Renal consequences of systemic disease Flashcards
Briefly describe the pathogenesis of diabetic nephropathy
Increases glucose activates growth factors in the kidney which leads to glomerulosclerosis.
This leads to inflammation which leads to podocyte dysfunction and thickening of the basement membrane. This then causes tubulo interstitial fibrosis.
What is the initial sign of diabetic nephropathy?
Microalbuminuria
What tests do you do to look for proteinuria?
Dipstick Spot urine (Albumin: Creatanine ratio and protein creatanine ratio)
What are the options for prevention and management of diabetic nephropathy?
- Glycaemic control (HbA1c less than 7)
- Anti hypertensives (aim for less than 130/80) with ACEi and ARBs
- Lipid control
What is the most common cause of renal failure in the UK?
Diabetes
What is ischaemic nephropathy?
Reduced GFR as a result of reduced renal blood flow beyond the level of autoregulatory compensation. This leads to renal atrophy and progressive CKD
What imaging can you do to show renal artery stenosis?
Renal US Renal artery doppler CT angiography MR angiography Conventional angiography
What medications are used in renal artery stenosis?
Statin
Anti platelet
ACEi (not if bilateral)
Angioplasty and stenting (only really for fibromuscular dysplasia)
What is the treament for myeloma related kidney disease?
Manage hypercalcaemia Chemotherapy Stem cell transplant Plasma exchange Dialysis
How does myeloma cause kidney disease?
There is a few mechanisms by which the renal damage occurs in myeloma:
- The monoclonal paraproteins collect in the glomerulus
- Dehydration/hypercalcaemia/bisphosphonates all also contribute
- Cast nephropathy due to tubular damage
What tests do you do if you suspect myeloma?
Bloods - Serum protein electrophoresis - Serum free light chains Urine - Bence jones protein
Bone marrow biopsy
Skeletal survey
Renal biopsy
Which type of vasculitis (large, medium or small vessel) usually has effects on the kidneys?
Small vessel vasculitis
What are the ANCA associated vasculitis?
Microscopic polyangitis
Churg strauss
Wegners granulomatosis
What is the most common renal abnormality seen in lupus nephritis?
Proteinuria
Discuss the staging for lupus nephritis?
Class I: Minimal mesangial Class 2: Mesangial proliferative Class 3: Focal proliferative Class 4: Diffuse proliferative Class 5: Membranous Class 6: Advanced sclerosing
