Kidney in Systemic Disease

Question 1

What is the commonest cause of ESRF

Answer 1

Diabetic Nephropathy

Question 2

What can infective endocarditis cause and how

Answer 2

GN
Small vessel vasculitis
Due to immune comple formation

Question 3

What causes infective endocarditis

Answer 3

S.Aureus
Strep viridans
ENterococci

Question 4

What are the symptoms of infective endocarditis in relation to the kidney

Answer 4

Haematruia
Abnormal u+e
Low complement
Plus standard symptoms

Question 5

What systemic disease, autoimmune disease and infections can cause kidney issues

Answer 5

MM
Amyloidosis
HUS / TTP = AKI
Sickle cell 
Pregnancy - PET / obstruct 

Autoimmune 
SLE
ANCA vasculitis
HSP
Systemic sclerosis 
Scleroderma
Sarcoid
Sjogren

Infection 
TB
Malaria
Hepatitis
HIV

Question 6

What is vasculitis

Answer 6

Inflammatory reaction in any blood vessel

Question 7

What type of vasculitis affects large arteries

Answer 7

Takayasu

Giant cell

Question 8

What type of vasculitis affects small arteries

Answer 8

Granulomatois poly
Microscopic poly
Curg-Strauss

Question 9

What does granulomatous polyarteritis present with

Answer 9

URT- epistaxis / sinusitis / deaf
LRT - cough / SOB / haemoptysis 
Renal - FOCAL NECROTISING GN WITH CRESCENTS 
Other 
Scleritis
Pericarditis 
Fever
Weight loss
Rash

Question 10

What Ab in granulomatous

Answer 10

C-ANCA Ab against proteinase-3

Question 11

How does microscopic present

Answer 11

Similar presentation

More common renal

Question 12

What Ab in microscopic

Answer 12

P-ANCA Ab against myeloperoxidase

Question 13

How do you Dx vasculitis

Answer 13

Urinanalysis
Bloods - FBC, U+E, LFT
Ab
Renal biopsy

Question 14

What is gold standard

Answer 14

+ve ANCA

Renal biopsy

Question 15

What does urine show

Answer 15

Blood

Protein

Question 16

What do bloods show

Answer 16

Abnormal U+E
Increased CRP
Increased ALP

Question 17

What is show on FBC

Answer 17

Anaemia
Thrombocytopenia
Leucocytosis
Hyperglobuliaemia

Question 18

How do you treat vasculitis

Answer 18

Steroid - pred
Immunosuppression - Cyclophosphamide
Biologics
Plasma exchange if renal failure / anti-GBM

Question 19

What risks of cyclophosphamide

Answer 19

Bladder TCC

Question 20

What do you do if symptomatic on cyclophosphamide

Answer 20

Refer to urology if haematuria / cystitis

Question 21

Complications of vasculitis

Answer 21

Progress to ESRF

Question 22

What is MM

Answer 22

Monoclonal proliferation of plasma cell

Produce excess of Ig and light chains

Question 23

What are the symptoms of MM

Answer 23

Anaemia
Back pain
Weight loss
Fractures
Infection
Cord compression
Elevated ESR
Hypercalcaemia 
Renal failure

Question 24

How do you Dx MM

Answer 24

Bone marrow aspirate = diagnostic 
Serum paraprotein / light chain
Electrophoresis + immunofixation 
Urinary bench jones protein
Skeletal survey

Question 25

What does aspiration show

Answer 25

>10% clonal plasma cells

Question 26

How do you treat

Answer 26

Fluid + biphosphonate for hypercalcaemia Plasma exchange to remove light chains Myeloma Rx

Question 27

Why should you be careful with biphosphonates

Answer 27

if eGFR <30

Question 28

What causes renal failure in MM

Answer 28

``` Cast nephropathy - Ig gets stuck in tubules Light chain nephropathy Amyloidosis Hypercalcaemia Hyperuricaemia ```

Question 29

What is amyloidosis

Answer 29

Deposits of amyloid | Affects any organ

Question 30

What causes

Answer 30

Idiopathic 2d to infection / solid organ tumour / lymhpoma MGUS

Question 31

How do you Dx amyloidosis

Answer 31

Biopsy of area affected

Question 32

How does kidney affect CVS

Answer 32

Hypertension Fluid overload Calcification of vessel

Question 33

How does CVS disease affect kidney

Answer 33

``` Hypertension = CKD Atheroembolism Warfarin Vascular procedures Nephrotoxic drugs ```

Question 34

When would you use diuretics in kidney disease

Answer 34

If HF is the reason for the kidney issue

Question 35

How should you investigate systemic disease

Answer 35

``` Urinanalysis Urine culture Bloods Specific - ANA/ ANCA / complement Blood culture CXR / USS / CT / ECHO Biopsy ```