Renal Complications of Systemic Disease

Question 1

What is the pathology of Diabetic nephropathy?

Answer 1

Concurrent lesions
Hyperglycaemia → renal hyperperfusion → hypertrophy
and ↑ renal size
Reactive oxygen species → glomerulosclerosis and nephron loss → RAS activation → HTN

Question 2

What are some of the clinical signs of Diabetic nephropathy?

Answer 2

Microalbuminuria → Proteinuria
Diabetic retinopathy usually co exists
HTN commonly

Question 3

How regularly should patients with T2DM be screened for microalbuminuria?

Answer 3

6 monthly

Question 4

What is the management of Diabetic nephropathy?

Answer 4

Good glycaemic control - delays onset and progression
Target BP 130/80
Start ACEi/ARB even if normotensive
Smoking cessation

Question 5

What are the features of renal involvement in Amyloidosis?

Answer 5

Proteinuria
Nephrotic syndrome
Progressive renal failure

Question 6

How can you diagnose renal involvement in Amyloidosis?

Answer 6

Enlarged kidneys on US

Biopsy

Question 7

What are the direct effects malignancy can have on the kidneys?

Answer 7

Renal infiltration: leukaemia, lymphoma
Obstruction eg pelvic tumour
Metastases

Question 8

What are the nephrotoxic effects malignancy can have on the kidneys?

Answer 8

Toxic effects of chemotherapy
Analgesics
Tumour lysis syndrome

Question 9

What is Tumour lysis syndrome?

Answer 9

Release of intracellular potassium, phosphate and nucleic acids
The catabolism of which produces large amounts of excess uric acid

Question 10

What are the symptoms of Tumour lysis syndrome?

Answer 10

Hyperkalaemia - cardiac conduction abnormalities, muscle paralysis
Hyperphosphatemia - causes AKI due to deposition of calcium phosphate crystals in the kidney parenchyma
Hypocalcaemia - Tetany, Papilloedema
Lactic acidosis - malaise, abdominal pain

Question 11

What are some of the risk factors for Tumour lysis syndrome?

Answer 11

High tumour burden
High grade tumours with rapid cell turnover
Pre existing renal disease
Cancer involvement in renal system
Increasing age

Question 12

What effect can Myeloma have on the renal system?

Answer 12

Monoclonal Ab ± light chains (Bence Jones proteins) block tubules and have direct toxic effects
→ ATN
Association with hypercalcaemia

Question 13

What is the presentation of renal impairment due to Myeloma?

Answer 13

Acute renal failure
Chronic renal failure
Amyloidosis

Question 14

How can you manage renal impairment due to Myeloma?

Answer 14

Ensure fluid intake of 3L/d to prevent further impairment

Dialysis may be required in severe Acute renal failure