renal complications of systemic disease

Question 1

what is diabetic nephropathy and its pathophysiology?

Answer 1

describes conglomerate of lesions occurring concurrently.

Hyperglycaemia → renal hyperperfusion → hypertrophy and ↑ renal size

Hypertrophy and metabolic defects inc. ROS production → glomerulosclerosis and nephron loss

Nephron loss → RAS activation → HTN

Question 2

what are the clinical features of diabetic nephropapthy?

Answer 2

Microalbuminuria (30-300mg/d or albumin:creatinine >3)
- Strong independent RF for CV disease

Progresses to proteinuria (albuminuria >300mg/d)

Diabetic retinopathy usually co-exists and HTN is
common

Question 3

what screening is required for diabetic nephropathy?

Answer 3

type 2 diabetes should be screened for microalbuminuria every 6 months

Question 4

what is the treatment for diabetic nephropathy?

Answer 4

Good glycaemic control delays onset and progression

BP target 130/80
Start ACEi/ARB even if normotensive

Stop smoking

Combined kidney pancreas Tx possible in selected pts

Question 5

why does amyloidosis effect the kidneys?

Answer 5

Renal involvement usually caused by AL/AA amyloid

Question 6

what are the features of renal involvement of amyloidosis?

Answer 6

 Proteinuria
 Nephrotic syndrome
 Progressive renal failure

Question 7

how is renal involvement of amyloidosis diagnosed?

Answer 7

USS- large kidneys
biopsy

Question 8

what infections can lead to glomerulonephritis?

Answer 8

post strep
HCV
HBV
HIV
SBE/IE
visceral abscess

Question 9

what infections can lead ot vasculitis?

Answer 9

HBV
HCV
post strep

Question 10

what infections can lead to TIN?

Answer 10

bacterial pyelonephritis
CMV
HBV
toxo

Question 11

why can nephrotoxicity occur in malignancy?

Answer 11

toxic chemotherapy
anaglesia
tumour lysis syndrome

Question 12

what malignancies can lead to renal involvement and why?

Answer 12

leukaemia + lymphoma -> renal infiltration

pelvic tumours -> obstruction

metastases

Question 13

why can hyperparathyroidism lead to renal involvement?

Answer 13

hyperparathyroidism can cause hypercalcaemia

Question 14

what effect does sarcoidosis have on the kidneys?

Answer 14

raise calcium
TIN

Question 15

what is the pathophysiology of myeloma and effect on kidneys?

Answer 15

Excess production of monoclonal Ab ± light chains (excreted and detected in 60% as urinary BJP).

Light chains block tubules and have direct toxic effects → ATN.

Myeloma also associated with ↑↑Ca2+

Question 16

what is the presentation of myeloma?

Answer 16

acute/chronic renal failure
amyloidosis

Question 17

what is the treatment of myeloma regarding renal involvement?

Answer 17

Ensure fluid intake of 3L/d to prevent further impairment
Dialysis may be required in ARF

Question 18

what effect on kidneys can rheumatoid arthritis have on kidneys and why?

Answer 18

ATN due to NSAIDs
membranous GN due to penicillamine + gold

AA amyloidosis occurs in 15%

Question 19

what effect on kidneys can SLE have?

Answer 19

involves glomerulus in 40-60% so can lead to acute/chronic renal failure

proteinuria and high BP common

Question 20

how do you treat renal involvement of SLE?

Answer 20

proteinuria- ACEi
aggressive GN- immunosuppression

Question 21

what is the renal involvement of diffuse systemic sclerosis?

Answer 21

Renal crisis: malignant HTN + ARF
- Commonest cause of death

Question 22

what is the treatment of renal involvement in diffuse systemic sclerosis?

Answer 22

ACEi if raised BP or renal crisis