9. Renal manifestations of systemic disease

Question 1

how does diabetes cause kidney failure?

Answer 1

Chronic loss of kidney function due to hyperglyceamia. Causes increased glomerular capillary pressure.

30-40% of patients will need renal replacement therapy

Question 2

What are the signs of diabetic nephropathy

Answer 2

Albuminuria is the first clinical sign

Scarring and fibrosis

Question 3

How do you treat diabetic nephropathy

Answer 3

Intensive DM control to prevent microalbuminuria

BP <130/80. BP accelerates disease progression

Sodium restriction to <2g/day

Statins to reduce CV risk

Question 4

How does lupus cause kidney injury?

Answer 4

Lupus is the autoimmune disease with antibodies against nuclear components. Deposition of antibody complexes cause inflammation and widespread tissue damage (including kidneys).

Question 5

How do you treat lupus nephropathy?

Answer 5

ACE-i or ARB and hydrochloriquinone for extra-renal disease

Immunosuppresion in serious disease

Question 6

small vessel vasculitis can cause glomerulernephritis. What screen is done for this?

Answer 6

ANCA
MPO
PR3

Question 7

How do you treat small vessel vasculitis?

Answer 7

High dose glucocorticosteroids plus cyclophosphamide or rituximab

Question 8

What other systemic diseases may cause kidney problems?

Answer 8

Myeloma
Amyloid
HUS
Thrombotic cytopenia purpura
Atherosclerotic renovascular disease
Scleroderma renal crisis
Sickle cell nephropathy