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Medicine II > Nephro: The Kidney in Systemic Disease > Flashcards

Nephro: The Kidney in Systemic Disease Flashcards

1
Q

why is renal involvement relevant in systemic disease?

A
  • there is a worse prognosis if the kidneys are involved
  • different treatment is needed if the kidneys are involved
  • rarely the nature of systemic disease is only established by a renal biopsy
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2
Q

when should you suspect renal involvement in systemic disease?

A
  • evidence of renal disease
  • evidence of systemic disease
  • both of the above have to correlate with each other
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3
Q

what is the most obvious abnormality in multiple myeloma

A

diminished renal function

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4
Q

indicators of renal disease

A
  • abnormal renal function
  • abnormal urinalysis (IMP)
  • abnormal renal imaging
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5
Q

how is the renal structure in AKI?

A

renal size and anatomy are preserved

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6
Q

what happens if systemic disease equally affects both kidneys

A

use functional imaging like IVU, CT with contrast and DTPA scan
- can also be detected by blood tests

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7
Q

what renal test is always significant

A

a drop in eGFR (disease can also be present in a normal eGFR)

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8
Q

how does the eGFR vary between genders

A

females have a eGFR which is 15% less than in men

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9
Q

what can urinalysis show?

A

haematuria and proteinuria

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10
Q

what does urine microscopy show?

A

casts

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11
Q

what types of casts can be found on microscopy?

A

granular and hyaline casts may mean nothing

cellular casts are always bad

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12
Q

how do you quantify proteinuria?

A
  • simple urinalysis
  • ACR
  • 24h urine collection
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13
Q

what is the dipstick sensitive to?

A

albumin

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14
Q

what does albuminuria indicate?

A

glomerular pathology

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15
Q

what will kidneys damaged by multiple myeloma show

A
  • negative dipstick
  • normal ACR
  • elevated PCR
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16
Q

important things to get from a history

A
  • other comorbidities
  • symptoms related to multisystem disorders
  • underlying malignancy
  • is the patient at risk of being HepB, HepC or HIV positive?
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17
Q

what are features that suggest diabetic nephropathy?

A
  • nephrotic-range proteinuria
  • time between diagnosis of DM and DN is more than 5 years
  • evidence of microvascular disease elsewhere like in the eyes and NS
  • the condition is progressing at a slow rate
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18
Q

what does haematuria in a diabetic mean?

A

means that there is another renal problem apart from the DN

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19
Q

when would you do a renal biopsy?

A

when there are signs which are not linked with DN such as haematuria, cellular casts, rapid progression in disease or serological tests suggesting other systemic disease

20
Q

risk factors for nephrosclerosis

A
  • age
  • HTN
  • diabetes
21
Q

examples of connective tissue disorders that affect the kidneys

A
  • SLE
  • RA
  • mixed CT disease
22
Q

examples of primary vasculitides that affect the kidneys

A
  • microscopic polyangiitis
  • wegeners granulomatosis
  • churg strauss syndrome
  • Henoch-Schonlein purpura
23
Q

others disease that effect the kidneys

A
  • Goodpasteur’s disease
  • subacute bacterial endocarditis
  • mixed essential cryoglobulinaemia
24
Q

what are these systemic diseases with renal involvement have in common

A
  • glomerular involvement
  • presence of cellular casts
  • rapidly progressive disease
  • microscopic haematuria
25
Q

what does a glomerulonephritis screen include?

A
  • ANA, anti-ds DNA, RF, ENA
  • complements
  • ANCA, anti-MPO, anti-PR3
  • HBsAg and HepC antibodies
  • Anti-GBM
26
Q

which tests are positive in connective tissue disorders?

A

ANA, anti-ds DNA, RF, ENA

27
Q

when is there hypocomplementaemia

A
  • lupus nephritis
  • bacterial endocarditis
  • mixed essential cryoglobulinaemia
28
Q

when is Anti-GBM positive??

A

in Goodpasture’s syndrome

29
Q

what heart conditions are associated with SLE?

A
  • endocarditis
  • chordae tendinae rupture
  • mitral regurgitation
30
Q

what is the first sign of lupus?

A

butterfly rash

31
Q

what is the classification of lupus nephritis

A 
I: minimal mesangial LN
II: mesangioproliferative LN
III: focal proliferative LN
IV: diffuse proliferative LN
V: membranous LN
VI: advanced sclerosing LN
32
Q

from which stage of lupus nephritis is the capillary wall being involved?

A

Stage 3 onwards

33
Q

in which stages of LN are there mesangial deposits?

A

Stage I and II

34
Q

in which stages of LN are there subendothelial deposits?

A

Stage III and IV

35
Q

in which stage is there subepithelial deposits?

A

Stage V

36
Q

when would you treat with glucocorticoids?

A

Stage II onwards

37
Q

what are additional drugs that can be used to treat LN

A
  • mycophenolate mofetil
  • cyclophosphamide
  • rituximab
  • cyclosporin
  • tacrolimus
38
Q

investigations for multiple myeloma

A
  • ESR
  • CBC
  • SPE
  • urinary protein electrophoresis
  • free light chain assay (serum and urine)
  • bone marrow aspirate
  • skeletal survery/MRI
39
Q

effects of multiple myeloma on the kidney

A
  • decreased renal perfusion
  • hyperuricaemia
  • direct complications of monoclonal light chains
  • plasma cell infiltration
40
Q

why is the uric acid level high?

A

it is crystallised within the tubules, causing obstructive uropathy

41
Q

what do the monoclonal light chains cause in the kidney?

A
  • myeloma cast nephropathy
  • light chain deposition disease
  • AL amyloidosis
  • croglobulinaemia
  • membranoproliferative glomerulonephritis
  • heavy chain deposition disease
42
Q

what is the commonest cause of renal impairment in multiple myeloma

A

myeloma cast nephropathy

43
Q

investigations in myeloma cast nephropathy

A
  • urine dipstick (albuminuria is negative but no light chains)
  • Bence-Jones proteins in urine
  • aggregation of light chains with Tamm-Horsfall protein
  • drop in eGFR (due to the blockage)
44
Q

what can the light chain fragments be converted to?

A

beta pleated sheets, forming amyloidosis

45
Q

how can amyloidosis be detected?

A

congo red positive glomerular deposits

46
Q

what happens if the fragments cannot form beta pleated sheets?

A

they deposit in the kidney, causing light chain deposition disease (negative in congo red stain)

47
Q

what do light chain deposition disease and amyloidosis have in common?

A
  • nephrotic proteinuria

- renal impairment

Medicine II (16 decks)

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