Systemic Disease Affecting The Kidneys Flashcards Preview

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Flashcards in Systemic Disease Affecting The Kidneys Deck (15):
1

What is the histology of diabetic nephropathy?

Thickening of the glomerular basement membrane
Nodular glomerulosclerosis

2

How does systemic disease manifest in kidneys?

Failure to excrete wast products suddenly
- AKI
Failure to excrete waste products grandually
- CKD
Kidneys inflamed and leak blood and protein
- nephritic syndrome
Kidney's leak a bit of protein
- proteinuria
Kidney's leak a lot of protein
- nephrotic syndrome

3

Differential diagnosis for when someone with high BP has increased creatinine when on an ACE inhibitor?

Obstruction
Renovascular disease (more likely if they have systemic vascular disease)
Interstitial nephritis

4

If someone has systemic vascular disease, what is the most likely diagnosis?

Renal artery stenosis

5

How is renal artery disease managed?

Medically
- BP control (not ACEI/ARB)
- statin
- glycaemic control is diabetic
Lifestyle
- smoking cessation
- exercise
- low sodium diet

6

How is renal artery stenosis diagnosed?

Angioplasty
Rapidly deteriorating renal failure
Uncontrolled BP on multiple agents
Flash pulmonary oedema

7

What are the differential diagnoses for someone with nephrotic syndrome and a history of ulcerative colitis?

Diabetic nephropathy
Lupus nephritis
- vasculitis
Viral infections (HBV, HCV, HIV)
Amyloidosis
Myeloma

8

Describe amyloidosis.

Deposition of highly insoluble proteineous material in extracellular space (felt-like substance made of beta-pleated sheets)
Deposits in the kidney, heart, liver and lungs
Has a high affinity for the constituents of the capillary wall

9

How does amyloidosis look on microscopy?

Light microscopy
Electron microscopy
- amyloid fibrils 9-11nm
- causes mesangial expansion

10

What are the two classes of amyloidosis?

AA - systemic amyloidosis (inflammation and infection, related to IBD)
AL - immunoglobulin fragments from heamatological conditions (e.g. myeloma)

11

How is amyloid treated?

AA - treat underlying source of infection/inflammation
AL - treat the underlying haematological condition

12

What is the differential diagnoses for nephritic syndrome with symptoms of vasculitis?

Vasculitis - ANCA associated
Vasculitis - anti-GBM disease
Vasculitis - lupus nephritis
IgA nephropathy (crescentic variety)

13

What is systemic lupus erythematosis?

An auto-immune disease (mediated by immune complexes)
Multiple autoantibodies
- directed against DNA, histones and transcriptional/translational machinery

14

How is SLE treated?

Immunosuppression
- steriods
- MMF
- cyclophosphamide
- rituximab

15

How is ANCA associate vasculitis treated?

ITU - ventilatory support
Antibody removal/depletion
- methyl prednisolone
- plasma exchange
- cyclophosphamide