5: Kidneys in systemic disease Flashcards
What endocrine disease causes nephropathy?
Diabetes mellitus
What causes the nephropathy seen in diabetes?
1. Hyperglycaemia causes endothelial damage (oxidative stress etc.) predisposing to atherosclerosis
- Growth factors causes inflammation, leading to vasoconstriction and renal hypoperfusion > renal hypertension, inflammation, proteinuria…
What will be seen on biopsy of a glomerulus from someone with diabetic nephropathy?
Focal segmental glomerulosclerosis
What happens to GFR in diabetic nephropathy?
Increases
to everything, causing proteinuria
What is an early marker of kidney disease?
Microalbuminuria
What decreases in late diabetic nephropathy?
Renal function
i.e eGFR, A/C ratio…
What happens to GFR in
a) early
b) late
diabetic nephropathy?
a) Increases (mesangial proliferation, more permeable to protein)
b) Decreases (as kidneys fail)
As diabetic nephropathy progresses, the protein leak (increases/decreases).
increases
Does a urine dipstick pick up any particular type of protein?
No
What measurements are used to quantify proteinuria?
24h urine protein
Albumin/creatinine ratio
Protein/creatinine ratio
What should be controlled to limit the progression of diabetic nephropathy?
Glycaemic control (HbA1c < 48)
Blood pressure (< 130/80 mmHg)
Cholesterol - statin
Which drugs are used to manage blood pressure in those with kidney disease?
ACE inhibitors
ARBs
dilate efferent arterioles (by acting on RAAS), reducing renal blood pressure
What is the treatment for end-stage diabetic nephropathy?
Renal replacement therapy
or Supportive
What are three types of renal replacement therapy?
Haemodialysis
Peritoneal dialysis
Kidney transplant
What surgical procedure are fit Type 1 diabetics with end-stage renal failure offered?
Joint kidney-pancreas transplant
to replace their beta cells
Why is long-term survival quite low for diabetics on dialysis?
Lots of co-morbidities
What urinary sign is a marker of diabetic nephropathy progression?
Proteinuria
What is renovascular disease?
Poor blood supply to kidneys (for loads of reasons) causes disease
What is ischaemic nephropathy?
Decrease in kidney function caused by reduced blood flow
What happens when renal perfusion is reduced?
RAAS activation
Sympathetic vasoconstriction
Renal hypertension
Further ischaemia
repeat
What are the renal consequences of ischaemic nephropathy?
Atrophy
Chronic kidney disease
What is the main cause of ischaemic nephropathy, caused by secondary hypertension?
Renal artery stenosis
What are the risk factors for renal artery stenosis?
Age
Male
Ethnicity
Alcohol
Smoking
Poor exercise
Poor diet
Hyperlipidaemia
What process causes renal artery stenosis?
Atherosclerosis
Can also be caused by AAA
Is renal artery stenosis unilateral or bilateral?
Usually unilateral
People with renal artery stenosis will be systemically ___.
hypertensive
What happens when you treat someone with hypertension, secondary to renal artery stenosis, with antihypertensive drugs?
AKI
What is a rare respiratory presentation of renal artery stenosis?
Flash pulmonary oedema
How is renal arterty stenosis diagnosed?
CT / MRI angiography
How is renal artery stenosis treated with drugs?
ACE inhibitor / ARB
Statin - secondary prevention
Anti-platelets
When are ACE inhibitors contraindicated in renal artery stenosis?
Bilateral
causes severe AKI as blood supply reduced further
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?
Fibromuscular dysplasia
Young women
Ehlers-Danlos syndrome
Stenting
Renal disease exacerbates ___ failure.
heart failure
What are terminally differentiated B cells called?
What is their function?
Plasma cells
Produce antibodies
What disease causes abnormal production of plasma cells?
Myeloma
How does plasma cell function go to pot in myeloma?
Abnormal proteins produced
(Accumulate in bone marrow, stopping it from producing normal blood cells)
Abnormal proteins also cause renal dysfunction
If someone presents with back pain and renal failure, what do they probably have?
Myeloma
What are some symptoms of myeoma?
Bone pain
Weakness
Fatigue
WL
What is a renal sign of myeloma?
Elevated BENCE JONES PROTEIN in urine
How is myeloma treated?
Chemotherapy
Stem cell transplant
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
How do patients with vasculitis present?
Fever
Weight loss
Anorexia
Arthralgia
After constitutional symptoms, how do patients with vasculitis present?
Organ damage
How is vasculitis treated?
Immunosuppression - your standards, cyclophosphamide
How is late-stage renal disease, caused by vasculitis, treated?
Dialysis
What CTD is notorious for causing kidney disease?
SLE
What investigation should be done for anyone with suspected lupus?
Urinalysis
Antibodies - ANA, anti-dsDNA
What are you trying to detect with urinalysis in someone with SLE?
Proteinuria
How do you classify the severity of glomerulonephritis caused by SLE?
Renal biopsy
