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Year Two - Urinary System > Kidneys in Systemic Disease > Flashcards

Kidneys in Systemic Disease Flashcards

1
Q

What are the three main systemic diseases that involve the kidney?

A

Diabetic nephropathy

Lupus nephritis

Multiple myeloma

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2
Q

What is diabetic nephropathy?

A

A kidney complication of both type one diabetes mellitus and type two diabetes mellitus

It involves chronic high levels of glucose passing through the glomerulus and causing scarring

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3
Q

Describe the pathophysiology of diabetic nephropathy

A

Diabetes mellitus patients have a raised concentration of glucose within their blood

This hyperglycaemia results an increased production of glycosylation end products and growth factors which cause haemodynamic and hormone changes within the kidneys.

These changes specifically include hyperfiltration and hypertension, which causes the glomerulus to leak out albumin (albuminuria) and depositions to accumulate within the extracellular matrix

Overtime, this will result in inflammation of the glomerulus – which leads to interstitial fibrosis and glomerulosclerosis

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4
Q

What lesions are found in diabetic nephropathy?

A

Kimmelsteil-Wilson nodules

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5
Q

What are the four risk factors of diabetic nephropathy?

A

Hypertension

Smoking

Hypercholesterolaemia

Family History

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6
Q

What are the seven clinical features of diabetic nephropathy?

A

Proteinuria, which is the presence of protein within the urine – specifically the presence of more than 0.5g/d of albumin.

Polyuria, which is an increased urine output > 3L per 24hrs

Peripheral Oedema

Hypertension

Pruritus, which is defined as persistent itching of the skin

Nausea & Vomiting

Fatigue

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7
Q

What four investigations are used to diagnose diabetic nephropathy?

A

Blood Tests

Urine Tests

CT scan

Renal Biopsy

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8
Q

What are the two blood tests used to diagnose diabetic nephropathy?

A

eGFR, which would be decreased

Serum Creatinine, which would be elevated

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9
Q

What urine test result indicates diabetic nephropathy?

A

Albuminuria

This is specifically defined as an albumin level greater than 0.5g/d

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10
Q

How are CT scans used to diagnose diabetic nephropathy?

A

It determines if the kidney’s structure is abnormal and whether it is functioning effectively

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11
Q

What is a renal biopsy?

A

It involves the insertion of a thin needle into the kidneys to collect a tissue sample

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12
Q

What are the two signs of diabetic nephropathy on renal biopsy?

A

Kimmelsteil-Wilson nodules

Fibrosis

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13
Q

What are the three complications of diabetic nephropathy?

A

End Stage Kidney Disease

Cardiovascular Complications, such as heart failure and hypertension

Hyperkalaemia

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14
Q

What is lupus nephritis?

A

A common complication of systemic lupus erythematosus in which lupus autoantibodies affect structures in the kidneys

This kidney damage can result in albumin and haemoglobin leaking from the kidneys into urine

It is an autoimmune condition, specifically a form of immune-mediated glomerulonephritis

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15
Q

Is lupus nephritis a nephrotic or nephritic syndrome?

A

Nephrotic syndrome

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16
Q

What are the three risk factors of lupus nephritis?

A

Gender, with women having an increased risk

Age, with individuals between the ages of 15-45 being the most commonly affected

Ethnicity, with individuals of African, Caribbean or Asian descent having an increased risk

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17
Q

What are the five clinical features of lupus nephritis?

A

Haematuria, which is the presence of blood in the urine resulting in pink coloured urine.

Proteinuria, which is the presence of protein in the urine resulting in the appearance of foamy urine.

Hypertension, which is elevated blood pressure levels

Malor Rash, which is a rash present over the cheeks and nose

Joint Pain & Swelling

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18
Q

What are the three investigations used to diagnose lupus nephritis?

A

Blood Tests

Urine Test

Kidney Biopsy

19
Q

What are the two blood tests used to diagnose lupus nephritis?

A

eGFR, which would be decreased

Serum Creatinine, which would be elevated

20
Q

What are the two urine tests used to diagnose lupus nephritis?

A

Proteinuria, which is the presence of protein in urine. This is specifically defined as a protein level greater than 0.5g/d.

Microscopic Haematuria, which is the presence of blood in urine. This is specifically defined as more than three RBCs per high power field.

21
Q

How is renal biopsy used to diagnose lupus nephritis?

A

It allows the classification of lupus nephritis to be determined

This classification determines the immunosuppression treatment prescribed to the patient

22
Q

What are the two treatments of lupus nephritis?

A

Immunosuppresion

Hypertensive agents

23
Q

What are immunosuppressants?

A

They slow or stop the immune system from attacking healthy cells.

24
Q

What are the five immunosuppressants used to treat lupus nephritis?

A

Prednisolone

Cyclosporine

Tacrolimus

Cyclophosphamide

Azathioprine

25
Q

What are the two hypertensive agents used to treat lupus nephritis?

A

ACE inhibitors

ARBs

26
Q

What are the two complications of lupus nephritis?

A

Cardiovascular Complications

End Stage Kidney Disease

27
Q

What is multiple myeloma?

A

A malignancy of plasma cells

28
Q

What is the function of plasma cells?

A

They fight infections within the body through the production of antibodies and immunoglobulin proteins

29
Q

Describe the pathophysiology of multiple myeloma

A

A cancerous plasma cell undergoes monoclonal proliferation in an uncontrolled manner

This results in the accumulation of plasma cells in bone marrow, crowding out the healthy tissue

Bone marrow is involved in the production of red blood cells and therefore multiple myeloma leads to complications of anaemia and impaired immune function

30
Q

How does multiple myeloma mainly affect the kidneys?

A

Cast nephropathy

31
Q

What is cast nephropathy?

A

It occurs when the proteins produced by the clone of plasma cells pass into the tubules of the kidney

In the kidney, these proteins join up with another type of protein, which is physiologically present in urine, Tamm-Horsfall protein

This results in the formation of large protein casts, which cause an inflammatory reaction within the kidney tubules and therefore obstruction

32
Q

What are the other two mechanisms in which multiple myeloma affect the kidneys?

A

Neprocalcinosis

Amyloidosis

33
Q

What is neprocalcinosis?

A

This is due to plasma cells secreting factors that activate osteoclasts.

Osteoclasts are involved in breaking down bone, which results in the release of calcium and therefore hypercalcaemia.

This hypercalcaemia means that more calcium needs to be filtered by the kidneys, therefore leading to kidney damage.

34
Q

What is amyloidosis? How does it affect the kidney?

A

Amyloidosis occurs due to plasma cells secreting amyloid proteins, which can then accumulate in organs and tissue throughout the body – including the kidney.

This accumulation of amyloid disrupts kidney function.

35
Q

What are the five risk factors of multiple myeloma?

A

Age, with individuals of an increasing age having an increased age – with most people diagnosed in their mid 60s.

Gender, with males having an increased risk

Ethnicity, with individuals of Black descent having an increased risk

Family History

Certain Conditions, such as monoclonal gammopathy of undetermined significance (MGUS)

36
Q

What are the five clinical features of multiple myeloma?

A

Anaemia, which results in individuals becoming tired and weak

Bone Pain, which most commonly affects the spine and chest

Weight Loss

Bone Fractures

Recurrent Infections

37
Q

Why does multiple myeloma result in bone fractures?

A

This is due to healthy bone marrow tissue being crowded out by the cancerous plasma cells

38
Q

Why does multiple myeloma result in recurrent infections?

A

This is due to a hyperactive immune system caused by multiple myeloma

39
Q

What are the four investigations used to diagnose multiple myeloma?

A

Blood Tests

Urine Tests

Bone Marrow Aspirate

X-Ray

40
Q

What are the four blood tests used to diagnose multiple myeloma?

A

M Proteins, which are proteins produced by myeloma cells and will therefore be elevated in multiple myeloma

Beta 2-Microglobulin, which is an abnormal protein produced by myeloma cells. It will indicate the severity of the myeloma.

Serum ESR, which will be elevated

Serum Paraprotein, which will be elevated and appears as a distinct band on protein electrophoresis.

41
Q

What urine test result indicates multiple myeloma?

A

The presence of Bence Jones protein (BJP), which is a specific abnormal protein produced by myeloma cells.

42
Q

What is a bone marrow aspirate?

A

It involves the insertion a long needle into bone, which enables a sample of bone marrow to be collected

This sample is then examined in a lab

43
Q

What bone marrow aspirate result indicates multiple myeloma?

A

> 10% of plasma cells

44
Q

What x-ray scan indicates multiple myeloma?

A

Skeletal lytic lesions in bone

Year Two - Urinary System (15 decks)

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