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Flashcards in The Kidneys In Systemic Disease Deck (23):
1

What are the systemic diseases affecting the kidney?

Cardiovascular disease (cardiac failure, atheroembolism, hypertension, atherosclerosis)

Infection (sepsis, post infective GN, Infective endocarditis)

Inflammation in blood vessels (SLE, vasculitis, scleroderma)

Myeloma

Amyloidosis

Drugs

2

What is the progression of diabetic nephropathy?

1. Silent sub-clinical phase

    Hyperfiltration

    Increased GFR

2. Microalbuminuria

    [20 - 200ug/d]

3. Clinical nephropathy

    [proteinuria > 0.5g/d]

4. Established renal failure

 

Increasing proteinuria is usually assocaited with a declining GFR

3

Does diabetic nephropathy depend on the type of diabetes you have?

No, it just depends on glycaemic control

4

What is the commonest single cause of ESRF?

Diabetes

 

Leading to the need for dialysis or transplantation

5

What are the classifications of renal disease?

6

What are the common causes of atheroembolic disease?

Eosinophilia

Peripheral Skin lesions

Warfarin Therapy

Vascular Procedures

7

What is vasculitis?

Inflammatory reaction in the wall of any blood vessel

Defined by size of vessel involved - can affect single or multiple organs, wide spectrum of clinical presentations

8

What are the vasculitic conditions that affect large arteries?

Takayasu arteritis

Giant cell arteritis

9

What are the vasculitic conditions that affect medium arteries?

Polyarteritis nodosa

Kawasaki disease

10

What are the vasculitic conditions that affect the small vessels?

–Wegener’s granulomatosis

–Microscopic polyarteritis

–Churg-Strauss syndrome (eosinophilic polyarteritis)

11

What type of glomerulonephritis does Wegner's cause?

Focal necrotising glomerulonephritis with crescents

12

What are the manifestations of wegners?

Upper respiratory tract

Epistaxis, nasal deformity, sinusitis, deafness

Lower respiratory tract

–Cough, dyspnoea, haemoptysis

–Pulmonary haemorrhage

Kidney  - glomerulonephritis

Joints  - arthralgia, myalgia

Eyes  - scleritis

Heart  - pericarditis

Systemic  - fever, weight loss, vasculitic skin rash

13

Microscopic polyarteritis

Similar clinical spectrum to Wegener’s granulomatosis

 

Can present with systemic disease, renal and pulmonary involvement

 

More commonly renal limited disease

14

How do we make a diagnosis of vasculitis?

Urine

–Blood/protein

Renal function

–Raised urea/creatinine

Biochemistry

–Raised alk phos, CRP, low albumin

Haematology

–Anaemia, thrombocytosis, leukocytosis

Immunology

–Hyperglobulinaemia

–Positive ANCA

Renal biopsy

15

What immunostaining test do you use for Wegners and microscopic polyangitis?

16

What is infective endocarditis and what are the typical infections?

Endocarditis: a result of bacterial (or fungal) infection on cardiac valves

–Staphylococcus aureus

–Viridans streptococci

–Enterococci

17

Why does infective endocarditis cause glomerulonephritis with or without small vessel vasculitis?

Due to immune complex formation

18

What are clues that there is renal involvement in glomerulonephritis?

Renal involvement suggested by

–Abnormal urea/creatinine

–Haematuria, red cell casts

–Reduced complement levels

 

Renal disease should recover when underlying infection treated

19

What is multiple myeloma?

A monoclonal proliferation of plasma cells producing an excess of immunoglobulins and /or light chains

Light chain is part of an immunoglobulin

20

What are the clinical features of multiple myeloma?

–Markedly elevated ESR

–Anaemia

–Weight loss

–Fractures

–Infections

–Back Pain /Cord compression

21

How is multiple myeloma diagnosed?

–Bone marrow aspirate >10% clonal plasma cells

–Serum paraprotein ± immunoparesis

–Urinary Bence-Jones protein (BJP)

–Skeletal survey - lytic lesions

22

What are the causes of renal failure in myeloma?

Cast nephropathy - ‘myeloma kidney’

Light chain nephropathy

Amyloidosis

Hypercalcaemia

Hyperuricaemia

23