secondary glomerulonephritis (systemic)

Question 1

what is multiple myeloma

Answer 1

B cell cancer –> over production of plasma (dysproteinaemia)

Question 2

symptoms myeloma

Answer 2

CRABBI: hyperCalcaemia // Renal disease // anaemia // bleeding // bone marrow (fractures + back pain) // Infection

Question 3

renal pathology myeloma

Answer 3

tubular = light chain deposits + Ig // golumerular = amyloid, nephrocalcinosis, nephrolithaias (stones)

Question 4

blood invx myeloma

Answer 4

FBC, U+Es, calcium, blood film = rouleaux

Question 5

electrophoresis myeloma

Answer 5

blood = raised monoclonal IgA or IgG (free light chains) // urine = bence jones

Question 6

imaging + bone marrow myeloma

Answer 6

aspiration = raised plasma // MRI, skull X ray

Question 7

mx myeloma

Answer 7

dexamethasone + cyclophosphamide // stem cell transplant // supportive dialysis

Question 8

what is amyloidosis

Answer 8

deposit of insoluble fibrill proteins in organs –> dysfunction

Question 9

symptoms amyloidosis

Answer 9

renal: proteinuria + failure // cardiomyopathy // peripheral neuropathy // hepatosplenomegaly // malabsorption

Question 10

what is AL amyloidosis

Answer 10

seen in myeloma = light chain production (abnormal Ig from plasma cells)

Question 11

what is AA amyloidosis

Answer 11

develops in patients with chronic conditions –> amyloid A protein

Question 12

diagnosis amyloid

Answer 12

renal biopsy = congo red stain: apple green birefringence // SAP scan // skin, rectal, abdo biopsy

Question 13

which ANCA vasculitis affect the kidneys

Answer 13

GPA (cANCA + PR3) // MPA (pANCA + MPO) // HSP

Question 14

what type of vasculitis is HSP

Answer 14

small vessel IgA

Question 15

when does HSP usually present

Answer 15

kids following infection

Question 16

symptoms HSP

Answer 16

palpable pupuric rash + oedema // abdo pain // arthritis // haematuria, AKI

Question 17

how is renal disease monitored in HSP

Answer 17

BP + urinalysis

Question 18

mx HSP

Answer 18

supportive + self limiting

Question 19

how should SLE patient be monitered for renal disease

Answer 19

urinalysis for protein

Question 20

WHO kidney classification

Answer 20

I = normal –> VI = sclerosing

Question 21

most common and severe form of SLE nephritis

Answer 21

IV - diffuse proliferative glomerulonephritis

Question 22

class IV SLE nephritis biopsy

Answer 22

wire -loop // electron = immune complex deposit // immunofluorescence = granular

Question 23

mx SLE nephritis

Answer 23

treat hypertension // class III or IV = steroids + mycophelonate or cyclophosphamide

Question 24

how is diabetic nephropathy screened for

Answer 24

proteinuria = albumin: creatinine (ACR) // early first pass morning specimen

Question 25

what ACR result indicates proteinuria

Answer 25

> 2.5 = microalbuminuria // >3 = clinically significant

Question 26

what BP should be aimed for in diabetic nephropathy

Answer 26

<130/80

Question 27

mx diabetic nephropathy

Answer 27

ACEi or ARB if ACR >3 // statins

Question 28

what is renal papillary necrosis

Answer 28

coagulative necrosis of renal papillae

Question 29

what causes renal papillary necrosis (5)

Answer 29

pyelonephritis // diabetes // obstructive nephropathy // NSAIDs // sickle cell anaemia

Question 30

symptoms renal papillary necrosis

Answer 30

visible haematuria, loin pain, proteinuria

Question 31

what is the most common cause of renal artery stenosis

Answer 31

atherosclerosis (90%)

Question 32

symptoms renal artery stenosis

Answer 32

hypertension, CKD, flash pulm oedema (rapid decompensated HF)

Question 33

second most common cause renal artery stenosis

Answer 33

fibromuscular dysplasia