Kidneys in systemic disease Flashcards
Diabetic nephropathy is a MICRO/MACRO -vascular complication of diabetes?
Microvascular
Diabetic nephropathy - the afferent arteriole CONSTRICTS/DILATES and the efferent arteriole CONSTRICTS/DILATES ?
Afferent - dilates
Efferent - constricts
This is due to the RAAS system
Diabetic nephropathy - pathogenesis
Glomerular hypertension
Pressure goes up in the glomerulus which causes proteins to leak out
Renal hypertrophy
- nodule formation and diffuse glomerulosclerosis
Inflammation
- causes damage to filtering unit
Diabetic nephropathy - it is common to get proteinuria. True or false?
True
- due to the podocyte dysfunction
Diabetic nephropathy - investigations
GFR - should be normal Urinalysis - microalbuminuria/proteinuria Renal biopsy - only if haematuria present
What is the earliest sign of diabetic nephropathy?
Microalbuminuria / proteinuria
Diabetic nephropathy - management
Maintain tight glycaemic control Reduce proteinuria - ACE inhibitor - ARB Statin RRT (if severe)
Diabetic nephropathy - why are ACE inhibitors good to use?
Reduce proteinuria
Dilate the efferent arteriole by blocking the RAAS system
Transplantation in diabetic nephropathy can cure diabetic nephropathy AND diabetes. True or false?
True
- simultaneous kidney-pancreas transplant
- only works for type 1 diabetes
Renovascular disease(RVD) - name some examples
Hypertension
Cardio-renal syndrome
Ischaemic nephropathy
Renal artery stenosis
RVD - ischaemic nephropathy - definition
Reducred GF associated with reduced renal blood flow beyond the level of auto-regulatory compensation
A reduction in renal perfusion pressure ACTIVATES/DEACTIVATES a series of hormonal and neuronal responses that RAISE/DROP systemic arterial BP?
Activates
Raise
Who gets essential hypertension?
Elderly patients
Poorly controlled hypertension
Who gets secondary hypertension?
Younger hypertensive patients
Renal artery stenosis pts
What is renal artery stenosis?
Blockage of the major blood supply to the kidney
Severe narrowing of the renal artery
Renal artery stenosis - who gets it?
Elderly
Males
Those with risk factors of generalised atherosclerosis
Renal artery stenosis is usually unilateral/bilateral?
Unilateral
Renal artery stenosis - clinical features
Renovascular hypertension
Atherosclerosis elsewhere
Flash pulmonary oedema
Renal artery stenosis - examination findings
Abdominal bruit
Renal artery stenosis - investigations
Imaging - Discrepancy in kidney size US Renal artery duplex studies CT angiography MRI angiography
Renal artery stenosis - management
Statin
Anti-platelet
ACE inhibitor
Angioplasty +/- stent
When are ACE inhibitors contra-indicated in renal artery stenosis?
In BILATERAL renal artery stenosis
Cardio-renal syndrome - definition
Kidneys are trying to hold on to salt and water to keep them functioning
Heart muscle gets overloaded and is more stressed
Small vessel vasculitis - types
GPA
EGPA
Microscopic polyangitis
Which of the following do NOT have granulomas?
- GPA
- EGPA
- MPA
Microscopic polyangitis
Small vessel vasculitis - investigations
Urinalysis Bloods - raised inflammatory markers Immunology - ANCA Renal biopsy
cANCA + anti-PR3 suggests which small vessel vasculitis?
GPA
pANCA + anti-MPO + NO granulomas suggests which small vessel vasculitis?
Microscopic polyangitis
pANCA + anti-MPO + granulomas suggests which small vessel vasculitis?
EGPA
Small vessel vasculitis - management
Steroids + cyclophosphamide
Plasma exchange
Lupus nephritis - investigations
Urinalysis
- proteinuria
Renal biopsy
