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*Urinary System > Kidneys in Systemic Disease > Flashcards

Kidneys in Systemic Disease Flashcards

1
Q

What systemic diseases affect the kidney? (8 broad headings)

A
  • Diabetes mellitus
  • Cardiovascular disease
  • Infection
  • Inflammation of blood vessels
  • HUS/TTP (Hemolytic uremic syndrome and thrombotic thrombocytopenic purpura)
  • Myeloma
  • Amyloidosis
  • Drugs
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2
Q

Name 4 CVS diseases which affect the kidney

A

Cardiac failure

Atheroembolism

Hypertension

Atherosclerosis

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3
Q

Name 3 systemic disease infections which affect the kidney

A

Sepsis

Post-infectious GN

Infective endocarditis

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4
Q

Name 3 systemic diseases which inflame the blood vessels and affect the kidney

A

SLE

Vasculitis

Scleroderma and other connective tissue diseases

Cryoglobulinaemia

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5
Q

Single causes of ESRF

A

Inc diabetes, GN, renal vascular disease, hypertension

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6
Q

Name 5 types of drugs which affect the kidney

A

Aminoglycosides

ACEI

Penicillamine, gold

NSAIs

Radiocontrast

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7
Q

Describe the 4 stages of the natural history of diabetic nephropathy (development of proteinuria and decline in GFR)

A
  1. Silent sub-clinical phase; hyperfiltration; increased GFR
  2. Microalbuminaemia (20-200ug/d)
  3. Clinical nephropathy (proteinuria > 0.5g/d)
  4. Established renal failure
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8
Q

What is the commonest single cause of ESRF (leading to the need for dialysis or transplantation)?

A

Diabetes

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9
Q

Does diabetic nephropathy depend on the type of diabetes you have?

A

No, it depends on glycaemic control

Type 1 and type 2 are equally at risk

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10
Q

What is increasing proteinuria usually associated with?

A

Declining GFR

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11
Q

What is chronic kidney disease classification based on?

A

Kidney function/GFR:

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12
Q

Show the relationship with stages of CKD and CVS disease complications

A
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13
Q

Give 2 common causes of renal failure in older patients (vascular)

A

Reno-vascular disease

Atheroembolic disease (eosinophilia, peripheral skin lesions, warfarin therapy, vascular procedures)

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14
Q
A
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15
Q

What is vasculitis?

A

Inflammatory reaction in the wall of any blood vessel

Defined by size of vessel involved

Can affect single or multiple organs

Wide spectrum of clinical presentations

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16
Q

3 broad nomenclatures for vasculitis

A
  • Aorta/large artery
  • Medium artery
  • Small vessel
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17
Q

What are the 2 aorta/large vessel vasculitis?

A

Takayasu arteritis

Giant cell arteritis

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18
Q

What are the 2 medium artery vasculitis?

A

Polyarteritis nodosa

Kawasaki disease

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19
Q

What are the 3 small vessel vasculitis?

A

Wegener’s granulomatosis

Microscopic polyarteritis

Churg-Strauss syndrome

20
Q

What is Wegener’s granulomatosis?

A

Granulomatous inflammation in resp tract

21
Q

What type of GN does Wegener’s cause?

A

Focal necrotising GN with crescents

22
Q

What demographic is more likely to be affected by Wegener’s?

A

Males slightly more common

Affects all ages, most common 40-60y

23
Q

How does Wegener’s present in the upper vs lower resp tract?

A

Upper = epistaxis, nasal deformity, sinusitis, deafness

Lower = cough, dyspnoea, haemoptysis, pulmonary haemhorrage

24
Q

What else does Wegener’s present with (inc kidney)?

A

Kidney = glomerulonephritis

Joints = arthralgia, myalgia

Eyes = scleritis

Heart = pericarditis

Systemic = fever, weight loss, vasculitic skin rash

25
What does microscopic polyarteritis have a similar clinical spectrum to?
Wegner's granulomatosis
26
What can microscopic polyarteritis present with?
Systemic disease, renal and pulmonary involvement (more commonly renal limited disease)
27
What are methods of diagnosis in vasculitis? (6)
- **Urine** = blood/protein - **Renal function** = raised urea/creatinine - **Biochemistry** = raised alk phosp, CRP, low albumin - **Haematology** = anaemia, thrombocytosis, leukocytosis - **Immunology** = hyperglobulinaemia, positive ANCA - **Renal biopsy**
28
ANCA in vasculitis
29
What type of ANCA is found in Wegener's v in Microscopic polyarteritis?
Wegeners = \>90% C-ANCA MP = usually P-ANCA (ANCA can be false positive e.g. inflammatory bowel disease - importance of renal biopsy)
30
What is endocarditis?
A result of bacterial (or fungal) infection on cardiac valves
31
What are the 3 typical bacteria in endocarditis?
Staph aureus Viridans strep Enterococci
32
What does infective endocarditis lead to in the kidney?
Glomerulonephritis (GN) +/- small vessel vasculitis due to immune complex formation
33
What 3 test results point towards GN (renal involvement) in infective endocarditis?
- Abnormal urea/creatinine - Haematuria - red cell casts - Reduced complement levels
34
How does renal disease recover in infective endocarditis?
When underlying infection is treated
35
What is multiple myeloma?
A monoclonal proliferation of plasma cells producing an excess of immunoglobulins and light chains (common in elderly)
36
What are the clinical features of multiple myeloma?
- Markedly elevated ESR - Anaemia - Weight loss - Fractures - Infections - Back pain/cord compression
37
What 4 investigations are diagnostic for multiple myeloma?
* Bone marrow aspirate \>10% clonal plasma cells* * Serum paraprotein +/- immunoparesis* * Urinary Bence-Jones protein (BJP) (light chains)* * Skeletal survey - lytic lesions*
38
Lytic lesions
39
How does renal failure manifest in myeloma?
Cast nephropathy ('myeloma kidney') Light chain nephropathy Amyloidosis Hypercalcaemia Hyperuricaemia
40
Cast nephropathy
41
Light chain disease: TBM Ig Deposition
42
Amyloid
Deposition of abnormal fibrillary proteins that persist Primary/secondary
43
What history features would make you suspect systemic disease with renal involvement?
Fever, malaiase, weight loss, arthralgia, myalgia, skin rash (vasculitic), gritty eyes, breathlessness, haemoptysis, epistaxis, haematuria, oedema
44
Give signs for each: hands, face, skin, CVS, chest, locomotor, CNS, which suggest systemic disease with renal involvement
Hands = splinter haemhorrage, purpura, Raynaud's Face = scleritis, uveitis, nasal deformity, retinal vasculitis, hypertensive retinopathy Skin = vasculitic rash, scleroderma CVS = hypertension, murmur Chest = crepitations, haemoptysis Locomotor = joint swelling, tenderness CNS = stroke, encephalopathy
45
Give the components of initial investigations into urine and blood
Urine: - blood/protein on urinalysis - microscopy - red cell casts Blood: - elevated urea/creatinine - raised CRP - thrombocytosis, anaemia - raised alkaline phosphatase
46
Further blood investigations for systemic disease?
ANCA (anti-MPO/anti-PR3 antibodies) ANA, dsDNA antibodies Complement levels C3, C4 Blood cultures
47
What further investigations for systemic disease can be done?
- Radiology = CXR, USS abdo (renal size), CT thorax (pulm granulomas, interstitial disease), echo - Biopsy - kidney, nasal mucosa, lung, skin

*Urinary System (26 decks)

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