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Gen Med (Renal) > Systemic Disease Affecting the Kidneys > Flashcards

Systemic Disease Affecting the Kidneys Flashcards

1
Q

What defines renovascular disease?

A

Stenosis of the renal artery or one of its branches

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2
Q

What is the most common cause of renovascular disease?

A

Atherosclerosis

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3
Q

What is the second most common cause of renovascular disease after atherosclerosis?

A

Fibromuscular dysplasia

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4
Q

What demographic is fibromuscular dysplasia most likely to affect?

A

Females aged < 50

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5
Q

What percentage of cases of fibromuscular dysplasia are familial? What is significant about these cases?

A

10% - they are often bilateral

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6
Q

In those with bilateral renal artery stenosis, what happens after treatment is given with an ACE inhibitor or ARB?

A

Decline in renal function, possible AKI

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7
Q

How does renovascular disease most commonly present?

A

Hypertension which is resistant to treatment

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8
Q

Patients with renovascular disease can experience ‘flash’ pulmonary oedema - what is meant by this?

A

Sudden onset pulmonary oedema, with no LV impairment on ECHO

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9
Q

What sign of renovascular disease may be detectable on abdominal examination?

A

Abdominal bruit

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10
Q

What is the first line imaging investigation for renovascular disease?

A

Renal ultrasound + Doppler

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11
Q

What happens to the size of a kidney affected by renovascular disease?

A

It is small

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12
Q

What is the gold standard imaging investigation for renovascular disease?

A

CT/MR angiogram

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13
Q

What is the treatment of choice for hypertension management in those with unilateral renal artery stenosis?

A

ACE inhibitor or ARB

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14
Q

When are ACE inhibitors and ARBs contraindicated in renovascular disease?

A

If the condition is bilateral

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15
Q

What are some interventional options for the management of renovascular disease?

A

Transluminal angioplasty / revascularisation surgery

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16
Q

Kimmelstiel-Wilson nodules seen on histology suggests what underlying pathology?

A

Diabetic nephropathy

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17
Q

What are the 4 main stages of diabetic nephropathy?

A

Elevated GFR / glomerular hyperfiltration / microalbuminuria / nephropathy

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18
Q

What defines microalbuminuria?

A

30-300mg of albumin passed in 24h

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19
Q

Patients with diabetes should be screened annually for what, to detect early evidence of renal damage?

A

Microalbuminuria

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20
Q

In diabetics, microalbuminuria gives early warning of impending renal problems, but is also a strong independent risk factor for what?

A

Cardiovascular disease

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21
Q

How can microalbuminuria be detected?

A

By using specialised dipsticks or an albumin: creatinine ratio

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22
Q

In diabetic patients who are positive for microalbuminuria, what treatment is required?

A

ACE inhibitor or ARB

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23
Q

An albumin: creatinine ratio of what suggests microalbuminuria?

A

> 2.5mg/mmol

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24
Q

What is the target blood pressure for all diabetic patients?

A

< 130/80

25
Q

What is the target blood pressure for diabetic patients with microalbuminuria?

A

< 125/75

26
Q

Once an ACE inhibitor or ARB has been started, what blood test should be monitored periodically?

A

U&Es

27
Q

If a diabetic patient is started on an ACE inhibitor or ARB, the medication should be stopped if there is a rise in creatinine of more than what?

A

20%

28
Q

Other than blood pressure control, what are some other areas of management for microalbuminuria in diabetics?

A

Good glycaemic control and management of CV risk factors

29
Q

What is an option for RRT in type 1 diabetic patients which is not available to type 2 diabetic patients?

A

Simultaneous kidney-pancreas transplant

30
Q

What is the most common class of lupus nephritis?

A

Class IV

31
Q

What is meant by class IV lupus nephritis?

A

Diffuse proliferative glomerulonephritis

32
Q

Glomeruli showing a ‘wire loop’ appearance on histology is suggestive of which pathology?

A

Lupus nephritis

33
Q

How is lupus nephritis managed?

A

Immunosuppression and tight control of hypertension

34
Q

cANCA and anti-PR3 antibodies are suggestive of which small vessel vasculitis?

A

GPA

35
Q

pANCA and anti-MPO antibodies are suggestive of which small vessel vasculitis?

A

MPA and EGPA

36
Q

How is small vessel vasculitis managed?

A

Immunosuppression +/- plasma exchange

37
Q

What is the ‘classic’ presentation of myeloma?

A

Back pain and renal failure

38
Q

What are the two main signs which can be detected on blood testing that are suggestive of myeloma?

A

Anaemia and hypercalcaemia

39
Q

What blood testing is done specifically to detect myeloma?

A

Protein electrophoresis and serum free light chains

40
Q

What urine testing is done specifically to detect myeloma?

A

Bence-Jones proteins

41
Q

How should hypercalcaemia caused by myeloma be managed?

A

Saline +/- bisphosphonates

42
Q

What are the definitive management options for myeloma?

A

Chemotherapy or stem cell transplant

43
Q

Regardless of the underlying cause, what are the two main features of haemolytic uraemic syndrome?

A

Thrombocytopenia and AKI

44
Q

90% of cases of haemolytic uraemic syndrome are due to what?

A

Infection with E. coli O157

45
Q

If haemolytic uraemic syndrome is caused by infection, what other clinical features will be present?

A

Abdominal pain and bloody diarrhoea

46
Q

What will be seen on a blood film of someone with haemolytic uraemic syndrome?

A

Fragmented RBCs (schistocytes)

47
Q

What will be seen on urinalysis of someone with haemolytic uraemic syndrome?

A

Proteinuria and haematuria

48
Q

What are the two major abnormalities that will be seen on an FBC of someone with haemolytic uraemic syndrome?

A

Low Hb and platelets

49
Q

The mortality of thrombotic thrombocytopenic purpura is reduced from > 90% to 20% with what treatment?

A

Plasma exchange

50
Q

The unexplained occurrence of thrombocytopenia and anaemia should prompt immediate consideration of what diagnosis?

A

Thrombotic thrombocytopenic purpura

51
Q

What additional symptoms may Henoch-Schonlein purpura have over IgA nephropathy?

A

Purpuric rash (on extensor surfaces), polyarthritis and abdominal pain

52
Q

Immunofluorescence will be positive for what in a skin or renal biopsy of someone with Henoch-Schonlein purpura?

A

IgA and C3

53
Q

Anti-GBM disease is caused by autoantibodies to what?

A

Type IV collagen

54
Q

Other than the kidneys, what other body systemic is affected by anti-GBM disease and what symptom does it usually cause?

A

Respiratory - causes haemoptysis

55
Q

Patients with anti-GBM disease usually present with what?

A

Haematuria, or nephritic syndrome

56
Q

How is anti-GBM disease treated?

A

Plasma exchange, steroids +/- cytotoxic immunosuppressants

57
Q

How does amyloidosis affecting the kidneys present?

A

Proteinuria, or nephrotic syndrome

58
Q

What happens to the size of the kidneys affected by amyloidosis?

A

Large

59
Q

A renal biopsy which shows positive Congo-red staining with red-green birifringence under polarised light microscopy suggests what diagnosis?

A

Amyloidosis

Gen Med (Renal) (18 decks)

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