secondary glomerulonephritis (systemic) Flashcards
what is multiple myeloma
B cell cancer –> over production of plasma (dysproteinaemia)
symptoms myeloma
CRABBI: hyperCalcaemia // Renal disease // anaemia // bleeding // bone marrow (fractures + back pain) // Infection
renal pathology myeloma
tubular = light chain deposits + Ig // golumerular = amyloid, nephrocalcinosis, nephrolithaias (stones)
blood invx myeloma
FBC, U+Es, calcium, blood film = rouleaux
electrophoresis myeloma
blood = raised monoclonal IgA or IgG (free light chains) // urine = bence jones
imaging + bone marrow myeloma
aspiration = raised plasma // MRI, skull X ray
mx myeloma
dexamethasone + cyclophosphamide // stem cell transplant // supportive dialysis
what is amyloidosis
deposit of insoluble fibrill proteins in organs –> dysfunction
symptoms amyloidosis
renal: proteinuria + failure // cardiomyopathy // peripheral neuropathy // hepatosplenomegaly // malabsorption
what is AL amyloidosis
seen in myeloma = light chain production (abnormal Ig from plasma cells)
what is AA amyloidosis
develops in patients with chronic conditions –> amyloid A protein
diagnosis amyloid
renal biopsy = congo red stain: apple green birefringence // SAP scan // skin, rectal, abdo biopsy
which ANCA vasculitis affect the kidneys
GPA (cANCA + PR3) // MPA (pANCA + MPO) // HSP
what type of vasculitis is HSP
small vessel IgA
when does HSP usually present
kids following infection
symptoms HSP
palpable pupuric rash + oedema // abdo pain // arthritis // haematuria, AKI
how is renal disease monitored in HSP
BP + urinalysis
mx HSP
supportive + self limiting
how should SLE patient be monitered for renal disease
urinalysis for protein
WHO kidney classification
I = normal –> VI = sclerosing
most common and severe form of SLE nephritis
IV - diffuse proliferative glomerulonephritis
class IV SLE nephritis biopsy
wire -loop // electron = immune complex deposit // immunofluorescence = granular
mx SLE nephritis
treat hypertension // class III or IV = steroids + mycophelonate or cyclophosphamide
how is diabetic nephropathy screened for
proteinuria = albumin: creatinine (ACR) // early first pass morning specimen
what ACR result indicates proteinuria
> 2.5 = microalbuminuria // >3 = clinically significant
what BP should be aimed for in diabetic nephropathy
<130/80
mx diabetic nephropathy
ACEi or ARB if ACR >3 // statins
what is renal papillary necrosis
coagulative necrosis of renal papillae
what causes renal papillary necrosis (5)
pyelonephritis // diabetes // obstructive nephropathy // NSAIDs // sickle cell anaemia
symptoms renal papillary necrosis
visible haematuria, loin pain, proteinuria
what is the most common cause of renal artery stenosis
atherosclerosis (90%)
symptoms renal artery stenosis
hypertension, CKD, flash pulm oedema (rapid decompensated HF)
second most common cause renal artery stenosis
fibromuscular dysplasia
