Systemic Disease and the Kidney

Question 1

Is survival on dialysis higher in type 1 or type 2s?

Answer 1

type 1s

Question 2

What is the most common cause of renal failure in the UK?

Answer 2

diabetes

Question 3

What should you screen for in diabetes to avoid renal failure?

Answer 3

urinary protein abnormalities

Question 4

Use of what slows progression in renal disease for diabetics?

Answer 4

ACE Is and ARBs

Question 5

What characterizes diabetic nephropathy in terms of albuminuria

Answer 5

persistant albuminuria (300mg/24hr) on at least 2 occasions separated by 3-6 months

Question 6

Describe pathophysiological changes in diabetic nephropathy.

Answer 6

• haemodynamic change (casodilation, Increased GFR)
• Renal hypertrophy (due to plasma glucose stimulating renal growth factors)
• Mesangial expansion, nodule formation
• proteinuria
• tubulointerstitial fibrosis

Question 7

Is there haematuria in diabetic nephropathy?

Answer 7

not normally no

Question 8

How should diabetic nephropathy be treated?

Answer 8

Maintain glycaemic control (HBa1c of less than 7)
Antihypertensives eg ACEIs
Lipid control
Dialysis
In type 1, may be able to do kidney pancreas transplant

Question 9

Name some types of small vessel vasculitis.

Answer 9

Polyarteritis nodosa, Kawasaki disease , ANCA associated Churg strauss

Question 10

What are the main features of Churg Strauss?

Answer 10

chronic rhinosinutis, asthma and prominent peripheral blood eosinophilia, also involvement of lung

Question 11

Is there skin involvement in Churg Strauss?

Answer 11

yes in 2/3 of patients

Question 12

What symptoms are common in Wegener’s (GPA)?

Answer 12

ALL very ENT ish symptoms
Nasal crusting
Sinusitis
Persistent rhinorrheoa
Otitis media
SADDLE NOSE

Question 13

What are the main features of MPA (microscopic polyangiitis)?

Answer 13

pulmonary features

cough, hoarsness, haemoptysis, SOB, pleuritic pain

Question 14

In which two conditions is renal involvement of vasculitis very common?

Answer 14

GPA and MPA

Question 15

How does vasculitis present in the kidney?

Answer 15

AKI - proteinuria, red cell casts

Question 16

What will a renal biopsy show in vasculitis?

Answer 16

segmental necrotizing glomerulonephritis

crescents

Question 17

Name the cutaneous manifestations of vasculitis.

Answer 17

Purpura affecting lower extremities eg ankle

Question 18

How should vasculitis in renal terms be treated?

Answer 18

immunosuppression
plasma exchange
may require renal support

Question 19

Who is SLE most common in?

Answer 19

women in 20s/30s

Question 20

What does SLE cause most commonly in the kidneys?

Answer 20

most common abnormality = proteinuria
nephrotic syndrome
granular or red cell casts

Question 21

What antibodies etc are high in SLE?

Answer 21

positive ANA, dsDNA, SmAb, low complement

Question 22

Treatment of SLE?

Answer 22

ace Is and ARBS
also immunosuppression eg cyclophomude/MMF
Predisolone

Question 23

What syndrome may make prognosis of SLE worse?

Answer 23

antiphospholipid syndrome

Question 24

What percentage of renovascular disease is ostium?

Answer 24

85%

Question 25

What percentage of renovascular disease is bilateral?

Answer 25

30-80%

Question 26

Who is renal vascular disease more common in?

Answer 26

older men

Question 27

What may flash pulmonary oedema be seen in?

Answer 27

renal artery stenosis

Question 28

When are ACE Is contraindicated?

Answer 28

BILATERAL renal artery stenosis

Question 29

What are the main features of myeloma kidney?

Answer 29

lymphoid malignancy bone pain, weakness/fatigue/weight loss hypercalaemia, renal failure, amyloidosis

Question 30

In whom is incidence of myeloma kidney doubled?

Answer 30

blacks

Question 31

What are treatment options of myeloma kidney?

Answer 31

``` stop any nephrotoxins eg NSAIDs treat hypercalaemia avoid contrast agents Chemo to reduce tumour load eg dexamethasone Plasma exchange to remove light chains Dialysis ```