Kidney

Question 1

CASE HX

i) what is a patient presenting with if they have elevated creatnine?
ii) give three differentials for cough, haemop, AKI, blood and prot in urine?
iii) which size vessels does renal vasculitis affect? what is the most common type?which criteria classifies vessel vasculitis?

Answer 1

i) AKI
ii) ANCA assoc vasculitis, goodpastures syndrome, SLE, uraemic lung, pneum with infectious glom nephritits

iii) small vessels >ANCA assoc vasculitis
- chapel hill consensus

Question 2

VASCULITIS

i) what is the mechanism?
ii) name three presentations
iii) what will be found in the kidney? what may be seen systemically?
iv) what may be seen in resp tract
v) what happens in the glomeruli?

Answer 2

i) infection > pro inflam cytokines > binds ANCA antibodies > inflammatory process
ii) pulmonary, renal and skin (rash and ulceration)

iii) AKI (blood and protein in urine) with or without fall in GFR
- systemically - polymyalgia, fatigue

v) necrosis > crescent glomerulonephritis

Question 3

SMALL VESSEL VASCULITIS

i) what happens?

ii)

v) what is goodpastures syndrome? what antibodys is involved? how should it be treated?

Answer 3

i) rapid progressive glomnephritis > acute renal fail that can cause dialysis

v) anti GBM antibodies attacks basement membrane in lungs and kidney (histol similarity)
- presents with renal - glomneph,
- presents with pulmonary - cough, SOB
- tx with steroids and cyclophosphamide

Question 4

RHEUM DISEASES AND THE KIDNEY

i) which condition presents with butterfly rash? what happens if there is also blood in urine
ii) what are the three categories of links between renal and rheum disease

Answer 4

i) SLE > lupus nephritis

ii) 1) kidney involved as direct consequence of rheum disease eg anti GBM causing glomneph
2) drug induced kidney disease - rheum drugs can affect the kidney (NSAIDS > interstit glomnephritis)
3) manifestations of kidney disease mimicking rheum disease (mainly linked to kidney but look like rheum disease)
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Question 5

SLE

i) is it more common in females or mailes?
ii) what may be seen if there is renal involvement?
iii) what causes lupus? which HLA types can increase susceptibility?
iv) which ABs may be seen?
v) how many classes of lupus nephritis are there? why does this happen?

Answer 5

i) female
ii) haematuria, proteinuria, elevated criteria

iii) loss of immune tolerance > prod ABs against own cells
- HLADR3/2

v) six classes
- get deposition of immune complexes and depends where they are deposited eg if under epithelial cells > type V

Question 6

CARDIAC RENAL SYNDROME

i) patient presents with elevated creat (usually high) and pulmonary oedema - what could the diagnosis be?
ii) what is cardio renal syndrome? how many types are there
iii) explain the stage I and II of CRS? does heart or renal dysfunc come first?
iv) explain the stage III and IIV of CRS? does heart or renal dysfunc come first?
v) where does type V start? what happens?

Answer 6

i) acute kidney injury on top of CKD
- may be caused by cardio renal syndrome

ii) HF and renal failure
- 5 types

iii) type I and II starts from the heart
heart not pumping enough (abrupt deterioration in heart func) > decreased renal perfusion > AKI (type I)
- may be chronic abnorm in cardiac func > progressive and permanent CKD (type II)

iv) type III and IV starts from kidney
- AKI (complete anuria) kidney dysfunc > accum fluid > heart strain > HF and pulm oedema (type III)
- CKD can contrib to decreased cardiac func > inc risk of adverse cardiac events

v) systemic cause > causes both cardiac and renal dysfunc (eg diabetes or sepsis)

Question 7

RENAL FUNCTION IN CONGESTIVE HEART FAILURE

i) name two drugs that can cause renal impairement that can be used in HF?
ii) what is retained in CHF? what happens to blood vessel tone?
iii) what can prolonged diuretic use lead to?

Answer 7

i) ACEi and diuretics

ii) Na retnetion
- vasoconstrition > inc in A2, aldosterone etc) > leads to afferent arteriole v constric

iii) diuretic resistance due to

Question 8

HEPATORENAL DISEASE

i) what is it? who does it usually occur in?
ii) what can precipitate it?
iii) which electrolyte will be low in urine? why?
iv) is there struc damage to the kidney
v) which type is most rapidly progressive? which is slower?
vi) what is the first sign of HRS?

Answer 8

i) renal failure due to liver disease (espec cirrhosis)
- progressive oliguric renal failure
- usually occ in hospital patients

ii) ppt by bleeding, agressive diruesis or abdo paracentesis

iii) low sodium in urine (sodium retenetion)
- decreased renal blood flow (vasoconstriction) > inc absorption of sodium to maint volume leading to salt/water retention

iv) no
v) type I rapid progressive and type II is slow progressive
vi) liver cirrhosis with ascites and high serum creatinine

Question 9

TREATMENT OF HRS

i) what should be restricted?
ii) is dialysis effective?

Answer 9

i) restrict salt and water
ii) no -