Systemic diseases affecting the kidneys Flashcards
(9 cards)
What is the presentation of diabetic nephropathy?
Microalbuminaemia, retinopathy, and hypertension.
What is the pathophysiology of diabetic nephropathy?
Hyperglycaemia causes increased AGEs and mesanigal expansion, leading to accumulation of ECM, causing proteinuria.
The glomerular basement membrane thickens
Intraglomerular hypertension leads to glomerular sclerosis via podocyte and endothelial damage.
What is renal artery stenosis?
Atherosclerosis in renal arteries leads to decreased renal perfusion.
GFR falls and the other kidney compensates, whilst the affected kidney gets cortical hypoxia, inflammation, and fibrosis.
What is presentation of renal artery stenosis?
High BP despite antihypertensive drugs
US shows one enlarged kidney, and can hear bruit.
What is management of renal artery stenosis?
Statins
Stop ACEi/ARB, since this will lead to failure of efferent arteriole to constrict, leading to decreased intraglomerular pressure and decreased GFR. Since renal artery stenosis depends on efferent arteriole tone to maintain kidney function, leads to rapid deterioration.
ACEi can however prevent hypefiltration and kidney damage in CKD.
Also: angioplasty if rapidly deteriorating renal failure.
What does amyloidosis do to the kidneys?
Protein deposition in extracellular space, with high affinity for the capillary wall.
How is amyloidosis diagnosed?
Renal biopsy with congo red stain - apple green bifringence
How does SLE affect the kidneys?
Anitbody complexes at glomerulus can attach to GBM
How is SLE treated?
Steroids, cyclophosphamide
