Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Urinary System > Kidneys in Systemic Disease > Flashcards

Kidneys in Systemic Disease Flashcards

1
Q

Why are the kidneys a particular target for any systemic diseases?

A

The kidney receives more blood flow per unit volume than any other organ in the body

The glomeruli may filter proteins which are then reabsorbed by the tubule epithelial cells

The glomeruli may trap proteins or immune complexes

The kidney metabolises or excretes certain drugs, which may be toxic to the kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name common systemic diseases which can effect the kidney

A
  • Diabetes mellitus
  • Myeloma
  • Amyloidosis
  • Hemolytic uremic syndrome (HUS) is a condition that affects the blood and blood vessels.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the CVS diseases which can effect the kidneys?

A
  • Cardiac failure
  • Atheroembolism
  • Hypertension
  • Atherosclerosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are infectious diseases which can effect the kidneys?

A
  • Sepsis
  • Post-infectious glomerulonephritis
  • Infective endocarditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the diseases which causes inflammation of blood vessels can effect the kidneys?

A

Systemic lupus erythematosus (SLE)
Vasculitis
Scleroderma and other connective tissue diseases
Cryoglobulinaemia (blood contains large amounts of pathological cold sensitive antibodies called cryoglobulins)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What drugs can effect the kidneys?

A
  • Aminoglycosides
  • NSAIDs
  • ACE inhibitors
  • Radiocontrast
  • Penicillamine, gold
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is diabetic nephropathy?

A

Divided into five stages of deterioration, with the final one being ESRD.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the stages of diabetic nephropathy?

A
  1. Silent sub-clinical phase: hyperfiltration + increased GFR due to increase glomerular blood flow (glomerular hypertension)
  2. Microalnuminuria filtered through tubule
  3. Clinical nephropathy (macroproteinuria which can be detected in the urine)
  4. Established renal failure (less proteinuria as kidneys have failed)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the long term risk in Type I diabetes in diabetic nephropathy

A

4% with Type 1 DM will develop nephropathy within 10 years

25% with Type 1 DM will develop nephropathy within 25 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the long term risk in Type II diabetes in diabetic nephropathy

A

10% with Type 2 DM will have nephropathy by 5 years

30% with Type 2 DM will have nephropathy by 20 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the features of diabetic nephropathy?

A

Diabetic nephropathy develops over many years

Type I and Type II patients are equally at risk

Increasing proteinuria is usually associated with declining GFR

Diabetic nephropathy is the single commonest cause of ESRF leading to the need for dialysis or transplantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the classification of chronic kidney disease?

A

NKF Kidney Disease Outcomes Quality Initiative (NKF KDOQI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the different stages of NKF Kidney Disease Outcomes Quality Initiative (NKF KDOQI) for chronic kidney disease

A

Stage 1: kidney damage / normal or high GFR (GFR > 90)

Stage 2: kidney damage / mild reduction in GFR (GFR 60-89)

Stage 3: moderately impaired (GFR 30-59)

Stage 4: severely impaired (GFR 15 - 29)

Stage 5: advanced or on dialysis (GFR <15)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the relationship between CVS disease and chronic kidney disease?

A

More likely to die of CVS disease than requiring dialysis

Hypertension, congestive heart failure or ischaemic heart disease, LV hypertrophy (caused by hypertension)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In over 65s, what is the most common cause of renal failure?

A

Reno-vascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In under 65s, what is the most common cause of end-stage kidney disease?

A

Diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the features of atheroembolic disease (common cause of renal failure in elderly)?

A

Eosinophilia
Peripheral Skin lesions

Treatment:
Warfarin Therapy
Vascular Procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Name two types of vasculitis of aorta/large arteries

A

Takayasu arteritis

Giant cell arteritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Name two types of vasculitis of medium arteries

A

Polyarteritis nodosa

Kawasaki disease

20
Q

Name three types of vasculitis of small vessels

A

Wegener’s granulomatosis (or granulomatous polyarteritis)
Microscopic polyarteritis
Churg-Strauss syndrome

21
Q

What are the features of Wegener’s granulomatosis (or granulomatous polyarteritis)?

A
  • Granulomatous inflammation in resp. tract
  • Focal necrotising glomerulonephritis with crescents
  • Slightly more common in males
  • Affects all age groups, most common 40-60yrs
22
Q

What are the symptoms of Wegener’s granulomatosis?

A

Upper resp. tract:
• Epistaxis, nasal deformity, sinusitis, deafness

Lower resp. tract:
• Cough, dyspnoea, haemoptysis
• Pulmonary haemorrhage

23
Q

What is the effect of Wegener’s granulomatosis on the kidneys?

A

Glomerulonephritis

24
Q

What are other body manifestations of Wegener’s granulomatosis?

A
  • Joints - arthralgia, myalgia
  • Eyes - scleritis
  • Heart - pericarditis
  • Systemic - fever, weight loss, vasculitic skin rash
25
Q

What is microscopic polyarteritis?

A

Similar clinical spectrum to Wegener’s granulomatosis

Can present with systemic disease, renal and pulmonary involvement

More commonly renal limited disease

26
Q

What is the diagnosis in vasculitis?

A
  • Urine - blood/protein
  • Renal function - raised urea/creatinine
  • Biochemistry - raised alk phos, CRP, low albumin
  • Haematology - anaemia, thrombocytosis, leukocytosis
  • Immunology - hyperglobulinaemia and positive ANCA
  • Renal biopsy
27
Q

What is an important investigation for vasculitis?

A

Detection of Antineutrophil cytoplasmic antibodies (ANCA)

28
Q

What are two methods of detection of ANCA?

A
  • P-ANCA acting on myeloperoxidase antibodies in ELISA

* C-ANCA acting on proteinase 3 in ELISA

29
Q

Describe the results of ANCA for Wegener’s granlomatosis

A

> 90% C-ANCA

30
Q

Describe the results of ANCA for microscopic polyarteritis

A

P-ANCA

31
Q

What is infective endocarditis?

A

Bacterial (or fungal) infection on cardiac valves

32
Q

What bacteria typically cause infective endocarditis?

A

Staphylococcus aureus
Viridans streptococci
Enterococci

33
Q

How does infective endocarditis affect the kidneys?

A

Leads to glomerulonephritis ± small vessel vasculitis due to immune complex formation

Chronic inflammation -> chronic activation of immune system -> immune complexes deposited in renal tubule causing inflammation

34
Q

How does glomerulonephritis present in infective endocarditis?

A
  • Abnormal urea/creatinine
  • Haematuria, red cell casts
  • Reduced complement levels

Renal disease should recover when underlying infection treated

35
Q

What is multiple myeloma?

A

Cancer of plasma cells, a type of white blood cell typically responsible for producing antibodies

A monoclonal proliferation of plasma cells producing an excess of immunoglobulins and light chains (of the Ig)

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

How is multiple myeloma diagnosed?

A
  • Bone marrow aspirate >10% clonal plasma cells
  • Serum paraprotein ± immunoparesis (hypogammaglobulinemia)
  • Urinary Bence-Jones protein (BJP) - immunoglobulin light chain found in the urine
  • Skeletal survey - lytic lesions (destruction of bone)
38
Q

How does multiple myeloma cause renal failure?

A
  • Cast nephropathy - ‘myeloma kidney’ (renal failure resulting from urinary excretion of monoclonal immunoglobulin light chains or Bence Jones proteins)
  • Light chain nephropathy
  • Amyloidosis
  • Hypercalcaemia
  • Hyperuricaemia
39
Q

What is amyloidosis?

A

Build-up of an abnormal protein called amyloid in organs and tissues throughout the body. The build-up of amyloid proteins (deposits) can make it difficult for the organs and tissues to work properly.

40
Q

With what symptoms should renal involvement be suspected. with systemic disease?

A

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

41
Q

With what signs should renal involvement be suspected. with systemic disease?

A

Hands:
Splinter haemorrhages, purpura, Raynaud’s disease

Face:
Scleritis, uveitis, nasal cartilage deformity, retinal vasculitis, hypertensive retinopathy

Skin:
Vasculitic rash, scleroderma

CVS:
Hypertension, murmur

Chest:
Crepitations, haemoptysis

Locomotor:
Joint swelling, tenderness

CNS:
Stroke, encephalopathy

42
Q

What is Raynaud’s disease?

A

Affects fingers and toes — to feel numb and cold in response to cold temperatures or stress.

In Raynaud’s disease, smaller arteries that supply blood to your skin narrow, limiting blood circulation to affected areas (vasospasm).

43
Q

What is uveitis?

A

Inflammation of the uvea — the middle layer of the eye that consists of the iris, ciliary body and choroid.

44
Q

What are the initial investigations are used to determine renal involvement?

A

Urine:
• Blood/protein on urinalysis
• Microscopy - red cell casts

Blood:
• Elevated urea/creatinine
• Raised CRP
• Thrombocytosis, anaemia
• Raised alkaline phosphatase
45
Q

What further blood tests are used to determine renal involvement?

A
  • ANCA (anti-MPO/anti-PR3 antibodies)
  • ANA, dsDNA antibodies
  • Complement levels C3, C4
  • Blood cultures
46
Q

What further radiological tests are used to determine renal involvement?

A
  • CXR
  • USS abdomen
  • Renal size
  • CT thorax
  • Pulmonary granulomas, interstitital disease
  • Echocardiography
47
Q

What further biopsy tests are used to determine renal involvement?

A
  • Kidney
  • Nasal mucosa
  • Lung
  • Skin

Urinary System (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions