Flashcards in Systemic Disease and the Kidneys Deck (16)
Describe the presentation of diabetic nephropathy. (3)
Describe the histology of diabetic nephropathy. (2)
What are these 2 features called collectively?
Thickening of glomerular basement membrane
What are the 5 ways in which systemic disease might present in the kidneys?
Acute kidney injury
Chronic kidney disease
If a patient has deranged U&Es, what further tests would you do? (5)
Urinalysis - proteinuria? haematuria?
Quantitative protein tests (uPCR)
What systemic conditions can
cause acute kidney injury? (3)
Renovascular disease (e.g. renal artery stenosis)
How do you diagnose renal artery stenosis? (2)
NO angiogram/CT etc - contrast can make kidney failure worse
How would you manage renal artery stenosis? (7)
Treat underlying conditions
-Stop ACE inhibitors
-Avoid ACEIs/ARBs in future
-Other BP control
Angioplasty is only rarely used in AKI.
List 3 indications.
Rapidly deteriorating renal failure
Hypertension despite multiple anti-hypertensives
Flash pulmonary oedema
Which systemic conditions can cause nephrotic syndrome? (6)
Where relevant, give some examples.
-Minimal change disease
Viral infections (e.g. HIV, hep B/C)
How would you diagnose amyloidosis? (3)
Biopsy - fibrin strands
Light microscopy - apple green birefringence on Congo red stain
Electron microscopy - fibrin strands, mesangial expansion
Describe the 2 types of amyloidosis.
AA - systemic amyloidosis (e.g. due to infection, inflammation)
AL - immunoglobulin fragments from haematological conditions (e.g. due to myeloma)
How would you treat amyloidosis? (1)
Treat underlying condition
Which systemic diseases can cause nephritic syndrome? (5)
-ANCA positive vasculitis
-Anti-GBM positive (Goodpasture's syndrome)
Describe the pathophysiology of kidney damage in SLE. (3)
How is this diagnosed? (1)
2. Immune complexes are deposited in mesangial cells
3. This causes complement activation, which then causes damage to the glomerulus
How would you treat kidney damage in SLE? (4)