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AY Renal > Kidney in systemic disease > Flashcards

Kidney in systemic disease Flashcards

1
Q

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

A

Diabetes

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2
Q

How is overt diabetic nephropathy characterized?

A

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

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3
Q

Microvascular complications of diabetes?

A

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

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4
Q

Macrovascular complications of diabetes

A

Stroke
Coronary heart disease
Peripheral vascular disease

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5
Q

Features of diabetic nephropathy

A 
Renal hypertrophy
Mesangial expansion 
Nodule formation 
Inflammation 
Proteinuria 
Tubulo-interstitial fibrosis
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6
Q

Why does diabetic nephropathy cause renal hypertrophy?

A

Plasma glucose stimulates several growth factors within the kidneys

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7
Q

What are the lesions in nodular diabetic glomerulosclerosis called?

A

Kimmelstiel-Wilson lesion

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8
Q

Hw is diabetic nephropathy diagnosed?

A

History of DM
Proteinuria
Presence of other diabetic complications

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9
Q

Is haematuria a finding of diabetic nephroapthy?

A

Not usually

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10
Q

Prevention & treatment of diabetic nephropathy?

A

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

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11
Q

Surgical nephropathy

A

KP transplant K transplant

Haemo & peritoneal dialysis

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12
Q

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

A

Reducing proteinuria

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13
Q

What is renovascular hypertension secondary to?

A

Renal artery senosis

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14
Q

Qhat are the 2 types of renovascular disease?

A 
Fibromuscular dysplasia (rare)
Atherosclerotic renovascular disease (common)
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15
Q

What is fibromuscular dysplasia associated with?

A

Ehlers-Danlos

Marfans

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16
Q

Is atherosclerotic renovascular disease more common in males or females?

A

Males

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17
Q

Clinical presentation of atherosclerotic renovascular disease

A

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

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18
Q

How is ischaemic renal disease diagnosed?

A 
Renal USS
Renal artery duplex studies 
CT angiography 
MR angiography 
Angiography
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19
Q

What drug is contraindicated in bilateral renal artery stenosis?

A

ACE INHIBITORS!!!!!!!!`

20
Q

Main therapy of renal artery stenosis

A

BP control
Reduce risk factors
Stenting/angioplasty

21
Q

What is multiple myeloma?

A

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

22
Q

Pathogenesis of multiple myeloma

A

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

23
Q

Clinical signs of multiple myeloma

A 
Anaemia 
Hypercalcaemia 
Renal failure 
Amyloidosis 
Recurrent infections
24
Q

Symptoms of multiple myeloma

A

Bone pain
Weakness
Fatigue
Weight loss

25
Q

Biochemical findings of multiple myeloma

A 
Normocytic anaemia 
Rouleaux formation 
Raised CRP/PV
Renal impairment 
Protein electrophoresis BENCE-JONES protein in urine 
Lytic lesions on skeletal survery
26
Q

Renal manifestations of myeloma

A

AKI secondary to hypercalcaemia
Monoclonca immunoglobulin deposition disease
Cast nephropathy
Amyloidosis

27
Q

What is amyloidosis?

A

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

28
Q

Histological appearance of amyloidosis

A

Positive congo red staining showing apple green birefringence under polarised light

29
Q

Treatment of patient with myeloma and ARF

A 
Stop nephrotoxins (NSAIDs, diuretics)
Treat hypercalcaemia
Chemo (to reduce tumour load) High dose deamethosone 
Plasma exchange 
Dialysis
30
Q

What should be avoided in patients with myeloma and AR?

A

Contrast agents

31
Q

How do patient with necrotising polyangitis present?

A

Generalised symptoms

32
Q

Symptoms of GPA

A 
Nasal crusting 
Saddle nose 
Persistent rhinorrhea 
Otitis media 
Oral/nasal ulcer 
Bloody nasal discharge
33
Q

Features of Churg-Strauss

A 
Asthma & eosinophilia 
Skin involvement (palpable purpura to subcutaneous nodules)
34
Q

What is cANCA/PR3 in?

A

GPA

MPA

35
Q

What is pANCA/MPO in?

A

Churg-Strauss

MPA

36
Q

Which vasculitis is renal involement most common in?

A

GPA & MPA

37
Q

Presentation of renal vasculitis

A

Haematuria
Proteinuria
AKI

38
Q

Rena biopsy findings of vasculitis

A

Segmental necrotizing glomerulonephritis

39
Q

Treatment of renal vasculitis

A

Immunosuppressive therapy

Plasma exchange

40
Q

Risk factors for SLE

A

Women
20-30’s
African Americans & Hispanics

41
Q

Investigations for SLE

A

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

42
Q

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

A

Up to 50%

43
Q

ISN classification of luus nephropathy

A

Class I: Minimal mesangial
Class II: Mesangial Proliferative

Class III: Focal Proliferative
Class IV: Diffuse Proliferative

Class V: Membranous

Class VI: Advanced sclerosing

44
Q

Treatment of proliferative lupus nephropathy

A

ACE/ARB - BP control

Immunosuppresion

45
Q

Poor prognostic indications in lupus nephritis

A

Renal disease
Male sex
Antiphospholipid syndrome

AY Renal (15 decks)

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