Renal manifestations of systemic disease Flashcards
Name 8 different systemic conditions that can affect the kidney.
1) Amyloidosis
2) Diabetes
3) Infection
4) Malignancy
5) Myeloma
6) Rheumatological diseases
7) Hyperparathyroidism
8) Sarcoidosis
How does amyloidosis affect the kidney?
- Proteinuria
- Nephrotic syndrome
- Progressive renal failure
What percentage of ESRF does Diabetes account for in the UK?
18%
What is the general progression of renal disease seen in diabetes?
1) Raised GFR - glomerular and tubular hypertrophy occur, increasing blood flow leading to higher GFR. Also leads to microalbuminaemia
2) Glomerular hyperfiltration - next 5-10 years, increased AGE cause inflammation and deposition of type IV collagen and mesangial expansion. Microalbuminaemia is absent
3) Mircoalbuminaemia - this highlights progression of the disease. Lasts another 5-10 years. Process has reached a point of arterial hyalinization and thickening of the mesangium and GBM, leading to nodular glomerulosclerosis (Kimmelstein-wilson lesions). GFR may be raised or normal.
4) Nephropathy - GFR begins to decline, proteinuria increases
What are the infective causes of renal disease?
SO many, can be:
Glomerulonephritis - post strep, HEP B +C, HIV, syphilis, malaria
Vasculitis - Hep B + C, post strep or staph septicaemia
Interstitial - bacterial pyelonephritis, viral (CMV, HIV Hep B), fungal and parasitic (leishmaniasis, toxoplasmosis) infections
With malignancy, what are the direct and indirect effects on the kidney?
Direct - infiltration, obstruction, metastasis
Indirect - Hypercalcaemia, nephrotic syndrome, acute renal failure, amyloidosis, glomerularnephritis
What is myeloma characterised by?
An excess production of monoclonal antibody light chains.
These are excreted and detected in 2/3 of cases as Bence Jones proteinuria.
Myeloma kidney is characterised by blockage of tubules by light chain casts. These light chains have a direct toxic effect on tubular cells, causing acute tubular necrosis.
What are the features of myeloma kidney?
AKI, CKD, amyloidosis (proteinuria and nephrotic syndrom), hypercalcaemic nephropathy.
How do you treat amyloidosis?
Ensure 3L / 24hr intake of fluids.
Dialysis may be required in AKI
Plasma exchange
How do rheumatological diseases affect the kidneys?
RA - use of NSAIDS
SLE - 40-60% have glomerular involvement. Histological patters range from minimal change to crescentic GN
Systemic Sclerosis - may affect kidney. A renal ‘crisis’ presents with AKI and accelerated HTN
How does hyperparathyroidism affect the kidney?
Features are from hypercalcaemia
How does Sarcoidosis affect the kidneys?
Primarily by abnormal calcium metabolism.
Interstitial nephritis and rarely GN are involved.
