Renal Manifestations Of Systemic Disease Flashcards
What effect does hyperglycaemia have on the kidney that causes damage?
It leads to increased growth factors, raas activation, production of advanced glycosylation end products and oxidative stress. This causes increased glomerular vascular pressure, podocyte damage and endothelial dysfunction
What are the clinical signs of diabetic nephropathy?
First sign is albuminuria which can be picked up early on. Next is scarring (glomerularsclerosis) and formation of nodules and finally fibrosis with loss of renal function
How is a diagnosis of diabetic nephropathy made?
Microalbuminuria which is a A:Cr of 3-30mg/mmol
Regression at this stage is possible
This cannot be detected on dipstick and must be sent off, is screened for annually
What are the four main treatments for diabetic nephropathy?
Intensive DM control to prevent microalbuminuria progressing to macroalbuminuria (A:Cr ≥30 mg/mmol)
BP < 130/80 use ACE-i or ARB to protect CV and renal over blood pressure control
Limit salt intake <5g per day
Statins to reduce CV risk
What is the potential risk of patients being on Ace i and Arb?
Increased risk of hyperkalemia
There is no clear benefit of dual therapy so it is not done
What is the difference between nephrosis and nephritis?
Nephrosis is proteinuria due to podocyte damage
Nephritis is haematuria due to inflammatory damage
What is the pathology of lupus causing renal disease?
ANA bind and cause immune complex deposition, these immune complexes cause inflammation and damage
How does lupus kidney disease present?
Can present as nephrosis or nephritis
How is lupus kidney disease diagnosed?
ANA is sensitive but non specific
Anti-dsDNA is 75-100% specific
How is lupus kidney disease treated?
Mild types can use acei/arb for renal protection
More severe will require immunosuppression - mycophenolate, glucocorticoids, cyclophosphamide, rituximab
What is the pathophysiology of vasculitis renal disease?
ANCA cause glomerulonephritis which results in inflammatory damage to the glomerulus
What are the symptoms of anca associated vasculitis?
It presents with generalized vasculitis symptoms ask about lethargy, fever, myalgia, anorexia. Ask about respiratory symptoms and investigate for pulmonary haemorrhage.
How is a diagnosis of vasculitis renal disease made?
Clincial +anca+ biopsy
How is vasculitis renal disease treated?
With high dose corticosteroids and cyclophosphamide or rituximab
How does myeloma cause renal disease?
deposition of Ig/light chains in the glomerulus causes tubular obstruction. This causes proteinuria, hypercalcaemia (increased bone reabsorption) and renal tract infection due to immunoparesis
