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Flashcards in The kidney in systemic disease Deck (44)
1

Saddle nose

GPA

2

Renal biopsy shows segmental necrotising glomerulonephritis

Vasculitis

3

Class I

Minimal mesangial

4

Class II

Mesangial proliferative

5

Class III

Focal proliiferative

6

Class IV

Diffuse proliferative

7

Class V

Membranous

8

Class VI

Advanced sclerosing

9

Anaemia in myeloma

Normocytic anaemia

10

ESR/PV in myeloma

ESR/PV is raised

11

Rouleaux formation

Myeloma

12

The proportion of patients who develop proteinuria and elevated serum Cr is related to what?

The duration of diabetes

13

What is overt diabetic nephropathy?

Overt diabetic nephropathy is characterized by persistent albuminuria .300mg/24h on at least 2 occasions separated by 3- 6 months

14

Diagnosis of diabetic nephropathy?

History of Diabetes Mellitus
Proteinuria
Presence of other diabetic complications eg retinopathy
Renal Impairment in later stages

Note no haematuria – if present may require renal biopsy

15

Haematuria in diabetic nephropathy

This is not essential for diagnosis of diabetic nephropathy
-if this is present then you will need to do biopsy to establish the cause of it

16

Prevention and treatment of diabetic nephropathy?

Glycaemic control
Maintain tight glycaemic control
(HbA1c < 7)
Anti-hypertensive therapy
Tight BP control
ACE inhibitors and ARBs
Lipid control

17

Most common cause of renal failure in the UK?

Diabetes

18

In diabetic nephropathy, what does microalbuminuria progress to?

Progresses to proteinuria and frank nephropathy

19

Which type of vasculitis do nephrologists usually encounter?

Small vessel vasculitis

20

How might small vessel ANCA associated vasculitis present?

Patients present with constitutional symptoms eg fever, migratory arthralgia, weight loss, anorexia and malaise
Prodromal symptoms may last for weeks to months before specific organ involvement

21

Characterised by chronic rhinosinusitis, asthma, and prominent peripheral blood eosinophilia

Lung most commonly involved (asthma in > 95%)
2/3 have skin involvement (palpable purpura to subcutaneous nodules)

Churg-Strauss

22

Nasal crusting, sinusitis, persistent rhinorrhea, otitis media, oral/nasal ulcers, bloody nasal discharge
WG-evidence of bony/cartilage destruction (saddle nose)

Granulomatosis with Polyangitis (Wegeners)

23

Granulomatosis with polyangitis (Wegeners)

Nasal crusting, sinusitis, persistent rhinorrhea, otitis media, oral/nasal ulcers, bloody nasal discharge
WG-evidence of bony/cartilage destruction (saddle nose)

24

Microscopic polyangitis lung symtpoms

Cough, hoarseness, haemoptysis, SOB, pleuritic pain

25

Renal presentation in vasculitis

AKI- with proteinuria, red cell casts
Renal biopsy shows SEGMENTAL NECROTISING GLOMERULONEPHRITIS

26

Segmental necrotising glomerulonephritis

Vasculitis (renal biopsy)

27

Diagnosis of vasculitis and renal involvement

Examination
Routine bloods, CRP, PV, complement, ANCA, virology
Urinalysis
Tissue –kidney, skin, nasal, lung

28

Treatment for vasculitis and renal involvement

Immunosuppressive therapy
Plasma Exchange
May require renal support

29

Most frequent presentation of lupus nephritis

Abnormality in proteinuria

30

Complement in SLE/lupus nephritis

Low

31

Antibodies in SLE

ANA
dsDNA
Sm
Low complement

32

Target BP in SLE?

130/80

33

Immunosuppressive therapy for SLE

Cyclophosphamide
MMF
Prednisolone

34

Poor prognosis factors for SLE survival

Renal disease
Male sex
Young age or older age at presentation
Poor socioeconomic status
ANTIPHOSPHOLIPID SYNDROME
High overall disease activity

35

Clinical presentation of renovascular disease?

AKI after treatment of hypertension, usually with ACEi.
CKD in elderly with diffuse vascular disease
‘Flash’ pulmonary oedema

Microscopic haematuria
Hypertension
Abdominal bruit
Atherosclerotic disease elsewhere

36

Diagnosis of ischaemic renal disease

Renal ultrasound
Renal doppler studies
MRA

37

Bone Pain
Weakness and Fatigue
Weight Loss
Symptoms related to other manifestations
Hypercalcaemia
Renal Failure
Amyloidosis
Increased risk of infection

Myeloma Kidney

38

M protein

Multiple myeloma

39

Normocytic Anaemia 75%
Raised ESR/PV 30%
Rouleaux formation 50%
Renal Impairment
Monoclonal Band 97%
IgG 50% IgA 20% LC only 16%
Kappa: Lambda 2:1
Increased β2-microglobulin
Lytic lesions on skeletal survey

Multiple myeloma

40

Kappa:lambda

Multiple myeloma

41

Increased beta 2 microglobulin?

Multiple myeloma

42

Incidence of MM in blacks?

Risk doubles in blacks

43

Drug management of the patient with MM and acute renal failure

Stop nephrotoxins (NSAIDS, diuretics in view of risk increasing cast formation)

Treat hypercalcemia:
IV NaCL to volume resucitate
IV Palmidronate if required

AVOID contrast agents!!

Chemotherapy to reduce tumour load
High dose dexamethasone may help reduce tumour load.
Thalidomide/ bortezomib

Plasma exchange
To remove light chains.

Dialysis to support AKI and CKD

44

What is IV palmidronate?

Good for treating hypercalcemia of malignancy