Systemic Disease and the Kidney Flashcards Preview

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Flashcards in Systemic Disease and the Kidney Deck (31):
1

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

type 1s

2

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

diabetes

3

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

urinary protein abnormalities

4

Use of what slows progression in renal disease for diabetics?

ACE Is and ARBs

5

What characterizes diabetic nephropathy in terms of albuminuria

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

6

Describe pathophysiological changes in diabetic nephropathy.

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

7

Is there haematuria in diabetic nephropathy?

not normally no

8

How should diabetic nephropathy be treated?

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

9

Name some types of small vessel vasculitis.

Polyarteritis nodosa, Kawasaki disease , ANCA associated Churg strauss

10

What are the main features of Churg Strauss?

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

11

Is there skin involvement in Churg Strauss?

yes in 2/3 of patients

12

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

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

13

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

pulmonary features
cough, hoarsness, haemoptysis, SOB, pleuritic pain

14

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

GPA and MPA

15

How does vasculitis present in the kidney?

AKI - proteinuria, red cell casts

16

What will a renal biopsy show in vasculitis?

segmental necrotizing glomerulonephritis
crescents

17

Name the cutaneous manifestations of vasculitis.

Purpura affecting lower extremities eg ankle

18

How should vasculitis in renal terms be treated?

immunosuppression
plasma exchange
may require renal support

19

Who is SLE most common in?

women in 20s/30s

20

What does SLE cause most commonly in the kidneys?

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

21

What antibodies etc are high in SLE?

positive ANA, dsDNA, SmAb, low complement

22

Treatment of SLE?

ace Is and ARBS
also immunosuppression eg cyclophomude/MMF
Predisolone

23

What syndrome may make prognosis of SLE worse?

antiphospholipid syndrome

24

What percentage of renovascular disease is ostium?

85%

25

What percentage of renovascular disease is bilateral?

30-80%

26

Who is renal vascular disease more common in?

older men

27

What may flash pulmonary oedema be seen in?

renal artery stenosis

28

When are ACE Is contraindicated?

BILATERAL renal artery stenosis

29

What are the main features of myeloma kidney?

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

30

In whom is incidence of myeloma kidney doubled?

blacks

31

What are treatment options of myeloma kidney?

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