Kidney in systemic disease Flashcards
(28 cards)
Define the perimeters for diabetic nephropathy
300mg/24h on at least 2 occasions separated by 3- 6 months
state the micro and macro vascular complications of diabetes
Microvascular Nephropathy Retinopathy Polyneuropathy Sensory Motor Autonomic neuropathy (Gastroparesis, Silent MI, Urogenital abnormalities)
Macrovascular
Stroke
Coronary heart disease
Peripheral vascular disease
Describe the pathogenesis of Diabetic Nephropathy (7)
-Haemodynamic changes-
afferent arteriolar vasodilatation mediated by range of vasoactive mediators e.g IGF-1
hyperfiltration
increased GFR
-Renal hypertrophy
plasma glucose stimulates several growth factors within the kidney
-Mesangial Expansion
-Nodule Formation
nodular diabetic glomerulosclerosis ( Kimmelstiel-Wilson lesion) and diffuse glomerulosclerosis
- Inflammation
- Proteinuria (GBM thickening and podocyte dysfunction)
- Tubulo-interstitial fibrosis
name the appearance on histology of glomerulosclerosis in diabetes
Kimmelstiel-Wilson lesion
describe the pattern of GFR and albuminuria in diabetic nephropathy?
initial increase as the kidneys undergoes hyperplasia and then decrease
albuminuria rises as GFR falls
Diagnosis of diabetic nephropathy (4)
-indications for biopsy?
History of Diabetes Mellitus
Proteinuria
Presence of other diabetic complications eg retinopathy
Renal Impairment in later stages
-haematuria
nephrotic range for proteinuria?
> 300 mg/day
treatment of diabetic nephropathy (3)
-mechansim?
Glycaemic control (Maintain tight glycaemic control (HbA1c
3 types of RRT in diabetic nephropathy
Simultaneous Kidney-Pancreas Transplant (Type 1 only)
Kidney transplant
Haemodialysis and Peritoneal Dialysis (need tight BG control as the fluid is high in glucose)
Renal vascular hypertension
- what is it?
- caused by?
- 2 types of renovascular disease
- secondary from of hypertension usually due to renal artery stenosis
- A reduction in renal perfusion pressure activates RAAS which raises systemic arterial BP.
-Fibromuscular dysplasia
Atherosclerotic Renovascular disease
ischaemic nephropathy
-what is it?
refers to the reduced GFR associated with reduced renal blood flow beyond the level of auotregulatory compensation
over time can lead to renal atrophy and CKD
Fibromuscular dysplasia
- what is it?
- population
- types
- associated
- presentation(4)
- non-atherosclerotic, non-inflammatory disease of the blood vessels that causes abnormal growth within the wall of an artery- rings of sclerosis and eventual renal artery stenosis
- 15-50 yeas
- familial, involves both renal arteries
-hereditary conditions e.g Ehlers-Danlos
can involve cerebral arteries and cause carotid artery dissection
-renal symptoms are hypertension and renal artery bruit also get headaches, dizziness and neck pain
Atherosclerotic renovascular disease
- population
- risk factors
- presentation (7)
- older patients, men, caucasians
- general atherosclerosis
-Renovascular hypertension
AKI after treatment of hypertension (usually with ACEi)
CKD in elderly with diffuse vascular disease
‘Flash’ pulmonary oedema
Microscopic haematuria
Abdominal bruit
Atherosclerotic disease elsewhere
what are the 3 conditions associated with renal artery stenosis?
ischaemic nephropathy (IN)
fibromuscular dysplasia (FMD)
atherosclerotic renovascular disease (ARVD)
investigations in ischaemic renal disease?
- managment
- contraindicated
-Screening tests Renal ultrasound Renal artery duplex studies CT angiography MR angiography Angiography
-control BP and reduce CV risk factors
Angioplasty/Angioplasty + stenting/Stenting alone
-ACE inhibitors
Myeloma
- what is it?
- pathognesis
- signs (5) and symptoms (4)
- investigations (6)
- renal manifestations (4)
- a cancer of plasma cells (a type of WBC normally responsible for producing antibodies)
- collections of abnormal plasma cells accumulate in the bone marrow where they interfere with the production of normal blood cells. most cases feature the production of paraprotein- an abnormal antibody which can cause kidney problems
-signs Anaemia Hypercalcaemia Renal Failure Amyloidosis Recurrent infections -symptoms Bone Pain Weakness Fatigue Weight Loss
-blood film FBC- CRP creatinine protein electrophoresis Bence-Jones protein in urine Lytic lesions on skeletal survey
-AKI secondary to hypercalcaemia
Monoclonal immunoglobin deposition disease
Amyloidosis
Amyloidosis
- what is it?
- classification
- histology
-Generic name for a family of diseases
Characterised by the deposition in extracellular spaces of a proteinaceous material
-Classified by the type of precursor protein that makes up the main component of the fibrils
Renal amyloidoses include primary (AL) amyloid and secondary (AA) amyloid
-Clasically positive Congo red staining showing apple-green birifringence under polarised light
Treatment of myeloma in acute renal failure?
- acute (7)
- long term (4)
Acute Stop Nephrotoxins -NSAID’s -Diuretics in view of risk increasing cast formation Treat hypercalcaemia -IV NaCl to volume resuscitate -IV Pamidronate if required \+ avoid contrast
long term -Chemotherapy to reduce tumour load \+High dose dexamethasone may help reduce tumour load. -Plasma exchange -To remove light chains. Dialysis to support AKI and CKD
Vasculitis
- type that effects kidneys most?
- name the 4 major subtypes of this
-small vessel vasculitis
-necrotising polyangitis
Granulomatosis with polyangitis
Churg-strauss syndrome
microscopic polyangitis
necrotising polyangiitis
- antibody associated
- effects?
- population
- presentation
- ANCA
- capillaries, venules and arterioles
- general symptoms; weight loss, anorexia, malaise
Granulomatosis with Polyangiitis
- what is it?
- presentation
- signs
- antibody
- Necrotising granulomatous inflammation which most commonly affects the respiratory tract
- nasal crusting, sinusitis, persistent rhinorrhea, otitis media, oral/nasal ulcers, bloody nasal discharge
- bony cartilage destruction- saddle nose
- c-ANCA
Churg-Strauss syndrome
- what is it?
- other features
- antibody
-necrotising granulomatous inflammation causing asthma and eosonophilia
lung most common involvement
- skin involvement= palpable purpura to subcutaneous nodules
- p-ANCA
Microscopic polyangitis
- what is it?
- complications
- small vessel vasculitis, no granulomatous inflammation
- pulmonary haemorrhage as a consequence of alveolar capillary involvement
Investigations in small vessel vasculitis? (7)
Hx examination Bloods (CRP, PV, complement, ANCA, virology) urinalysis Biopsy (kidney, skin, nasal, lung) cytoplasmic PR3 (c-ANCA) perinuclear MPO (p-ANCA)
