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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
how do we diagnose ischaemic renal disease
renal ultrasound ,renal artery duplex studies, CT angiography, MR angiography, angiography
26
when is ACEi contra-indicated
bilateral renal artery stenosis
27
what are therapeutic approaches to ischaemic renal disease
angioplasty, angioplasty + stenting, stenting
28
what is multiple myeloma
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
what are signs of multiple myeloma
anaemia, hypercalcaemia, renal failure, amyloidosis, recurrent infections, bone pain, fatigue, weakness, weight loss
30
how do you investigate multiple myeloma
normocytic anemia, rouleaux formation, raised CPR/ PV, renal impairment, protein electrophoresis,
31
what are complciations of myeloma
AKI secondary to hypercalcaemia, monoclonal immunoglobulin deposition disease, cast nephropathy, amyloidosis
32
what is amyloidosis
deposition of proteinaceous material in extracellular spaces. Classified by either primary AL from fibrils or secondary amyloid AA due to chronic inflammatory disease
33
what is the staining used in amyloidosis
congo red staining
34
how do you treat myeloma
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
what is associated with cANCA
granulomatosis with polyangitis
36
what is associated with pANCA
granulomatosis with polyangiitis with eosinophilia and microscopic polyangiitis
37
what are signs of vasculitis
saddle nose, sinusitis, resp tract, otitis media, nasal crusting, bloody nasal discharge, fever, weight loss, anorexia and malaise
38
what condition is associated with granulomatosis with polyangiitis and eosinophilia
asthma
39
which types of vasculitis can affect the renal tract
GPA and MPA
40
what would a biopsy of vasculitis show
necrotising glomerulonephritis 'crescent' shaped
41
how do you treat vasculitis
immunosuppressive therapy, plasma exchange, may require renal support
42
what areas of the body can lupus affect?
ANYWHERE
43
what age group and sex is most commonly affected
women in 20-30s and african american origin
44
what does SOAPBRAINMD stand for in SL
``` Serositis Oral ulcers Arthritis Photosensitivity Blood disorders Renal involvement ANAs Immunological conditions Neurological macular rash Discoid rash ```
45
what are other investigations of SLE
complement, Anti-cadioplin and anti-phospholipid antibody
46
what is the most common abnormality in lupus nephrits
proteinuria
47
what is the BP target in lupus nephropathy
130/80
48
What is the initial immunosuppressive therapy regime for lupus nephritis
high dose steroids, cyclophosphamide/ MMf/ azathioprine, rituximab

Renal (18 decks)

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