Kidneys & Systemic Disease Flashcards

1
Q

Heres some systemic disorders than can affect the kidneys:

A

DM - Diabetic Vascular disease
Hypertension, HF, atheroemboli & atherosclerosis
Infections - Post infective GN, infective endocarditis, sepsis

Inflammatory - SLE, Wegener’s

Myeloma

Amyloidosis

Drug Treatments e.g. Aminoglycosides and ACE inhibitors, penicillamine or gold, NSAIDS or contrast

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2
Q

Review the NKF DOQI staging of chronic kidney disease?

A

National Kidney Foundation Dialysis Outcome Quality Initiative.
1 - Kidney damage but GFR >90
2 - Kidney damage, GFR 60-89
3 - Moderate impairement, GFR 30-59
4 - Severe Impairment - GFR 15-29
5 - Advanced impairment (probably on dialysis) - GFR <15

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3
Q

When a patient presents with impaired renal function or abnormal urinalysis, what symptoms might suggest a systemic disease?

A

Fever - Malaise - Weight Loss

Arthralgia or Myalgia (incl joint swelling)

Vasculitic Rash - Scleroderma- Splinter haemorrhages

Breathlessness - Haemoptysis - Crepitations
Hypertension - Murmur

Epistaxis - Scleritis/uveitis - nasal cartilage deformity - retinal vasculitis - hypertensive retinopathy

Haematuria
Oedema

Stroke or encephalopathy

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4
Q

What blood tests might suggest a systemic disorder?

A
  • Elevated creatinine
  • Elevated urea
  • Raised CRP
  • Thrombocytosis – vasculitis
  • Anemia
  • Raised ALK PHOS
  • ANCA
  • dsDNA antibodies-lupus
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5
Q

How does diabetic nephropathy progess?

A

1) Silent subclinical phase in which GFR may increase due to hyperfiltration
2) Microalbuminuria phase in which 20-200ug/d reaches the urine
3) Clinical Nephropathy phase in which proteinuria exceeds 0.5g/d & GFR starts to fall
4) Renal Failure where GFR is very low and proteinuria is very high or eventually falls off to 0 as the kidneys fail completely

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6
Q

How does type of DM affect

Nephropathy risk?

A

Types 1 & 2 are equally at risk

DM is the commenest cause of ESRF

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7
Q

How does infective endocarditis lead to kidney disease?

A

Immune complex formation in response to endocarditis. Complexes become trapped in the glomeruli –> Glomerulonephritis +/- small vessel vasculitis

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8
Q

How do we handle glomerulonephritis from infective endocarditis?

A

IF the underlying infection is treated the kidneys should recover

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9
Q

What is wegener’s Granulomatosis?

A

A multi-system granulomatous inflammatory disorder, specifically vasculitic.

It affects:

  • Resp tract
  • Joints
  • Eyes
  • Heart
  • Skin
  • Kidneys
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10
Q

How might wegener’s present? (assuming kidneys are involved)

A

Generally in men in their 40s-60s:
Focal Necrotising Glomerulonephritis in kidneys +:
Epistaxis/nasal defomity/sinusitis/deafness/cough/dyspnoea/haemoptysis/haemorrhage of the respiratory tract.

Arthralgia & Myalgia

Slceritis in the eyes

Pericarditis in the heart

SYstemic signs including fever, weight loss and a vasculitis skin rash

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11
Q

How would we diagnose Wegener’s?

A
Urinalysis - confirm nephritic syndrome
RFTS - Raised U&amp;Es + Creatinine
Inflammatory so a raised CRP
Raised ALKP &amp; low albumin
Many cases have a +ve C-anca

Chest CT for visible granuomas

Anaemia, thrombocytosis and leucocytosis

A renal biopy

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12
Q

What is myeloma?

A

A monoclonal proliferation of plasma cells –> Excess immunoglobulins & Light chains

Quite common in the elderly

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13
Q

What features would make you think myeloma?

A

Renal Disease along with:

  • Markedly elevated ESR
  • Anaemia
  • Weight loss
  • Fractures
  • Infections
  • Back pain/cord compression
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14
Q

If you suspect myeloma how would you confirm?

A

Bone marrow aspirate looking for >10% clonal plasma cells.

Serum paraprotein +/- immunoparesis

Urinary Bence-jones protein (BJP)

Skeletal survey for lytic lesions

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15
Q

What test would confirm endocarditis?

A

Echocardiography

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16
Q

Why are the kidneys so prone to systemic disease?

A

They are a high target for many systemic diseases

  • Receive more blood per unit than any other organ in the body
  • Glomeruli can filter proteins which are then reabsorbed
  • Glomeruli can trap proteins and immune complexes
  • Can metabolise and excrete drugs which might be toxic to the kidneys
17
Q

What is the other form of vasculitis which commonly affects the kidneys?

A

Microscopic polyarteritis

18
Q

How does vasculitis lead to kidney disease?

A

immune complexes which deposit in the glomeruli and tubules

19
Q

Investigations/ presentation for infective endocarditis

A

You may see:

  • Abnormal U&Es
  • Haematuria &Red cell casts (nephritic syndrome)
  • Reduced complement