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Renal Week 2 2017/18 > 5: Kidneys in systemic disease > Flashcards

5: Kidneys in systemic disease Flashcards

1
Q

What endocrine disease causes nephropathy?

A

Diabetes mellitus

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2
Q

What causes the nephropathy seen in diabetes?

A

1. Hyperglycaemia causes endothelial damage (oxidative stress etc.) predisposing to atherosclerosis

  1. Growth factors causes inflammation, leading to vasoconstriction and renal hypoperfusion > renal hypertension, inflammation, proteinuria…
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3
Q

What will be seen on biopsy of a glomerulus from someone with diabetic nephropathy?

A

Focal segmental glomerulosclerosis

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4
Q

What happens to GFR in diabetic nephropathy?

A

Increases

to everything, causing proteinuria

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5
Q

What is an early marker of kidney disease?

A

Microalbuminuria

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6
Q

What decreases in late diabetic nephropathy?

A

Renal function

i.e eGFR, A/C ratio…

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7
Q

What happens to GFR in

a) early
b) late

diabetic nephropathy?

A

a) Increases (mesangial proliferation, more permeable to protein)

b) Decreases (as kidneys fail)

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8
Q

As diabetic nephropathy progresses, the protein leak (increases/decreases).

A

increases

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9
Q

Does a urine dipstick pick up any particular type of protein?

A

No

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10
Q

What measurements are used to quantify proteinuria?

A

24h urine protein

Albumin/creatinine ratio

Protein/creatinine ratio

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11
Q

What should be controlled to limit the progression of diabetic nephropathy?

A

Glycaemic control (HbA1c < 48)

Blood pressure (< 130/80 mmHg)

Cholesterol - statin

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12
Q

Which drugs are used to manage blood pressure in those with kidney disease?

A

ACE inhibitors

ARBs

dilate efferent arterioles (by acting on RAAS), reducing renal blood pressure

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13
Q

What is the treatment for end-stage diabetic nephropathy?

A

Renal replacement therapy

or Supportive

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14
Q

What are three types of renal replacement therapy?

A

Haemodialysis

Peritoneal dialysis

Kidney transplant

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15
Q

What surgical procedure are fit Type 1 diabetics with end-stage renal failure offered?

A

Joint kidney-pancreas transplant

to replace their beta cells

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16
Q

Why is long-term survival quite low for diabetics on dialysis?

A

Lots of co-morbidities

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17
Q

What urinary sign is a marker of diabetic nephropathy progression?

A

Proteinuria

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18
Q

What is renovascular disease?

A

Poor blood supply to kidneys (for loads of reasons) causes disease

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19
Q

What is ischaemic nephropathy?

A

Decrease in kidney function caused by reduced blood flow

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20
Q

What happens when renal perfusion is reduced?

A

RAAS activation

Sympathetic vasoconstriction

Renal hypertension

Further ischaemia

repeat

21
Q

What are the renal consequences of ischaemic nephropathy?

A

Atrophy

Chronic kidney disease

22
Q

What is the main cause of ischaemic nephropathy, caused by secondary hypertension?

A

Renal artery stenosis

23
Q

What are the risk factors for renal artery stenosis?

A

Age

Male

Ethnicity

Alcohol

Smoking

Poor exercise

Poor diet

Hyperlipidaemia

24
Q

What process causes renal artery stenosis?

A

Atherosclerosis

Can also be caused by AAA

25
Q

Is renal artery stenosis unilateral or bilateral?

A

Usually unilateral

26
Q

People with renal artery stenosis will be systemically ___.

A

hypertensive

27
Q

What happens when you treat someone with hypertension, secondary to renal artery stenosis, with antihypertensive drugs?

A

AKI

28
Q

What is a rare respiratory presentation of renal artery stenosis?

A

Flash pulmonary oedema

29
Q

How is renal arterty stenosis diagnosed?

A

CT / MRI angiography

30
Q

How is renal artery stenosis treated with drugs?

A

ACE inhibitor / ARB

Statin - secondary prevention

Anti-platelets

31
Q

When are ACE inhibitors contraindicated in renal artery stenosis?

A

Bilateral

causes severe AKI as blood supply reduced further

32
Q

What is a rare genetic condition causing renal artery narrowing?

Who tends to get it?

What condition, causing hypermobility and blue sclera, is it associated with?

How is it treated?

A

Fibromuscular dysplasia

Young women

Ehlers-Danlos syndrome

Stenting

33
Q

Renal disease exacerbates ___ failure.

A

heart failure

34
Q

What are terminally differentiated B cells called?

What is their function?

A

Plasma cells

Produce antibodies

35
Q

What disease causes abnormal production of plasma cells?

A

Myeloma

36
Q

How does plasma cell function go to pot in myeloma?

A

Abnormal proteins produced

(Accumulate in bone marrow, stopping it from producing normal blood cells)

Abnormal proteins also cause renal dysfunction

37
Q

If someone presents with back pain and renal failure, what do they probably have?

A

Myeloma

38
Q

What are some symptoms of myeoma?

A

Bone pain

Weakness

Fatigue

WL

39
Q

What is a renal sign of myeloma?

A

Elevated BENCE JONES PROTEIN in urine

40
Q

How is myeloma treated?

A

Chemotherapy

Stem cell transplant

41
Q

takayasu - aorta, large vessels, radial radial delay etc

kawasaki - kids, rash

GCA - jaw claud, headache, visual loss, assoc PMR

henoch schonlein - kids, posterior rash, abdo pain

GWP - nosebleeds, central midline stuff, ANCA (PR3)

EGWP - GWP with eosinophils, late onset asthma, ANCA (MPO)

Behcets - mouth, genital ulcers

A
42
Q

How do patients with vasculitis present?

A

Fever

Weight loss

Anorexia

Arthralgia

43
Q

After constitutional symptoms, how do patients with vasculitis present?

A

Organ damage

44
Q

How is vasculitis treated?

A

Immunosuppression - your standards, cyclophosphamide

45
Q

How is late-stage renal disease, caused by vasculitis, treated?

A

Dialysis

46
Q

What CTD is notorious for causing kidney disease?

A

SLE

47
Q

What investigation should be done for anyone with suspected lupus?

A

Urinalysis

Antibodies - ANA, anti-dsDNA

48
Q

What are you trying to detect with urinalysis in someone with SLE?

A

Proteinuria

49
Q

How do you classify the severity of glomerulonephritis caused by SLE?

A

Renal biopsy

Renal Week 2 2017/18 (11 decks)

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