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Renal 2020 > Kidneys in Systemic Diseases > Flashcards

Kidneys in Systemic Diseases Flashcards

1
Q

what is diabetic nephropathy?

A

small vessel damage due to poor glycaemic control

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2
Q

presentation of diabetic nephropathy

A

proteinuria
other small vessel damage
poor control signs/ history

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3
Q

management of diabetic nephropathy

A

ACEI (watch for dry cough)
good control HbA1c
may need RRT

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4
Q

what is myeloma?

A

dysproteinaemia that is a cancer of plasma cells (produce antibodies)

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5
Q

what happens in myeloma?

A

there is abnormal plasma cells accumulating in bone marrow resulting in reduced production of normal blood cells

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6
Q

what antibody produced in myeloma causes renal dysfunction?

A

paraprotein (Ab)

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7
Q

presentation of myeloma

A 
bone pain (lytic bone lesions, hypercalcaemia)
weakness, fatigue (anaemia)
weight loss
recurrent infections
renal failure
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8
Q

classic presentation of myeloma

A 
back pain
renal failure (AKI)
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9
Q

renal manifestations in myeloma

A
  • glomerular= AL amyloidosis and Ig deposition
  • tubular= light chain cast nephropathy
  • miscellaneous= dehydration, hypercalcaemia, contrast, bisphosphonates, NSAIDs (important to look at whole history)
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10
Q

diagnosis of myeloma

A 
bloods for serum protein electrophoresis and serum light chains
urine for Bence Jones protein (BJP)
bone marrow biopsy
skeletal survey
renal biopsy
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11
Q

management of myeloma

A

chemotherapy
stem cell transplant
stop nephrotoxics
manage hypercalcaemia (saline +/- bisphosphonates)
plasma exchange to remove light chains (supportive= dialysis)

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12
Q

what is amyloidosis?

A

deposition of insoluble, abnormally folded proteins

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13
Q

four types of amyloidosis

A
  1. primary/ light chain (AL)
  2. secondary/ systemic/ inflammatory (AA)
  3. dialysis
  4. hereditary and old age
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14
Q

what does AL amyloidosis produce?

A

abnormal immunoglobulin light chains from plasma cells

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15
Q

age group of AL amyloidosis

A

55-60

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16
Q

what does AA amyloidosis produce?

A

acute phase protein (serum amyloid A)

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17
Q

what is AA amyloidosis associated with?

A

inflammatory conditions such as RA, IBD, psoriasis, TB, osteomyelitis, bronchiectasis

18
Q

what organs does AA amyloidosis affect?

A

liver
spleen
kidneys
adrenals

19
Q

presentation of amyloidosis

A 
nephrotic proteinuria +/- impaired function
cardiomyopathy
peripheral or autonomic neuropathy
hepatomegaly/ splenomegaly
GI absorption
20
Q

diagnosis of amyloidosis

A

urinalysis and bloods
renal biopsy with Congo Red staining
SAP scan

21
Q

what is Congo red staining?

A

apple green birefringence under polarised light

22
Q

what is an SAP scan?

A

scintigraphy with radiolabelled serum amyloid

23
Q

management of AA amyloidosis

A

treat underlying condition

24
Q

management of AL amyloidosis

A

immunosuppression such as:

  • steroids
  • chemotherapy
  • stem cell transplant
25
Q

define vasculitis

A

inflammation of blood vessels

26
Q

what are the three small vessel ANCA vasculitis types

A
  1. GPA
  2. MPA
  3. eGPA
27
Q

what are the three small vessel ANCA vasculitis types?

A
  1. GPA
  2. MPA
  3. eGPA
28
Q

antibodies in GPA

A

anti-PR3 Ab

cANCA

29
Q

what is GPA

A

necrotising granuloma inflammation

30
Q

presentation of GPA/what does it affect?

A

pulmonary/ renal syndrome

31
Q

antibodies in MPA

A

anti-MPO Ab

pANCA

32
Q

what is MPA?

A

no granulomas

33
Q

what does MPA affect?

A 
systemic
renal
lung
skin
GI
nerves
34
Q

what is eGPA?

A

vasculitis associated with asthma and eosinophilia

has skin involvement

35
Q

presentation of vasculitis

A 
fever
arthralgia
weight loss
malaise 
saddle nose in GPA
prodomal symptoms can last weeks-months before specific  organ involvement
36
Q

diagnosis of vasculitis

A 
active urinalysis with protein and blood
raised inflammatory markers
AKI
anaemia
renal biopsy has crescent GN and pauci-immune
immunology
37
Q

management of vasculitis

A

immunosuppression (steroids, cyclophosphamide/ rituximab)
plasma exchange
dialysis
ventilation

38
Q

what is SLE?

A

chronic AI inflammatory disease of unknown origin

39
Q

diagnosis of SLE in terms of lupus nephritis

A

urinalysis has proteinuria +/- microscopic haematuria

40
Q

classification of lupus nephritis

A

ISN classification of I-VI

via renal biopsy

41
Q

management of lupus nephritis

A

immunosuppressants such as steroids, azathioprine, cyclophosphamide, etc.

42
Q

what age is vasculitis most common?

A

5-7th decade

Renal 2020 (26 decks)

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