The Kidney in Systemic Disease

Question 1

what is macrovascular disease?

Answer 1

disease that affects the large vessels of the body eg aorta, coronary arteries

Question 2

what is microvascular disease?

Answer 2

disease that affects the small vessels of the body eg optic vessels, small coronary arteries etc

Question 3

how does diabetes cause renal hypertrophy?

Answer 3

plasma glucose stimulates growth factors in kidney
mesangial cells get bigger and nodules form
BM thickening

Question 4

how does diabetes haemodynamically affect the kidneys?

Answer 4

vasodilates the kidneys
causes hyperfiltration
increases GFR

Question 5

diabetes decreases GFR: T or F

Answer 5

F, increases it until you get diabetic nephropathy which then decreases it

Question 6

how does diabetes cause renal hypertension?

Answer 6

dilates the afferent arteriole

constricts the efferent arteriole

Question 7

diabetic nephropathy is a slow progressive disease T or F

Answer 7

T

Question 8

how does diabetic nephropathy cause inflammation in the kidney?

Answer 8

proteins are lost from the glomerulus and deposited into the cytoplasm causing cell activation and inflammation

Question 9

what causes the decreased GFR in diabetic nephropathy?

Answer 9

microalbuminuria

hypertension

Question 10

albumin is higher in end stage renal disease from diabetic nephropathy than at the start T or F

Answer 10

T

Question 11

management of diabetic nephropathy?

Answer 11

HbA1c <7%
BP <130/80
ACEi
lipid control

Question 12

what effect do ACEi’s have on the blood pressure of the kidneys and how do they do this?

Answer 12

decrease it by decreasing pressure in the efferent arteriole

Question 13

renal replacement therapy for diabetics?

Answer 13

if young + T1, kidney/pancreas transplant
if young, kidney transplant
if not, dialysis

Question 14

diabetic patients are more symptomatic at a lower GFR T or F

Answer 14

F, more symptomatic when their GFR is high

Question 15

first sign of renal damage in diabetes

Answer 15

microalbuminuria

Question 16

there is a good prognosis for dialysis in diabetic patients T or F

Answer 16

F, very low survival rate over 5yrs

Question 17

hypertensive patients with shrunken kidneys on imaging and proteinuria?

Answer 17

hypertensive nephropathy

Question 18

what is ischaemic nephropathy

Answer 18

reduced GFR associated with reduced renal blood flow beyond the ability to compensate

Question 19

consequences of ischaemic nephropathy?

Answer 19

renal atrophy

progressive CKD

Question 20

what type of hypertension is most commonly the cause of hypertensive nephropathy?

Answer 20

essential

Question 21

what renal conditions can cause hypertension?

Answer 21

renal artery stenosis
fibromuscular disease (growth of BV wall)

Question 22

who gets renal artery stenosis?

Answer 22

older men with risk factors

Question 23

renal artery stenosis is usually unilateral T pr F

Answer 23

T

Question 24

signs of hypertensive nephropathy?

Answer 24

atherosclerotic disease
flash pulmonary oedema
abdo bruit
AKI/CKD

Question 25

how is hypertensive nephropathy diagnosed?

Answer 25

renal USS | CT/MR angiography to confirm

Question 26

3 mainstays of treatment for hypertensive nephropathy patients

Answer 26

statin anti-platelet ACEi

Question 27

surgical intervention for hypertensive nephropathy?

Answer 27

angioplasty +/- stenting

Question 28

when should an ACEi not be given for renal artery stenosis?

Answer 28

if it is bilateral

Question 29

who gets fibromuscular dysplasia?

Answer 29

females aged 15-50

Question 30

what are the main vessels affected in renal artery stenosis?

Answer 30

carotid arteries | renal arteries

Question 31

how is cardiorenal functon decreased in kidney disease?

Answer 31

kidneys trying to correct injury by reabsorbing more Na and H20 but this overloads the heart and decreases its function

Question 32

what is a myeloma?

Answer 32

cancer of the plasma cells

Question 33

how can antibodies be damaging to the kidneys?

Answer 33

are proteins so can deposit in the kidney and cause inflammation

Question 34

what is a paraprotein?

Answer 34

an abnormal antibody

Question 35

clinica signs of myeloma?

Answer 35

``` anaemia hypercalcaemia renal failure amyloidosis recurrent infection ```

Question 36

symptoms of myeloma?

Answer 36

bone pain weakness fatigue w loss

Question 37

classic presentation of myeloma?

Answer 37

back pain and renal failure

Question 38

where does AL amyloidosis from a myeloma deposit?

Answer 38

glomerulus

Question 39

how is myeloma detected via blood test?

Answer 39

serum protein electrophoresis | serum free light chains

Question 40

what biopsies should be done in suspected myeloma?

Answer 40

bone marrow | renal

Question 41

Tx of myeloma?

Answer 41

chemo | stem cell transplant

Question 42

how is hypercalcaemia managed in myeloma?

Answer 42

saline +/- bisphosphonates

Question 43

small vessel vasculitis presents in what decades of life?

Answer 43

50s-70s

Question 44

what findings would indicate kidney involvement in vasculitis?

Answer 44

proteinuria | creatinine high

Question 45

if there are 2 people with lupus standing next to each other, what would they be called?

Answer 45

lupi

Question 46

most common renal abnormality found in lupus?

Answer 46

proteinuria

Question 47

lupus nephritis is common in lupus patients T or F

Answer 47

T

Question 48

Tx for mild lupus nephritis?

Answer 48

treat lupus only

Question 49

Tx for severe lupus nephritis?

Answer 49

steroids cyclophosphamide azathioprne