Systemic Disease Flashcards
Leading cause of ESRD
Diabetic neprhopathy
What characterises diabetic nephropathy?
Albuminuria, 300mg/24 hours on at least 2 occasions 3-6 months apart
Microvascular complications of diabetes
Nephropathy
Retinopathy
Neuropathy - gastroparesis, silent MI, urogeital abnormalities
Macrovascular complications of diabetes
Stroke
CHD
PVD
Haemodynamic changes in diabetic nephropathy
Afferent arteriolar vasodilation
Hyperfiltration
Increased GFR
Why does renal hypertrophy happen in diabetic nephropathy?
Plasma glucose stimulates growth factors = mesangial expansion, nodule formation, inflammation, proteinuria, tubulo-interstitial fibrosis
Staining in diabetic nephropathy
Kimmelstiel-Wilson lesion - nodular diabetic glomerulosclerosis
Prevention and treatment of diabetic nephropathy
Glycaemic control
Anti-HT: ACEI or ARB
Statin
What does ACEI do to glomerulus?
Dilates efferent arteriole = reduced intraglomerular pressure = prevent hyperfiltration
What causes renovascular HT?
Renal artery stenosis = reduced renal perfusion = responses to incresae BP
Signs of renovascular HT
Flash pulmonary oedema
Microscopic haematuria
Abdominal bruit
Renovascular disease
Fibromuscular dysplasia
Atherosclerotic renovascular disease
Fibromuscular dysplasia
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)
Atherosclerotic renovascular disease
Older males
Obesity, smoking, HT
Also CVD, PVD
Ischaemic nephropathy
Due to renovascular HT and renovascular disease
Reduced GFR associated with reduced renal blood flow
Renal atrophy and progressive CKD
US, CT, MR