Kidneys in Systemic Disease Flashcards
What cardiovascular problems can contribute to renal disease?
Cardiac failure
Atheroembolism
Hypertension
Atherosclerosis
How does diabetes contribute to renal disease?
Progressive proteinuria and CKD
What infections can contribute to renal disease?
Post-infectious GN
Infective endocarditis
HIV
Hepatitis
What malignancy can contribute to renal disease?
Myeloma and amyloidosis
What drugs can effect the kidneys?
Interstitial nephritis
Aminoglycosides
NSAIDs
ACE inhibitors
Radiocontrast
What blood vessel diseases can effect the kidneys?
ANCA associated vasculitis
Thrombotic microangiopathy
HUS and TTP
Describe the pathophysiology of diabetes mellitus causing kidney damage
Glomerular hyperfiltration
Altered glomerular composition
Renal hypertrophy
Glomerular hypertension
These cause albuminuria and deposition in ECM - glomerulosclerosis and interstitial fibrosis
What is common in kidney biopsies of diabetic patients?
Kimmelstiel-Wilson nodules
What is the natural history of diabetes?
Silent subclinical phase, hyperfiltration and increased GFR
Microalbuminuria
Clinical nephropathy
Established renal failure
What is increased proteinuria in diabetes associated with?
Declining GFR
What is the single commonest cause of end stage renal disease (ESRD)?
Diabetic nephropathy
Leads to need for dialysis or transplantation
What is the key for controlling diabetes nephropathy?
Monitoring and managing proteinuria and glucose control
Describe systemic lupus erythematosus
Autoimmune illness
Affects both men and women, mainly women 15-45
Risk - African, Caribbean or Asian
Malor/ butterfly rash
Describe lupus nephritis
Up to 60% of lupus patients will get lupus nephritis
Immune mediated glomerulonephritis
Varying degrees of immune deposits and pattern of glomerular injury
What are the signs of lupus nephritis?
Proteinuria, nephrotic syndrome, haematuria, red cell casts and elevated creatinine
How is lupus nephritis classified?
Into 6 stages
Represent increase in glomerular damage - different changes correlate to immunosuppression given
What is key for control of lupus nephritis?
Early recognition and management of SLE with immunosuppressive drugs and corticosteroids
Describe multiple myeloma
Monoclonal proliferation of plasma cells producing an excess of immunoglobulins and light chains
Seen as monoclonal band on serum and urine electrophoresis
Common in elderly
What is the presentation of myeloma?
Markedly elevated ESR, anaemia, weight loss, fractures, infections and back pain/ cord compression
How is myeloma diagnosed?
Bone marrow aspirate >10% clonal plasma cells
Serum paraprotein and immunoparesis
Urine Bence Jones protein
Skeletal survey - lytic lesion
Describe myeloma kidney
20-40% of myeloma patients will have some kidney failure
Cast nephropathy
How does myeloma affect the kidneys?
Cast nephropathy, light chain nephropathy, amyloidosis, hyperuricaemia, and hypercalcaemia
What are some symptoms which suggest a systemic disease with renal involvement?
Fever, weight loss, skin rash, SOB, haemoptysis, oedema, arthralgia, myalgia, malaise, epistaxis and haematuria
What are some signs which can suggests a systemic disease with renal involvement?
Splinter haemorrhages, purpura, Raynaud’s, scleritis, uveitis, nasal cartilage deformity, retinal vasculitis, hypertensive retinopathy, vasculitis rash and scleroderma
What investigations are important?
Urine dip
Bloods - ANCA, ANA, blood cultures
Radiology - CXR, USS abdomen and CT thorax
Echocardiogram
Kidney biopsy
