Kidneys in Systemic Disease Flashcards
What kind of cancer classically presents with back pain and renal failure?
What is it a cancer of?
Myeloma
Cancer of plasma cells
What investigations should be done if you suspect myeloma?
Skeletal survey - look for lytic lesions
Bloods (tests for Ig in blood)
- serum protein electrophoresis
- serum free light chains
Urine (test for Ig in urine)
- Bence Jones urine
Bone biopsy
Why does myeloma cause renal failure?
Myeloma is a cancer of the plasma cells.
Plasma cells produce antibodies - in myeloma they produce many of these paraproteins (abnormal antibodies)
Paraproteins clog up the glomerulus and tubules -> renal failure
Due to the breakdown of bone in myeloma, what kind of symptoms may present? (3)
Hypercalcaemia
Anaemia
Bone pain
How is myeloma managed?
Chemotherapy
some may be eligible for stem cell transplants
What is amyloidosis?
What are the two most common types?
Rare condition involving abnormal depostition of abnormal amyloid (proteins)
Primary/light chain (AL)
Secondary/systemic/inflammatory (AA)
What kind of abnormal protein is produced in AL amyloidosis?
Abnormal Ig light chains from plasma cells
Who would present with AA amyloidosis?
Chronic inflam conditions/chronic infection patients e.g. RA IBD TB Osteomyelitis
In amyloidosis is it just the kidneys that are affected?
No
- dependant on what organ most of the deposition occurs
How would urinalysis be in amyloidosis?
Proteinuria
What must be done on a renal biopsy to look for amyloidosis?
What is done to check for extent of disease?
Congo red staining - apple green under polarised light
SAP scan - can only be done in London - all patients must be sent there annually
What type of vasculitis presents renally?
Small vessel
What is the most common age to present with vasculitis?
Late middle age/elderly
What results would come back on urinalysis in a patient with ANCA +ve vasculitis?
‘active urine’
- high blood
- high protein
How is ANCA +ve vasculitis managed?
Steroids
Supportive of renal - dialysis
What connective tissue disease can present with renal involvement?
How will their urinalysis present?
SLE
Proteinuria +/- microscopic haematuria (not particularly specific in lupus)
Lupus nephritis can be classed from Class I to VI. What is worse?
What class can present with nephrotic syndrome?
VI - kidney is over - need dialysis or transplant
V
How can you diagnose lupus nephritis (condition which affects ~60% of SLE patients)?
MUST DO Renal biopsy
most commonly seen on urinalysis as proteinuria first
