Systemic Disease and the Kidneys Flashcards Preview

14. Nephrology and Urology > Systemic Disease and the Kidneys > Flashcards

Flashcards in Systemic Disease and the Kidneys Deck (16)
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1

Describe the presentation of diabetic nephropathy. (3)

Proteinuria
Hypertension
Renal failure

2

Describe the histology of diabetic nephropathy. (2)

What are these 2 features called collectively?

Kimmelstiel-Wilson kidney

Thickening of glomerular basement membrane
Nodular glomerulosclerosis

3

What are the 5 ways in which systemic disease might present in the kidneys?

Proteinuria
Acute kidney injury
Chronic kidney disease
Nephrotic syndrome
Nephritic syndrome

4

If a patient has deranged U&Es, what further tests would you do? (5)

Urinalysis - proteinuria? haematuria?

Quantitative protein tests (uPCR)

Antibodies

Complement proteins

Imaging

5

What systemic conditions can
cause acute kidney injury? (3)

Obstruction
Renovascular disease (e.g. renal artery stenosis)
Interstitial nephritis

6

How do you diagnose renal artery stenosis? (2)

Clinical features

NO angiogram/CT etc - contrast can make kidney failure worse

7

How would you manage renal artery stenosis? (7)

Treat underlying conditions

Medical treatment:
-Stop ACE inhibitors
-Avoid ACEIs/ARBs in future
-Other BP control
-Statins

Lifestyle changes

Angioplasty

8

Angioplasty is only rarely used in AKI.

List 3 indications.

Rapidly deteriorating renal failure
Hypertension despite multiple anti-hypertensives
Flash pulmonary oedema

9

Which systemic conditions can cause nephrotic syndrome? (6)

Where relevant, give some examples.

Glomerulonephritis, e.g.
-Membranous glomerulonephritis
-Minimal change disease
-IgA nephropathy

Diabetic nephropathy
Lupus nephritis
Viral infections (e.g. HIV, hep B/C)
Amyloidosis
Myeloma

10

How would you diagnose amyloidosis? (3)

Biopsy - fibrin strands

Light microscopy - apple green birefringence on Congo red stain

Electron microscopy - fibrin strands, mesangial expansion

11

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)

12

How would you treat amyloidosis? (1)

Treat underlying condition

13

Which systemic diseases can cause nephritic syndrome? (5)

Glomerular disease

Vasculitis, e.g.
-ANCA positive vasculitis
-Anti-GBM positive (Goodpasture's syndrome)
-Lupus nephritis

IgA nephropathy

14

Describe the pathophysiology of kidney damage in SLE. (3)

How is this diagnosed? (1)

1. Autoimmune
2. Immune complexes are deposited in mesangial cells
3. This causes complement activation, which then causes damage to the glomerulus

Biopsy

15

How would you treat kidney damage in SLE? (4)

Immunosuppression, e.g.
-Steroids
-MMF
-Cyclophosphamide
-Rituximab (CD20)

16

How would you treat ANCA positive vasculitis? (4)

ITU and ventilation

Removal of antibodies, e.g.
-Methyl prednisolone
-Plasma exchange
-Cyclophosphamide