Systemic Disease Affecting The Kidneys Flashcards
What is the histology of diabetic nephropathy?
Thickening of the glomerular basement membrane
Nodular glomerulosclerosis
How does systemic disease manifest in kidneys?
Failure to excrete wast products suddenly
- AKI
Failure to excrete waste products grandually
- CKD
Kidneys inflamed and leak blood and protein
- nephritic syndrome
Kidney’s leak a bit of protein
- proteinuria
Kidney’s leak a lot of protein
- nephrotic syndrome
Differential diagnosis for when someone with high BP has increased creatinine when on an ACE inhibitor?
Obstruction Renovascular disease (more likely if they have systemic vascular disease) Interstitial nephritis
If someone has systemic vascular disease, what is the most likely diagnosis?
Renal artery stenosis
How is renal artery disease managed?
Medically - BP control (not ACEI/ARB) - statin - glycaemic control is diabetic Lifestyle - smoking cessation - exercise - low sodium diet
How is renal artery stenosis diagnosed?
Angioplasty
Rapidly deteriorating renal failure
Uncontrolled BP on multiple agents
Flash pulmonary oedema
What are the differential diagnoses for someone with nephrotic syndrome and a history of ulcerative colitis?
Diabetic nephropathy Lupus nephritis - vasculitis Viral infections (HBV, HCV, HIV) Amyloidosis Myeloma
Describe amyloidosis.
Deposition of highly insoluble proteineous material in extracellular space (felt-like substance made of beta-pleated sheets)
Deposits in the kidney, heart, liver and lungs
Has a high affinity for the constituents of the capillary wall
How does amyloidosis look on microscopy?
Light microscopy
Electron microscopy
- amyloid fibrils 9-11nm
- causes mesangial expansion
What are the two classes of amyloidosis?
AA - systemic amyloidosis (inflammation and infection, related to IBD)
AL - immunoglobulin fragments from heamatological conditions (e.g. myeloma)
How is amyloid treated?
AA - treat underlying source of infection/inflammation
AL - treat the underlying haematological condition
What is the differential diagnoses for nephritic syndrome with symptoms of vasculitis?
Vasculitis - ANCA associated
Vasculitis - anti-GBM disease
Vasculitis - lupus nephritis
IgA nephropathy (crescentic variety)
What is systemic lupus erythematosis?
An auto-immune disease (mediated by immune complexes)
Multiple autoantibodies
- directed against DNA, histones and transcriptional/translational machinery
How is SLE treated?
Immunosuppression
- steriods
- MMF
- cyclophosphamide
- rituximab
How is ANCA associate vasculitis treated?
ITU - ventilatory support Antibody removal/depletion - methyl prednisolone - plasma exchange - cyclophosphamide
