Kidney in systemic disease

Question 1

What is the leading cause of ESRD in most western countries?

Answer 1

Diabetes

Question 2

How is overt diabetic nephropathy characterized?

Answer 2

Persistent albuminurea (300mg/24h on at least 2 occasions separated by 3-6 months)

Question 3

Microvascular complications of diabetes?

Answer 3

Nephropathy
Retinopathy
Polyneuropathy
Autonomic neruopathy (gastroparesis, silent MI, urogenital abnormalities)

Question 4

Macrovascular complications of diabetes

Answer 4

Stroke
Coronary heart disease
Peripheral vascular disease

Question 5

Features of diabetic nephropathy

Answer 5

Renal hypertrophy
Mesangial expansion 
Nodule formation 
Inflammation 
Proteinuria 
Tubulo-interstitial fibrosis

Question 6

Why does diabetic nephropathy cause renal hypertrophy?

Answer 6

Plasma glucose stimulates several growth factors within the kidneys

Question 7

What are the lesions in nodular diabetic glomerulosclerosis called?

Answer 7

Kimmelstiel-Wilson lesion

Question 8

Hw is diabetic nephropathy diagnosed?

Answer 8

History of DM
Proteinuria
Presence of other diabetic complications

Question 9

Is haematuria a finding of diabetic nephroapthy?

Answer 9

Not usually

Question 10

Prevention & treatment of diabetic nephropathy?

Answer 10

Glycaemic control
Anti-hypertensice (ACEi & ARBs)
Lipid control (statins)

Question 11

Surgical nephropathy

Answer 11

KP transplant K transplant

Haemo & peritoneal dialysis

Question 12

WHta is the main method of slowing progression of diabetic nephropathy?

Answer 12

Reducing proteinuria

Question 13

What is renovascular hypertension secondary to?

Answer 13

Renal artery senosis

Question 14

Qhat are the 2 types of renovascular disease?

Answer 14

Fibromuscular dysplasia (rare)
Atherosclerotic renovascular disease (common)

Question 15

What is fibromuscular dysplasia associated with?

Answer 15

Ehlers-Danlos

Marfans

Question 16

Is atherosclerotic renovascular disease more common in males or females?

Answer 16

Males

Question 17

Clinical presentation of atherosclerotic renovascular disease

Answer 17

Renovascular hypertension
AKI after treatment of hypertension (usually with ACEi)
CKD in elderly with diffuse vascular disease
Flash pulmonary oedema
Microscopic haematuria
Abdominal bruit
Atherosclerotic disease elsewhere

Question 18

How is ischaemic renal disease diagnosed?

Answer 18

Renal USS
Renal artery duplex studies 
CT angiography 
MR angiography 
Angiography

Question 19

What drug is contraindicated in bilateral renal artery stenosis?

Answer 19

ACE INHIBITORS!!!!!!!!`

Question 20

Main therapy of renal artery stenosis

Answer 20

BP control
Reduce risk factors
Stenting/angioplasty

Question 21

What is multiple myeloma?

Answer 21

Caner of plasma cells a type of WBC normally responsible for producing antibodies

Question 22

Pathogenesis of multiple myeloma

Answer 22

Collections of abnormal plasma cells accumulate in the bone marrow where they interfere with the production of normal blood cells

Question 23

Clinical signs of multiple myeloma

Answer 23

Anaemia 
Hypercalcaemia 
Renal failure 
Amyloidosis 
Recurrent infections

Question 24

Symptoms of multiple myeloma

Answer 24

Bone pain
Weakness
Fatigue
Weight loss

Question 25

Biochemical findings of multiple myeloma

Answer 25

``` Normocytic anaemia Rouleaux formation Raised CRP/PV Renal impairment Protein electrophoresis BENCE-JONES protein in urine Lytic lesions on skeletal survery ```

Question 26

Renal manifestations of myeloma

Answer 26

AKI secondary to hypercalcaemia Monoclonca immunoglobulin deposition disease Cast nephropathy Amyloidosis

Question 27

What is amyloidosis?

Answer 27

Generic name for a family of disease characterised by the deposition in extracellular spaces of a proteinaceous matieral Classified by the type of precursor protein that makes up the main component of the fibrils

Question 28

Histological appearance of amyloidosis

Answer 28

Positive congo red staining showing apple green birefringence under polarised light

Question 29

Treatment of patient with myeloma and ARF

Answer 29

``` Stop nephrotoxins (NSAIDs, diuretics) Treat hypercalcaemia Chemo (to reduce tumour load) High dose deamethosone Plasma exchange Dialysis ```

Question 30

What should be avoided in patients with myeloma and AR?

Answer 30

Contrast agents

Question 31

How do patient with necrotising polyangitis present?

Answer 31

Generalised symptoms

Question 32

Symptoms of GPA

Answer 32

``` Nasal crusting Saddle nose Persistent rhinorrhea Otitis media Oral/nasal ulcer Bloody nasal discharge ```

Question 33

Features of Churg-Strauss

Answer 33

``` Asthma & eosinophilia Skin involvement (palpable purpura to subcutaneous nodules) ```

Question 34

What is cANCA/PR3 in?

Answer 34

GPA | MPA

Question 35

What is pANCA/MPO in?

Answer 35

Churg-Strauss | MPA

Question 36

Which vasculitis is renal involement most common in?

Answer 36

GPA & MPA

Question 37

Presentation of renal vasculitis

Answer 37

Haematuria Proteinuria AKI

Question 38

Rena biopsy findings of vasculitis

Answer 38

Segmental necrotizing glomerulonephritis

Question 39

Treatment of renal vasculitis

Answer 39

Immunosuppressive therapy | Plasma exchange

Question 40

Risk factors for SLE

Answer 40

Women 20-30's African Americans & Hispanics

Question 41

Investigations for SLE

Answer 41

Complement levels Anti-dsDNA Anti-cardiolipin Anti-phospholipid antibody (lupus anticoagulant

Question 42

What percentage of patient have renal involvement at presentation of luus?

Answer 42

Up to 50%

Question 43

ISN classification of luus nephropathy

Answer 43

Class I: Minimal mesangial Class II: Mesangial Proliferative Class III: Focal Proliferative Class IV: Diffuse Proliferative Class V: Membranous Class VI: Advanced sclerosing

Question 44

Treatment of proliferative lupus nephropathy

Answer 44

ACE/ARB - BP control | Immunosuppresion

Question 45

Poor prognostic indications in lupus nephritis

Answer 45

Renal disease Male sex Antiphospholipid syndrome