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Renal > 5.3: Kidneys and Systemic Disease > Flashcards

5.3: Kidneys and Systemic Disease Flashcards

1
Q

What is the leading cause of end stage renal disease in most western countries?

A

Diabetes

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2
Q

True or False:

  • Diabetic renal disease develops only in type 2?
  • The longer you have diabetes, the higher the chance you will get diabetic nephropathy
A

FALSE: Diabetic renal disease develops in both type 1 and type 2

TRUE; The longer you have diabetes, the higher the chance you will develop diabetic nephropathy

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3
Q

Name some microvascular and macrovascular complications of diabetes?

A

Micro - Nephropathy, Neuropathy, Retinopathy

Macro - Stroke, Coronary Heart Disease, Peripheral Vascular Disease

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4
Q

Describe the pathogenesis behind diabetic nephropathy?

A
  • Genetic factors
  • Haemodynamic Changes (Vasodilation)
  • Renal Hypertrophy
  • Nodule Formation (Diabetic Glomerulosclerosis)
  • Inflammation
  • Fibrosis
  • Proteinuria
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5
Q

When would you see Kimmestiel Wilson Lesions?

A

In Diabetic Nephropathy

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6
Q

Describe what happens to

  • GFR?
  • Albuminuria?

as diabetic nephropathy progress?

A

GFR decreases as nephropathy progresses

Albuminuria increases as nephropathy progresses

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7
Q

Describe what happens to the GFR in pre diabetic nephropathy?

During diabetic nephropathy?

A

GFR rises

GFR falls

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8
Q

What are the signs of diabetic nephropathy?

Describe the kidney in diabetic nephropathy?

A

Microalbuminuria

Proteinuria

Hypertension

Nephrotic Syndrome

Renal Hypertrophy

Tubulointerstitial Fibrosis

Nodules (Kimmelsteil Wilson Lesions)

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9
Q

What are the protein values (in mg/day) for

  • Normal albuminuria?
  • Microalbuminuria?
  • Over Nephropathy?
A

Normal >30mg/day

Micro = 30-300mg/day

Overt = >300mg/day

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10
Q

How do you prevent diabetic nephropathy/slow its progress?

A
  • Glycaemic Control

(HbA1c <7)

  • BP Control

(ACEIs and ARBs)

  • Lipid Control

(Statins)

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11
Q

What are the renal replacement therapy options for diabetic nephropathy?

A

Renal/Pancreas dual transplant (T1DM only)

Kidney Transplant

Dialysis (Haemodialysis, Peritoneal)

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12
Q

Why is it important to do urine dipstick on diabetics regularly?

A

This detects any urine abnormalities that may suggest a decrease in renal function (Eg: Diabetic Nephropathy)

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13
Q

Why are ACE Inhibitors (or ARBs) useful in diabetic nephropathy?

A
  1. They reduce BP which reduces mortality
  2. They also reduce proteinuria
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14
Q

True or False:

  • The 1yr, 2yr and 5yr year survival rate of diabetics on dialysis is higher than non diabetic patients on dialysis?
A

FALSE

Diabetics tend to have a worse prognosis on dialysis than those without diabetes

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15
Q

What is renovascular hypertension?

A

This is a secondary form of hypertension

Caused by renal artery stenosis

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16
Q

Describe how renal artery stenosis causes renovascular hypertension?

A

A reduction in renal perfusion activates the renal angiotensin aldosterone system (RAAS) as well as other systemic and hormonal influences

This raises blood pressure

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17
Q

Give a very common cause of renovascular disease?

Give an uncommon cause of renovascular disease?

Who does this uncommon cause normally affect?

A

Very common cause is atherosclerotic disease

An uncommon cause is fibromuscular dysplasia - this affects women and causes renal artery stenosis

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18
Q

What is ischaemic nephropathy?

What can this lead to?

A

This is reduced renal blood flow

This causes reduced GFR

This is beyond the levels of autoregulatory compensation (the blood flow cannot be increased anymore, this is the level of perfusion the kidneys will recieve)

Over time, this can lead to renal atrophy and progressive CKD

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19
Q

What is Fibromuscular Dysplasia?

Who gets it?

Why do they get it?

Link to renal?

A

An angiopathy that affects the medium sized arteries

Mainly seen in young women of child bearing age

In 10% of cases there is a family history

Causes renal artery stenosis and leads to renovascular hypertension

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20
Q

What is atherosclerotic renovascular disease?

Who is this seen in?

Risk factors?

Other arteries invovled?

When is it commonly found?

A

This is atherosclerotic disease affecting the arteries of the kidneys

Seen in elderly patients, especially males

Risk factors are the same for general atherosclerosis

Often affects most of the arteries of the body

Commonly found at autopsy - up to 20% of people could have it

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21
Q

What is the clinical presentation of renovascular hypertension?

A
  • AKI after hypertension treatment (Usually ACEI)
  • CKD in elderly
  • ‘Flash’ pulmonary oedema
  • Microscopic Haematuria
  • Renal Bruit
  • Atherosclerotic Disease elsewhere
22
Q

How is renovascular disease diagnosed?

A

Screening Tests:

  • Renal ultrasound
  • Renal Artery Duplex Studys
  • CT Angiography
  • MR Angiography
  • Angiography
23
Q

What does this photo show?

A

Renal Artery Sclerosis

(Renovascular Disease)

24
Q

What is the treatment of renovascular disease?

A

Angioplasty

Stenting

25
Q

If the patient has bilateral renal artery stenosis, what drug should be avoided?

A

ACE Inhibitors

26
Q

What is myeloma?

A

Myeloma is a cancer of plasma cells - the white blood cells normally responsible for producing antibodies

Often called Multiple Myeloma as there are multiple lesions (Myelomas)

27
Q

Describe how multiple myeloma is linked to the renal system?

A

In multiple myeloma, abnormal plasma cells collect in bone marrow where they interfere with production of normal blood cells

There is often the production of PARAPROTEIN - an abnormal antibody that affects kidney function

28
Q

Clinical presentation of multiple myeloma?

A

Symptoms: Bone Pain

Weakness

Fatigue

Weight Loss

Signs:

Anaemia

Hypercalcaemia

Renal Failure

Amyloidosis

Recurrent Infections

29
Q

Describe the investigations and results in multiple myeloma?

A

Normocytic Anaemia

Raised CRP/PV

Renal Impairment

Protein Electrophoresis

Bence Jones Protein in urine

Lytic Lesions on skeletal survey

30
Q

Multiple Myeloma:

  • Who?
  • How many have renal symptoms?
A

Common in elderly

Age about 70-80

Incidence double in blacks

50% have renal impairment

31
Q
  • AKI secondary to hypercalcaemia
  • Monoclonal Immunoglobulin Deposition Disease
  • Cast Nephropathy
  • Amyloidosis

What does this suggest?

A

Multiple Myeloma

32
Q

What is Amyloidosis?

Characterized by?

What is the classic histology?

A

Generic name for a family of diseases

Characterised by the deposition of protein material in extracellular spaces

APPLE GREEN BIFRINGENCE UNDER POLARIZED LIGHT

33
Q

Treatment of myeloma and acute renal failure?

A

Stop Nephrotoxins - NSAIDs, Diuretics

Treat Hypercalcaemia - IV NaCl, IV Pamidronate

Chemotherapy

Dialysis

34
Q

What does the drug Pamidronate do?

Relation to myeloma?

A

Treats osteoporosis

This can be caused by hypercalcaemia in multiple myeloma

35
Q

Vasculitis is classified depending on the…?

A

Vasculitis is classified depending on the vessels it affects (Eg: Small Vessels, Medium Vessel or Small Vessel)

36
Q

Small vessel vasculitis is associated with what antibody?

Describe small vessel vasculitis:

  • Who?
  • Symptoms?
A

ANCA

Affects middle aged (40s, 50s, 60s)

Patients have weight loss, malaise, fever, arthraglia (joint pain)

37
Q

Describe Wegener’s Granulomatosis?

  • Antibody?
  • Symptoms?
  • Signs?
A

ANCA Positive

Now called Granulomatosis with Polyangiitis

Necrotizing granulomatous inflammation that affects the respiratory tract

Nasal Crusting, Sinusitis, Rinorrhea, Otitis Media, Oral/Nasal Ulcers, Bloody Nasal Discharge

Evidence of bony cartilage destruction - Saddle Nose

38
Q

What does this photo show?

What condition does it suggest?

A 
Saddle Nose (Cartilage Destruction)
Wegener's Granulomatosis (Granulomatosis with Polyangiitis)
39
Q

Describe Churg-Strauss?

  • Symptoms?
  • Stages?
  • Antibody?
A

Necrotizing Granulomatosis Inflammation

There is asthma and eosinophilia

Lung most commonly involved

3 stages - Asthma, Eosinophilic then Vasculitic

2/3rd have cutaneous involvement (Palpable purpura to nodules)

Antibody = ANCA

40
Q

Describe Microscopic Polyangiitis?

Antibody?

A

This is small vessel vasculitis with no granulomatous infilitration

Symptoms include tiredness, respiratory invovlement, skin involvement

ANCA

41
Q

True or false:

  • The three vasculitis (Churg Strauss, Microscopic Polyangiitis and Wegners) can cause pulmonary haemorrhage
A

TRUE

Causes pulmonary haemorrhage due to aveolar capillary involvement

42
Q

How do you diagnose vasculitis?

A
  • Urinalysis (Proteinuria, haematuria)
  • Blood Tests - CRP, ANCA,
  • Biopsy (Skin, Lung, Kidney)
43
Q

Perinuclear ANCA antibody (p-ANCA) suggests what types of vasculitis?

A
  1. CHURG STRAUSS

  1. MICROSCOPIC POLYANGIITIS
  2. Wegeners (Granulomatosis with Polyangiitis)
44
Q

Cytoplasmic ANCA (c-ANCA) suggests which vasculitis diseases?

A
  1. Wegener’s (Granulomatosis with Polyangiitis)

  1. Microscopic Polyangiitis
  2. Churg Strauss
45
Q

Renal involvement is most common in which of the vasculitic diseases?

What are the renal symptoms?

What can happen to the kidney in these diseases?

A

GPA (Wegener’s) and MPA

Less common in Churg Strauss

Haematuria, Proteinuria

Acute Kidney Injury

46
Q

A kidney biopsy in vasculitic disease (Eg: Wegeners or microscopic polyangiitis) shows what?

A

Segmental Necrotizing Glomerulonephritis

47
Q

Treatment for vasculitis (with renal involvement)?

A

Immunosuppression

Plasma Exchange (like dialysis)

Renal Support

48
Q

Describe SLE?

Who does it commonly affected?

Common symptoms?

A

This is a chronic inflammatory disease

Affects women in their 20-30s

African Americans and Hispanics

Common symptoms include malar rash, discoid rash, photosensitivity, ulcers, non erosive arthritis

49
Q

Describe renal involvement in SLE?

Most common symptom?

A

Occurs in about 50%

Proteinuria (100%)

50
Q

Treatment for SLE?

A

ACEIs or ARBs

(Target BP is 130/80)

Immunosuppression:

High dose steroids

Cyclophosphamide/MMF

Aziathioprine, Tacrolimus (Just for induction)

51
Q

Do people with SLE go on to develop end stage renal disease?

A

Yes

Around 8-15% will go on to develop end stage renal disease

Renal (34 decks)

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