Kidney in systemic disease

Question 1

Diabetic kidney disease:

-when is this diagnosed?

Answer 1

persistant albuminuria 300mg/24hrs on 2 occasions separated by 3-6mths

Question 2

Diabetic kidney disease:

-what is the pathophysiology?

Answer 2

• increased GFR due to vasoactive mediators causing afferent arteriole dilatation
• renal hypertrophy: plasma glucose stimulates several growth factors
• mesangial expansion and nodule formation = thicker GBM
• proteinuria
• tubulo interstitial fibrosis

Question 3

how is diabetic kidney disease diagnosed?

Answer 3

• DM history
• proteinuria
• presence of other diabetic complications
• renal impairment

(microalbuminura leads to proteinuria leads to ESRD)

Question 4

What is the treatment of diabetic kidney disease?

Answer 4

• Haemodialysis or peritoneal dialysis

- simultaneous kidney and pancreas transplant

Question 5

What small vessel ANCA+ vasculitides can have renal involvement?

Answer 5

• Churg strauss (chronic rhinosinusitis, asthma, prominant peripheral blood eosinophilia, skin involvement)
• Granulomatosis with polyangiitis (nasal crusting, sinusitis, persistant rhinorrhea, otitis media, oral/nasal ulcers, bloody nasal discharge, saddle nose)
• Microscopic polyangitis (cough, hoaseness, haemopytsis, pleurisy, CXR, AKI)

Question 6

SLE:

• what abnormality is commonly involved assoc. with renal disease?
• what is the treatment?

Answer 6

-abnormaility proteinuria commonly observed

• treatment is ACEI or ARB (target 130/80)
• immunosuppression

Question 7

Renovascular disease:

• where does this usually affect?
• what is the epidemiology?

Answer 7

• Usually affects ostium in 85% pts., bilateral in 30-80%

- >50yrs, M>F, risk factors for atherosclerosis, caucasions

Question 8

Renovascular disease:

-presentation

Answer 8

• AKI after BP treatment
• CKD in elderly with diffuse vascular disease
• ‘flash’ pulmonary oedema

Question 9

Renovascular disease:

-signs

Answer 9

microscopic haematuria, hypertension, abdominal bruits, atherosclerosis elsewhere

Question 10

What is the diagnosis of renovascular disease?

Answer 10

angioplasty, renal doppler, MRA

Question 11

What is the treatment for renovascular disease? what drug is contraindicated in bilateral renal stenosis?

Answer 11

• angioplasty
• stenting
• ACEI contraindicated

Question 12

What are the different causes of nephrogenic diabetes insipidus (insensitivity to ADH hormone)?

Answer 12

genetic: the more common form affects the vasopression (ADH) receptor, the less common form results from a mutation in the gene that encodes the aquaporin 2 channel
electrolytes: hypercalcaemia, hypokalaemia
drugs: demeclocycline, lithium

tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis