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Urinary System > Kidneys in Systemic Disease > Flashcards

Kidneys in Systemic Disease Flashcards

1
Q

What cardiovascular problems can contribute to renal disease?

A

Cardiac failure
Atheroembolism
Hypertension
Atherosclerosis

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1
Q

How does diabetes contribute to renal disease?

A

Progressive proteinuria and CKD

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2
Q

What infections can contribute to renal disease?

A

Post-infectious GN
Infective endocarditis
HIV
Hepatitis

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3
Q

What malignancy can contribute to renal disease?

A

Myeloma and amyloidosis

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4
Q

What drugs can effect the kidneys?

A

Interstitial nephritis
Aminoglycosides
NSAIDs
ACE inhibitors
Radiocontrast

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5
Q

What blood vessel diseases can effect the kidneys?

A

ANCA associated vasculitis
Thrombotic microangiopathy
HUS and TTP

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6
Q

Describe the pathophysiology of diabetes mellitus causing kidney damage

A

Glomerular hyperfiltration
Altered glomerular composition
Renal hypertrophy
Glomerular hypertension
These cause albuminuria and deposition in ECM - glomerulosclerosis and interstitial fibrosis

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7
Q

What is common in kidney biopsies of diabetic patients?

A

Kimmelstiel-Wilson nodules

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8
Q

What is the natural history of diabetes?

A

Silent subclinical phase, hyperfiltration and increased GFR
Microalbuminuria
Clinical nephropathy
Established renal failure

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9
Q

What is increased proteinuria in diabetes associated with?

A

Declining GFR

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10
Q

What is the single commonest cause of end stage renal disease (ESRD)?

A

Diabetic nephropathy
Leads to need for dialysis or transplantation

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11
Q

What is the key for controlling diabetes nephropathy?

A

Monitoring and managing proteinuria and glucose control

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12
Q

Describe systemic lupus erythematosus

A

Autoimmune illness
Affects both men and women, mainly women 15-45
Risk - African, Caribbean or Asian
Malor/ butterfly rash

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13
Q

Describe lupus nephritis

A

Up to 60% of lupus patients will get lupus nephritis
Immune mediated glomerulonephritis
Varying degrees of immune deposits and pattern of glomerular injury

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14
Q

What are the signs of lupus nephritis?

A

Proteinuria, nephrotic syndrome, haematuria, red cell casts and elevated creatinine

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15
Q

How is lupus nephritis classified?

A

Into 6 stages
Represent increase in glomerular damage - different changes correlate to immunosuppression given

16
Q

What is key for control of lupus nephritis?

A

Early recognition and management of SLE with immunosuppressive drugs and corticosteroids

17
Q

Describe multiple myeloma

A

Monoclonal proliferation of plasma cells producing an excess of immunoglobulins and light chains
Seen as monoclonal band on serum and urine electrophoresis
Common in elderly

18
Q

What is the presentation of myeloma?

A

Markedly elevated ESR, anaemia, weight loss, fractures, infections and back pain/ cord compression

19
Q

How is myeloma diagnosed?

A

Bone marrow aspirate >10% clonal plasma cells
Serum paraprotein and immunoparesis
Urine Bence Jones protein
Skeletal survey - lytic lesion

20
Q

Describe myeloma kidney

A

20-40% of myeloma patients will have some kidney failure
Cast nephropathy

21
Q

How does myeloma affect the kidneys?

A

Cast nephropathy, light chain nephropathy, amyloidosis, hyperuricaemia, and hypercalcaemia

22
Q

What are some symptoms which suggest a systemic disease with renal involvement?

A

Fever, weight loss, skin rash, SOB, haemoptysis, oedema, arthralgia, myalgia, malaise, epistaxis and haematuria

23
Q

What are some signs which can suggests a systemic disease with renal involvement?

A

Splinter haemorrhages, purpura, Raynaud’s, scleritis, uveitis, nasal cartilage deformity, retinal vasculitis, hypertensive retinopathy, vasculitis rash and scleroderma

24
Q

What investigations are important?

A

Urine dip
Bloods - ANCA, ANA, blood cultures
Radiology - CXR, USS abdomen and CT thorax
Echocardiogram
Kidney biopsy

Urinary System (26 decks)

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