Lecture 23 Kidneys in Systemic Disease Flashcards
Why is the kidney to target for many systemic diseases
Large volume of blood flow
Protein reabsorption
Ability to trap protein complexes and immunoglobulins
Metabolises and excretes drugs
Name cardiovascular diseases that affect the kidneys
Cardiac failure
Atheroembolism
Hypertension
Atherosclerosis
Name infectious diseases that effect the kidneys
Sepsis
Post strep GN
Infective endocarditis
Name inflammation in the blood vessels hat affect the kidneys
Vasculitis
Scleroderma
SLE
Cryoglobulinemia
Name other systemic diseases that affect the kidneys
DM
Haemolytic-Uremic Syndrome/ Thrombotic thrombocytopenic purpura
Myeloma
Amyloidosis
What drugs can affect the kidneys
– Aminoglycosides – NSAIDs – ACE inhibitors – Radiocontrast – Penicillamine, gold
What is the commonest cause of ESRF
Diabetes mellitus (type I and II)
Increasing proteinuria is associated with what
Declining GFR
Stage 1 CKD
GFR >90
Stage 2 CKD
GFR 60-89
Stage 3 CKD
GFR 30-59
Stage 4 CKD
15-29
Stage 5 CKD
<15
Name common causes of renal failure in older patients
- Glomerulonephritis
- Diabetes
- Polycystic Kidney
- Pyelonephritis
- Renal Vascular Disease
- Hypertension
What is vasculitis?
Inflammatory reaction in the wall of any blood vessel
Vasculitis in the aorta/large artery s referred to as
– Takayasu arteritis
– Giant cell arteritis
Vasculitis in medium arteries are referred to as
– Polyarteritis nodosa
– Kawasaki disease
Vasculitis in small vessels are referred to as
– Wegener’s granulomatosis
– Microscopic polyarteritis
– Churg-Strauss syndrome
What are pathological features of Wegener’s Granulomatosis (Granulomatosis with polyangiitis)
- Granulomatous inflammation in respiratory tract
* Focal necrotising glomerulonephritis with crescents
What group does Granulomatosis with polyangiitis commonly affect
40-60 years
More common in males
What are the symptoms of Granulomatosis with polyangiitis (Wegener’s Granulomatosis) in the URT
Epstaxis
Nasal deformity
Sinusitis
Deafness
What are the symptoms of Granulomatosis with polyangiitis (Wegener’s Granulomatosis) in the LRT
Cough
Dyspnoea
Haemoptysis
What are the symptoms of Granulomatosis with polyangiitis (Wegener’s Granulomatosis) not seen in the respiratory tract
- Kidney- Glomerulonephritis
- Joints- arthralgia, myalgia
- Eyes- scleritis
- Heart- pericarditis
- Systemic- fever, weight loss, vasculitic skin rash
What tests can be done to diagnose vasculitis
- Urine- Blood/protein
- Renal function- Raised urea/creatinine
- Biochemistry- Raised alk phos, CRP, low albumin
- Haematology- Anaemia, thrombocytosis, leukocytosis
- Immunology- Hyperglobulinaemia, Positive ANCA (can be cytoplasmic or perinuclear)
- Renal biopsy
