Diabetic Neuropathy, Interstitial Kidney Disease, Acute tubular necrosis Flashcards
How does diabetic neuropathy affect the kidneys?
Chronic high level of glucose passing through the glomerulus causes scarring - glomerulosclerosis
Diabetic nephropathy is the most common cause of glomerular pathology and chronic kidney disease in the UK
What is a key feature of diabetic neuropathy?
Proteinuria
Damage to the glomerulus allowing protein to be filtered from blood to urine
How are diabetic patients screened?
Regular testing of:
albumin:creatinine ratio
U&Es
How is diabetic nephropathy managed?
Optimising blood sugar levels and blood pressure
ACE inhibitors should be started even if blood pressure is normal
What is interstitial kidney disease?
Inflammation of the space between cells and tubules (the interstitium) within the kidney
Two types of interstitial nephritis:
- acute interstitial nephritis
- chronic tubulointerstitial nephritis
How does acute interstitial nephritis present?
AKI
Hypertension
Acute inflammation of the tubules and interstitium
Other features:
Rash
Fever
Eosinophilia
What causes acute interstitial nephritis?
Usually caused by a hypersensitivity reaction to:
Drugs (e.g. NSAIDS or antibiotics)
Infection
How does chronic tubulointerstitial nephritis present?
Presents with chronic kidney disease
Involves chronic inflammation of the tubules and interstitium
Large number of underlying autoimmune, infectious, iatrogenic and granulomatous disease causes
What is the management of chronic tubulointerstitial nephritis?
Treat underlying cause
Steroids have a role when guided by a specialist
What is acute tubular necrosis?
Damage and death (necrosis) of the epithelial cells of the renal tubules
Most common cause of acute kidney injury
epithelial cells can regenerate making acute tubular necrosis reversible
7-21 days to recover
What are the causes of acute tubular necrosis?
Ischaemia can occur secondary to hypoperfusion in:
Shock
Sepsis
Dehydration
Direct damage from toxins can occur due to:
Radiology contrast dye
Gentamycin
NSAIDs
What is found on urinalysis in acute tubular necrosis?
“Muddy brown casts” found on urinalysis is a pathognomonic finding specific to acute tubular necrosis
Renal tubular epithelial cells in the urine
What is the management of acute tubular necrosis?
Treatment is the same as with other causes of an acute kidney injury:
Supportive management
IV fluids
Stop nephrotoxic medications
Treat complications
