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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
Q

What does microscopic polyarteritis have a similar clinical spectrum to?

A

Wegner’s granulomatosis

26
Q

What can microscopic polyarteritis present with?

A

Systemic disease, renal and pulmonary involvement

(more commonly renal limited disease)

27
Q

What are methods of diagnosis in vasculitis? (6)

A
  • 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
Q

ANCA in vasculitis

A
29
Q

What type of ANCA is found in Wegener’s v in Microscopic polyarteritis?

A

Wegeners = >90% C-ANCA

MP = usually P-ANCA

(ANCA can be false positive e.g. inflammatory bowel disease - importance of renal biopsy)

30
Q

What is endocarditis?

A

A result of bacterial (or fungal) infection on cardiac valves

31
Q

What are the 3 typical bacteria in endocarditis?

A

Staph aureus

Viridans strep

Enterococci

32
Q

What does infective endocarditis lead to in the kidney?

A

Glomerulonephritis (GN) +/- small vessel vasculitis due to immune complex formation

33
Q

What 3 test results point towards GN (renal involvement) in infective endocarditis?

A
  • Abnormal urea/creatinine
  • Haematuria - red cell casts
  • Reduced complement levels
34
Q

How does renal disease recover in infective endocarditis?

A

When underlying infection is treated

35
Q

What is multiple myeloma?

A

A monoclonal proliferation of plasma cells producing an excess of immunoglobulins and light chains

(common in elderly)

36
Q

What are the clinical features of multiple myeloma?

A
  • Markedly elevated ESR
  • Anaemia
  • Weight loss
  • Fractures
  • Infections
  • Back pain/cord compression
37
Q

What 4 investigations are diagnostic for multiple myeloma?

A
  • Bone marrow aspirate >10% clonal plasma cells*
  • Serum paraprotein +/- immunoparesis*
  • Urinary Bence-Jones protein (BJP) (light chains)*
  • Skeletal survey - lytic lesions*
38
Q

Lytic lesions

A
39
Q

How does renal failure manifest in myeloma?

A

Cast nephropathy (‘myeloma kidney’)

Light chain nephropathy

Amyloidosis

Hypercalcaemia

Hyperuricaemia

40
Q

Cast nephropathy

A
41
Q

Light chain disease: TBM Ig Deposition

A
42
Q

Amyloid

A

Deposition of abnormal fibrillary proteins that persist

Primary/secondary

43
Q

What history features would make you suspect systemic disease with renal involvement?

A

Fever, malaiase, weight loss, arthralgia, myalgia, skin rash (vasculitic), gritty eyes, breathlessness, haemoptysis, epistaxis, haematuria, oedema

44
Q

Give signs for each: hands, face, skin, CVS, chest, locomotor, CNS, which suggest systemic disease with renal involvement

A

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
Q

Give the components of initial investigations into urine and blood

A

Urine:

  • blood/protein on urinalysis
  • microscopy - red cell casts

Blood:

  • elevated urea/creatinine
  • raised CRP
  • thrombocytosis, anaemia
  • raised alkaline phosphatase
46
Q

Further blood investigations for systemic disease?

A

ANCA (anti-MPO/anti-PR3 antibodies)

ANA, dsDNA antibodies

Complement levels C3, C4

Blood cultures

47
Q

What further investigations for systemic disease can be done?

A
  • 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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