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Renal Pathology > The Kidneys in Systemic Disease > Flashcards

The Kidneys in Systemic Disease Flashcards

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1
Q

What organ receives more blood flow per unit volume than any other organ in the body?

A

The kidney

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2
Q

What may the glomeruli trap?

A

Proteins

Immune complexes

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3
Q

What systemic diseases affect the kidneys?

A 
DM
Cardiac failure
Atheroembolisms
HTN
Atherosclerosis
Sepsis
Post infectious glomerulonephritis
Infective endocarditis
SLE
Vasculitis
Scleroderma / other connective tissue diseases
Cryoglobulinaemia
HUS/TTP
Myeloma
Amyloidosis
Drugs
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4
Q

What drugs affect the kidneys?

A 
Aminoglycosides
NSAIDs
ACE inihibtors
Penicillamine
Gold
Radiocontrast
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5
Q

Stages of diabetic nephropathy

A
  1. Silent subclinical phase
    - hyperfiltration
    - increased GFR
  2. Microalbuminamia (20-200ug/d)
  3. Clinical nephropathy (proteinuria >0.5g/d)
  4. Established renal failure
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6
Q

What is the triad of nephropathy?

A

Proteinuria
Hypoalbuminaemia
Oedema

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7
Q

What are the risks of a T1DM patient developing nephropathy at 10 and 25 years?

A

10 - 4%

25 - 25%

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8
Q

What are the risks of a patient with T2DM developing nephropathy within 5 and 20 years?

A

5 - 10%

20 - 30%

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9
Q

What % of those with diabetic nephropathy will progress to ESRF?

A

30%

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10
Q

What does ESRF stand for?

A

End stage renal failure

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11
Q

What is the commonest cause of ESRF?

A

Diabetic nephropathy

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12
Q

What is increasing proteinuria usually assosiated with?

A

Declining GFR

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13
Q

What is the classification of CKD based on?

A

Kidney function

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14
Q

What does CKD stand for?

A

Chronic kidney disease

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15
Q

What does GFR stand for?

A

Glomerular filtration rate

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16
Q

How many stages does CKD have?

A

5

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17
Q

What are the 5 stages of CKD?

A

Stage 1 = Kidney damage -normal or high GFR - GFR > 90
Stage 2 = kidney damage - mild reduction in GFR - GFR = 60-89
Stage 3 = moderately impaired, GFR = 30-59
Stage 4 - severely impaired. GFR = 15-29
Stage 5 - advanced or on dialysis. GFR = < 15

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18
Q

What classification system relates CKD to CVS disease?

A

NKF K/DOQI classification system

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19
Q

What is the commonest cause of renal fialure in older patients?

A

Reno-vascular disease / atheroembolic disease

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20
Q

Features of atheroembolic disease affecting the kidneys

A

Eosinophilia

Peripheral skin lesion

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21
Q

Treatment of atheroembolic disease affecting the kidneys

A

Warfarin

Vascular procedures

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22
Q

Definition of vasculitis

A

Inflammatory reaction in the wall of any blood vessel

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23
Q

What is vasculitis defined by?

A

The size of the vessel involved

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24
Q

What vasculitis conditions affect aorta / large arteries?

A

Takayasu arteritis

Giant cell arteritis

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25
What vasculitis conditions affect the medium sized arteries?
Polyarteritis nodosa | Kawasaki disease
26
What vasculitis conditions affect the small vessel arteries?
Wegeners granulomatosis Microscopic polyarteritis Churg-strauss syndrome
27
What is wegeners granulomatosis?
Granulomatous inflammation in the respiratory tract
28
How does wegeners granulomatosis affect the kidneys?
Focal necrotising GN with crescents
29
Who does wegners more commonly affect?
Males | 40-60 y/o
30
Presentation of wegeners
``` Epistaxis Nasal deformity Sinusitis Deafness Cough Dyspnoea Haemopytsis Pulmonary haemorrhage GN Arthralgia Myalgia Scleritis Pericarditis Fever Weight loss Vasculitic skin rash ```
31
What can microscopic polyarteritis present with?
Systemic disease Renal involvement Pulmonary involvement
32
Investigations for vasculitis
``` Urine - blood/protein Renal function - raised creatinine/urea Biochemistry - raised ALP, CRP, low albumin Anaemia Thrombocytosis Leucocytosis Hyperglobulinaemia Positive ANCA Renal biopsy ```
33
What immunological molecule is seen in wegeners?
> 90% C-ANCA
34
What immunological molecule is usually seen in microscopic polyarteritis?
P-ANCA
35
Can ANCA be a false positive? Give an example
Yes | IBD
36
What is infective endocarditis?
Endocarditis as a result of bacterial or fungal infection on the cardiac valves
37
Causative organisms of infective endocarditis
Staph aureus Viridans streptococci Enterococci
38
What can infective endocarditis lead to in the kidneys?
GN +/- small vessel vasculitis due to immune complex formation
39
What does GN stand for?
Glomerulonephritis
40
What is myeloma?
A monoclonal proliferation of plasma cells producing an excess of immunoglobulins and light chains
41
Who is myeloma common in?
Elderly
42
Presentation of myeloma
``` Marked elevation of ESR Anaemia Weight loss Fractures Infections Back pain / cord compression ```
43
Diagnosis of myeloma
Bone marrow aspirate >10% clonal plasma cells Serum paraprotein +/- immunoparesis Urinary Bence-Jones protein Skeletal survery for lytic lesions
44
What does myeloma cause in the kidneys?
``` Cast nephropathy - 'myeloma kidney' Light chain nephropathy Amyloidosis Hypercalcaemia Hyperuricaemia ```
45
What does light chain disease lead to in the kidneys?
TBM IgM deposition
46
What is amyloidosis?
Deposition of abnormal fibrillary proteins that persist
47
What presentation would indicate there is renal involvement in the systemic disease?
``` Fever Malaise Weight loss Arthralgia Myalgia Vasculitic skin rash Gritty eyes Breathlessness Haemoptysis Epistaxis Haematuria Oedema Hands - splinter haemorrhages - purpura - raynauds Face - scleritis - uveitis - nasal cartilage deformity - retinal vasculitis - HTN retinopathy - scleroderma - HTN - murmur Haemoptysis Crepitations Joint Swelling / tenderness Stroke Encephalopathy ```
48
Investigations if suspect renal involvement in systemic disease
``` Urine dipstick Bloods - urea creatinine - CRP - anaemia - thrombocytosis - raised ALP - ANCA - Complement levels - blood cultures - CXR - USS abdo - CT thorax - ECHO Biopsy of - kidney - nasal mucosa - lung - skin ```
49
Who is HUS usually seen in?
Children
50
Triad of HUS
AKI Microangiopathic haemolytic anaemia Thrombocytopenia
51
Causes of HUS (secondary)
E coli 0157 Pneumococcal infection HIV Rare; SLE, cancer, drugs
52
Who is Ecoli the most common cause of HUS in?
Children
53
What is primary HUS due to?
Complement dysregulation
54
Investigations of HUS
``` FBC - anaemia - thrombocytopenia - fragmented blood film U + Es - AKI Stool culture ```
55
Management of HUS
Supportive
56
What does ADPKD stand for?
Autosomal dominant polycystic kidney disease
57
Presentation of ADPKD
``` HTN Recurrent UTIs Abdo pain Renal stones Haematuria CKD Extra renal manifestations ```
58
What are the extra renal manifestations of ADPKD
Liver cysts (70%) which manifests as hepatomegaly Berry aneurysms (8%) MVP, Aortic root dilatation, aortic dissection, mitral/tricuspid incompetence Diverticulosis Ovarian cysts
59
If a berry aneurysm ruptures, what may this cause?
SAH
60
What is the screening test for adult polycystic kidney disease?
USS
61
Osmolalities in Diabetes insipidus
High plasma osmolality | Low urine osmolality
62
Treatment of ascites
Spironolactone
63
What can the accumulation of amyloid fibrils lead to?
Tissue/organ dysfunction
64
Diagnosis of amyloidosis
Congo red staining; apple-green birefringence Serum amyloid precursor (SAP) scan Biopsy of rectal tissue
65
Presentation of amyloidosis
``` SOB Weakness Hepatomegaly Proteinuria Worsening renal function ```
66
What age does amyloidosis typically present in?
50 - 65 y/o
67
What does HSP stand for?
Henoch-Schonlein Purpura
68
What is HSP?
IgA mediated small vessel vasculitis
69
Who is HSP usually seen in?
Children following an infection
70
What does HSP have a degree of overlap with?
IgA nephropathy (Bergers disease)
71
Presentation of HSP
Palpable purpuric rash (with localised oedema) over buttocks and extensor surfaces of arms and legs Abdominal pain Polyarthritis Features of IgA nephropathy may occur e.g. - haematuria - renal failure
72
Treatment of HSP
Supportive | Analgesia for arthralgia
73
Prognosis of HSP
Excellent Self limiting Especially in children with no renal involvement
74
How many patients with HSP have a relapse?
1/3rd
75
What screening is done for diabetic nephropathy?
Albumin:Creatinine Ratio (ACR) - early morning specimen
76
What ACR is indicative of microalbuminuria?
> 2.5
77
Size of diabetic nephropathy kidneys on USS
Large / normal sized
78
Size of kidneys of most patients with CKD
Small kidneys
79
What is the earliest clinical detection manifestation of diabetic nephropathy?
Microalbuminuria

Renal Pathology (13 decks)

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