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Renal > Kidneys in systemic disease > Flashcards

Kidneys in systemic disease Flashcards

1
Q

what is the leading cause of end stage renal disease

A

diabetes

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2
Q

can both type 1 and 2 diabetes lead to ESRD?

A

yes

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3
Q

what is overt diabetic nephropathy defines as

A

persistent albuminuria on at least 2 occasions 3 months apart

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4
Q

what are microvascular complications of diabetes

A

nephropathy, retinopathy, neuropathy- autonomic (gastroparesis) and sensory/ motor neuropathy

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5
Q

what microvascular complications are associated with diabetes

A

stroke, coronary heat disease, peripheral vascular disease

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6
Q

what is the pathogenesis of diabetic nephropathy

A

afferent arteriole dilation mediated by IGF1, hyper filtration, increased GFR

renal hypertrophy

mesangial expansion

nodule formation (Kimmelstein Wilson lesion) and glomerulosclerosis

Inflammation, proteinuria and tubule-interstitial fibrosis

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7
Q

what happens to the albuminuria and GFR the longer they had diabetes

A

albuminuria increases over time

GFR increases initially and then decreases

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8
Q

how do you diagnose diabetic nephropathy

A

history of diabetes
proteinuria
other complication i.e. retinopathy
renal impairment

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9
Q

what is the link with proteinuria and diabetes complication

A

increase proteinuria increases risk of diabetes complication (30-300)

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10
Q

how do you treat diabetic nephropathy

A

glycemic control- HbA1c is less than 7

antihypertensive therapy- ACEi or ARBS

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11
Q

how do ACEi work on the kidneys

A

they increase diameter of efferent arterioles to decrease the pressure in the glomerulus

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12
Q

how do you manage normoalbuminuric/ normotensive type 1 diabetes

A

yearly check up for microalbuminuria, assess CV rid

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13
Q

how do you treat persistent microalbuminuria

A

BP, lipid monitoring, urinary albumin excretion, glycemic control, ADD ACEi or ARB

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14
Q

how do you treat hypertensive microalbuminuria

A

ACEi + hypertension control, addition of diuretic, or low sodium diet

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15
Q

how do you treat proteinuria

A

tight BP control, add low protein diet and lipid lowering drugs

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16
Q

how do you treat declining GFR

A

dialysis when GFR

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17
Q

what are the options for replacement therapy for diabetic nephropathy

A

kidney pancreas transplant, kidney transplant, haemodialysis or peritoneal dialysis

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18
Q

what drug reduces the progression of proteinuria

A

ACEi

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19
Q

what is renovascualr renal disease/ hypertension

A

renovascualr hypertension is a secondary cause of hypertension caused by renal artery stenosis

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20
Q

what are 2 types of renovascualr disease

A

fibromuscular dysplasia and atherosclerotic renovascular disease

21
Q

what does ischaemic nephropathy refer to

A

reduced GFR with reduced renal flow beyond autoregualtion of compensation

22
Q

what is fibromuscular dysplasia

A

abnormal growth within the wall of an artery which affects females aged 15-50 and can be familial in 10% of cases.

23
Q

what type of patients do atherosclerotic renovascular disease

A

older patients, men, atherosclerosis risk factors, usually caucasians,

24
Q

what type of patients get renovascualr disease

A

AKI after hypertension treatment due to aCE

CKD in elderly with diffuse vascular disease

Flash pulmonary oedema

microscopic haematuria

abdominal bruit

atherosclerotic disease elsewhere

25
Q

how do we diagnose ischaemic renal disease

A

renal ultrasound ,renal artery duplex studies, CT angiography, MR angiography, angiography

26
Q

when is ACEi contra-indicated

A

bilateral renal artery stenosis

27
Q

what are therapeutic approaches to ischaemic renal disease

A

angioplasty, angioplasty + stenting, stenting

28
Q

what is multiple myeloma

A

cancer of the plasma cells that normally produces antibodies. Abnormal plasma cells accumulate in bone marrow, interaction with normal RBC. Most cases involve a paraprotein (abnormal antibody that a can cause kidney problems)

29
Q

what are signs of multiple myeloma

A

anaemia, hypercalcaemia, renal failure, amyloidosis, recurrent infections, bone pain, fatigue, weakness, weight loss

30
Q

how do you investigate multiple myeloma

A

normocytic anemia, rouleaux formation, raised CPR/ PV, renal impairment, protein electrophoresis,

31
Q

what are complciations of myeloma

A

AKI secondary to hypercalcaemia, monoclonal immunoglobulin deposition disease, cast nephropathy, amyloidosis

32
Q

what is amyloidosis

A

deposition of proteinaceous material in extracellular spaces. Classified by either primary AL from fibrils or secondary amyloid AA due to chronic inflammatory disease

33
Q

what is the staining used in amyloidosis

A

congo red staining

34
Q

how do you treat myeloma

A

stop nephrotoxins ( NSAIDS or diuretics)

treat hypercalcaemia- IV NaCl, IV pamidronate

avoid contrast!!

chemotherapy + high dose dexamethasone

plasma exchange

dialysis t support AKI and CKD

35
Q

what is associated with cANCA

A

granulomatosis with polyangitis

36
Q

what is associated with pANCA

A

granulomatosis with polyangiitis with eosinophilia and microscopic polyangiitis

37
Q

what are signs of vasculitis

A

saddle nose, sinusitis, resp tract, otitis media, nasal crusting, bloody nasal discharge, fever, weight loss, anorexia and malaise

38
Q

what condition is associated with granulomatosis with polyangiitis and eosinophilia

A

asthma

39
Q

which types of vasculitis can affect the renal tract

A

GPA and MPA

40
Q

what would a biopsy of vasculitis show

A

necrotising glomerulonephritis ‘crescent’ shaped

41
Q

how do you treat vasculitis

A

immunosuppressive therapy, plasma exchange, may require renal support

42
Q

what areas of the body can lupus affect?

A

ANYWHERE

43
Q

what age group and sex is most commonly affected

A

women in 20-30s and african american origin

44
Q

what does SOAPBRAINMD stand for in SL

A 
Serositis
Oral ulcers 
Arthritis 
Photosensitivity
Blood disorders
Renal involvement 
ANAs
Immunological conditions 
Neurological
macular rash
Discoid rash
45
Q

what are other investigations of SLE

A

complement, Anti-cadioplin and anti-phospholipid antibody

46
Q

what is the most common abnormality in lupus nephrits

A

proteinuria

47
Q

what is the BP target in lupus nephropathy

A

130/80

48
Q

What is the initial immunosuppressive therapy regime for lupus nephritis

A

high dose steroids, cyclophosphamide/ MMf/ azathioprine, rituximab

Renal (18 decks)

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