidneys?

Paraprotein

31

How does multiple myeloma present?

Bone pain
Weakness
Fatigue
Weight loss
Hypercalcaemia
Renal failure**
Amyloidosis
Recurrent infections
Anaemia

32

Who is at most risk of multiple myeloma?

Black people
Old people
Female at a younger age than males

33

How do renal problems manifest in multiple myeloma?

AKI secondary to hypercalcaemia
Monoclonal immunoglobulin deposition disease
Cast nephropathy
Amyloidosis

34

What is amyloidosis?

Deposition of proteins in extracellular spaces

35

How can renal amyloidosis be classified?

Primary (AL) and secondary (AA) amyloid

36

How does amyloidosis present histologically?

Positive congo red stain
Apple green bifringence under polarised light

37

Apart from the kidneys where does amyloidosis tend to occur?

Heart

38

How is AKI due to multiple myeloma managed?

Stop nephrotoxics (NSAIDs, diuretics)
Treat hypercalcaemia
Avoid contrast
Chemotherapy for tumour (+/- dexamethasone)
Plasma exchange
Dialysis

39

How is kidney related hypercalcaemia treated?

Fluids
IV pamidronate

40

Which type of vasculitis affects the kidney the most? Name three of these

Small vessel ANCA
GPA, eGPA, microscopic polyangiitis

41

Which age group typically gets vasculitis'?

Elderly

42

How do vasculitis' present in general?

Constitutional symptoms (fever, arthralgia, weight loss, etc)

43

Where does GPA most commonly affect?

Respiratory tract

44

How does GPA present?

Nasal crusting
Sinusitis
Rhinorrhea
Otitis media
Ulcers
Epistaxis

45

Which clinical sign may be present in GPA?

Saddle nose (reduced blood supply to cartilage)

46

How does eGPA present?

Asthma (late onset)
Eosinophilia
Palpable purpura or subcutaneous nodules

47

Where does eGPA most commonly affect?

Lungs

48

What do GPA and eGPA have in common histologically?

Necrotising granulomatous inflammation

49

Are there granulomas in microscopic polyangiitis?

No

50

Pulmonary haemorrhages can occur in which small vessel vasculitis'? Why?

GPA
eGPA
Microscopic polyangiitis
Alveolar capillary involvement

51

How are small vessel vasculitis' diagnosed?

Urinalysis
CRP, PV
Complement
ANCA
Biopsy of involved sites

52

Which ANCAs are associated with the small vessel vasculitis'?

GPA - c-ANCA (cytoplasmic) & PR3
eGPA - p-ANCA (perinuclear) & MPO

53

Renal involvement is most common in which two small vessel vaculitis'? How does it present?

GPA
Microscopic polyangiitis

Proteinuria
Haematuria
AKI
Biopsy showing segmental necrotising GN

54

Crescents on renal biopsy are characteristic of what?

Vasculitis

55

How are vasculitis' treated?

Immunosuppression (IV methylpred & cyclophosamide)
Plasma exchange
Renal support (i.e dialysis)

56

What is the cause of SLE?

No one knows

57

What systems can be affected in SLE?

Skin
Joints
Kidneys
Lungs
Serous membranes
Nerves

58

Which patients most commonly get SLE?

Young woman
African american people
Hispanic people

59

How might SLE present?

Malar rash
Discoid rash
Photosensitivity
Oral ulcers
Non-erosive arthritis
Pluropericarditis
Renal impairment

60

Which antibodies are positive in SLE?

Anti-dsDNA
Anti-ANA
Anti-Sm

61

What is renal disease caused by SLE called? How does it most commonly present?

Lupus nephritis
Proteinuria +/- haematuria

62

How is lupus nephritis treated?

ACE/ARB
Immunosuppression (high dose steroids + immunosuppressant --> steroids + immunosuppressant)

63

What are the poor prognostic features of SLE?

Male
Renal involvement
Extremes of age at presentation
Anti-phospholipid syndrome
High disease activity

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