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Renal/Urology > Lecture 24 - The Kidneys in Systemic Disease > Flashcards

Lecture 24 - The Kidneys in Systemic Disease Flashcards

1
Q

What systemic diseases may affect the kidneys?

A 
DM
CV disease
Infection 
Inflammation of the BVs
HUS/TTP
Myeloma
Amyloidosis 
Drugs
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2
Q

What CV diseases may affect the kidney?

A

Cardiac failure
Artheroembolism
HTN
Atherosclerosis

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3
Q

What infections may affect the kidney?

A

Sepsis
Post-infectious GN
IE

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4
Q

What inflammatory diseases of BVs may affect the kidneys?

A

SLE
Vasculitis
Scleroderma + other connective tissue diseases
Cryoglobulinaemia

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5
Q

What drugs may damage the kidneys?

A 
Aminoglycosides
NSAIDs
Radiocontrast
ACEi
Penicillamine, gold
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6
Q

What is the commonest single cause of ESRD?

A

DM

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7
Q

What is the natural history of diabetic nephropathy?

A
  1. Silent sub-clinical phase with hyperfiltration + increased GFR
  2. microalbuminaemia
  3. Clinical nephropathy
  4. Established renal failure
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8
Q

Are type I or type II at more risk of diabetic nephropathy?

A

Equal risk

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9
Q

What is the classification of CKD based on?

A

Kidney function - GFR

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10
Q

What classification system is used to stage CKD?

A

NKF K/DOQI Classification system -

  1. Kidney damage/normal/high GFR (GFR >90)
  2. Kidney damage/mid deduction in GFR (GFR 60-89)
  3. Moderately impaired (GFR 30-59)
  4. Severely impaired (GFR 15-29)
  5. Advanced or on dialysis (GFR <15)
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11
Q

What does CKD have a relationship with?

A

CV disease

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12
Q

What is a very common cause of renal failure in older patients?

A

Renal vascular disease

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13
Q

What is vasculitis?

A

Inflammation in the wall of a blood vessel

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14
Q

What is the vasculitis categorised by?

A

Size of vessel involved

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15
Q

What are aortic/large artery vasculitides?

A

Takayasu arteritis

Giant cell arteritis

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16
Q

What are e.g.s of medium artery vasculitides?

A

Polyarteritis nodose

Kawasaki disease

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17
Q

What are e.g.s of small vessel vasculitides?

A

Wegner’s granulomatosis
Microscopic polyarteritis
Churg-strauss syndrome

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18
Q

What is Wegener’s granulomatosis (granulomatosis with polyangiitis)?

A

Autoimmune condition associated with a necrotizing granulomatous vasculitis, affecting the upper and lower RT and kidneys

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19
Q 
What are the features of Wegener's granulomatosis:
URT:
LRT:
Kidneys:
Joints:
Eyes:
Heart:
Systemic:?
A

URT: epistaxis, saddle deformity, sinusitis, deafness
LRT: cough, dyspnoea, haemoptysis, pulmonary haemorrhage
Kidneys: GN
Joints: arthalgia, myalgia
Eyes: scleritis
Heart: pericarditis
Systemic: fever, wt loss, vasculitic skin rash

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20
Q

What do you see on CXR in someone with Wegener’s?

A

Large cavitating lesions

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21
Q

What is often +ve in the blood work up of patients with Wegener’s?

A

cANCA (>90%), pANCA (25%)

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22
Q

How is Wegener’s managed?

A

Steroids
Cyclophosphamide
Plasma exchange

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23
Q

What is the median survival with Wegener’s?

24
Q

What is microscopic polyangiitis?

A

Small vessel ANCA vasculitis

25
What are the features of microscopic polyangiitis?
``` Renal impairment - raised Cr, haematuria, proteinuria Fever Lethargy, myalgia, wt loss Rash - palpable purpura Cough, dyspnoea, haemoptysis Mononeuritis multiplex ```
26
What ANCA antibodies are usually seen in microscopic polyangiitis?
pANCA (against MPO) - positive in 50-75% | cANCA (against PR3) - positive in 40%
27
What investigation results may point towards a vasculitis?
``` Blood/protein in urine Raised urea/creatinine Raised alk phosp, CRP, low albumin Anaemia, thrombocytosis, leucocytosis Hyperglobinulinaemia +ve ANCA ```
28
What does the c in cANCA stand for?
Cytoplasmic
29
What does the p in pANCA stand for?
Perinuclear
30
What are ANCA?
Anti-neutrophil cytoplasm antibodies are autoantibodies that target neutrophils
31
What two proteins do ANCA specifically bind to?
Proteinase 3 (PR3) and myeloperoxidase (MPO_
32
What does binding of ANCA to neutrophils in the blood lead to?
Release of toxic substances from neutrophils --> damage to small blood vessel walls + migration of neutrophils through BVs into surrounding tissues --> inflammation there Release of signalling molecules that attract more neutrophils and perpetuate the response
33
What two ways can ANCA blood tests be performed by?
Indirect immunofluorescence and ELISA
34
What does IIF involve?
Staining neutrophils cANCA leads to staining throughout the neutrophil pANCA leads to staining around the nucleus
35
Why is doing ELISA more beneficial than IIF?
It allows the level of PR3/MPO-ANCA to be measured
36
What protein is pANCA usually against?
MPO
37
What protein is cANCA usually against?
PR3
38
What ANCA is positive in Wegener's >90% of the time?
cANCA
39
What ANCA is positive in microscopic polyarteritis usually?
pANCA
40
When might ANCA give a false +ve?
If patient has IBD
41
What is infective endocarditis?
Bacterial (or fungal) infection of the cardiac valves
42
What are the typical causative organisms in IE?
Staph aureus Viridans strep Enterococci
43
What renal disease can IE lead to and why?
GN +/- small vessel vasculitis due to immune complex formation
44
What things may suggest renal involvement in IE?
Abnormal urea/cr Haematuria/red cell casts Reduced complement levels
45
How is renal involvement in IE treated?
It sound recover when underlying infection treated
46
What is multiple myeloma?
Monoclonal proliferation of plasma cells --> excess of Ig and light chains
47
Who is MM most common in?
Elderly
48
What are the clinical features of MM?
``` Markedly elevated ESR Anaemia Wt loss Fractures Infection Back pain/cord compression ```
49
How is MM diagnosed?
Bone marrow aspirate >10% clonal plasma cells Serum paraprotein +/0 immunoparesis Urinary bence hones protein Skeletal survey shows lytic lesions
50
How does MM affect the kidney?
Abnormal Ig are filtered in the glomerulus and get stuck and block up the renal tubules --> progressive renal failure
51
What are the features of renal failure in myeloma?
``` Cast nephropathy Light chain nephropathy Amyloidosis HyperCa Hyperuricaemia ```
52
What is amyloidosis?
Extracellular deposition of an insoluble fibrillar protein called amyloid
53
What is amyloid derived from?
Multiple precursor proteins
54
What are the non-fibrillary components of amyloid?
Amyloid P component (derived from the acute phase protein serum amyloid P) Apolipoprotein E Heparan sulphate proteoglycans
55
What does the accumulation of amyloid fibrils lead to?
Tissue/organ dysfunction
56
How do you diagnose amyloidosis?
Congo red staining - see apple-green birefringence Serum amyloid precursor scan Biopsy of rectal tissue

Renal/Urology (29 decks)

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