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Renal > Systemic Disease > Flashcards

Systemic Disease Flashcards

1
Q

Leading cause of ESRD

A

Diabetic neprhopathy

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2
Q

What characterises diabetic nephropathy?

A

Albuminuria, 300mg/24 hours on at least 2 occasions 3-6 months apart

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3
Q

Microvascular complications of diabetes

A

Nephropathy
Retinopathy
Neuropathy - gastroparesis, silent MI, urogeital abnormalities

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4
Q

Macrovascular complications of diabetes

A

Stroke
CHD
PVD

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5
Q

Haemodynamic changes in diabetic nephropathy

A

Afferent arteriolar vasodilation
Hyperfiltration
Increased GFR

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6
Q

Why does renal hypertrophy happen in diabetic nephropathy?

A

Plasma glucose stimulates growth factors = mesangial expansion, nodule formation, inflammation, proteinuria, tubulo-interstitial fibrosis

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7
Q

Staining in diabetic nephropathy

A

Kimmelstiel-Wilson lesion - nodular diabetic glomerulosclerosis

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8
Q

Prevention and treatment of diabetic nephropathy

A

Glycaemic control
Anti-HT: ACEI or ARB
Statin

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9
Q

What does ACEI do to glomerulus?

A

Dilates efferent arteriole = reduced intraglomerular pressure = prevent hyperfiltration

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10
Q

What causes renovascular HT?

A

Renal artery stenosis = reduced renal perfusion = responses to incresae BP

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11
Q

Signs of renovascular HT

A

Flash pulmonary oedema
Microscopic haematuria
Abdominal bruit

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12
Q

Renovascular disease

A

Fibromuscular dysplasia

Atherosclerotic renovascular disease

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13
Q

Fibromuscular dysplasia

A

Part of renovascular disease
Females age 15-50
Bilateral renal arteries if familial
Associated with Ehler-Danlos and Marfan’s
Can involve cerebral arteries (carotid artery dissection)

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14
Q

Atherosclerotic renovascular disease

A

Older males
Obesity, smoking, HT
Also CVD, PVD

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15
Q

Ischaemic nephropathy

A

Due to renovascular HT and renovascular disease
Reduced GFR associated with reduced renal blood flow
Renal atrophy and progressive CKD
US, CT, MR

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16
Q

Treatment of renovascular disease and HT

A

Reduce CV risk factors
Reduce BP
Angioplasty and stenting
ACEI (only in UNILATERAL renal artery stenosis)

17
Q

ACEI is contraindicated in what?

A

Bilateral renal artery stenosis

18
Q

What is MM?

A

Cancer of plasma cells (produce Abs) - accumulate in bone marrow = interferes with production of blood cells
Production of paraprotein (abnormal Ab)

19
Q

Symptoms of MM

A

Bone pain
Weakness
Fatigue
Weight loss

20
Q

Signs of MM

A 
Normocytic anaemia
Hypercalcaemia
Renal failure
Amyloidosis
Recurrent infections (chest, UTI)
21
Q

Investigations for MM

A 
Normocytic anaemia
Rouleaux formation (stacks of RBCs)
Raised CRP/PV
Renal impairment, ESKD
Electrophoresis
BJP in urine
Lytic lesions on skeletal survey
22
Q

Who gets MM?

A

Males 80
Females 70
Black

23
Q

Renal manifestations of MM

A

AKI
Paraprotein deposition = AKI/CKD
Paraprotein casts
Amyloidosis

24
Q

Amyloidosis

A

Protein in EC spaces - heart, kidney, brain, eye

25
Q

Histology of amyloidosis

A

Congo red stain - apple green birefringence

26
Q

Primary and secondary amyloidosis

A

Primary - AL fibrils

Secondary - AA fibrils (chronic inflammation, MM/IBD/RA)

27
Q

Treatment of MM and AKI

A 
Stop nephrotoxins (NSAID, diuretic)
Treat hypercalcaemia - IV NaCl, IV Pamdronate
Avoid contrast
Chemo and steroids to reduce tumour load
Plasma exchange
Dialysis
28
Q

GPA

A 
Granulomatosis with Polyangitis
Wegener's
cANCA (PR3)
Necrotising granulomatous inflammation affecting resp tract = nasal crusting, sinusitis, rhinorrhoea, OM, bloody nasal discharge, pulmonary haemorrhage
Saddle nose deformity
Crescents
29
Q

EGPA

A

Eosinophilic Granulomatosis with PolyAngitis
Churg-Strauss
Necrotising granulomatous inflammation
Late onset asthma and eosinophilia, skin involvement, pulmonary haemorrhage. Kidney involvement less common.
pANCA (MPO)

30
Q

MPA

A

Microscopic PolyAngitis
NO granulomatous inflammation
Pulmonary haemorrhage
Crescents

31
Q

Treatment for kidney involvement in vasculitis

A

Immsup - steroids, cyclophosphamide
Plasma exchange (removes ANCA)
Dialysis

32
Q

Investigations for lupus

A

Raised C3 and C4
Anti-phospholipid
Anti-dsDNA

33
Q

Nephritic or nephrotic syndrome in vasculitis?

34
Q

Nephritic or nephrotic syndrome in SLE?

Renal (19 decks)

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