Systemic Disease and the Kidney Flashcards
Is survival on dialysis higher in type 1 or type 2s?
type 1s
What is the most common cause of renal failure in the UK?
diabetes
What should you screen for in diabetes to avoid renal failure?
urinary protein abnormalities
Use of what slows progression in renal disease for diabetics?
ACE Is and ARBs
What characterizes diabetic nephropathy in terms of albuminuria
persistant albuminuria (300mg/24hr) on at least 2 occasions separated by 3-6 months
Describe pathophysiological changes in diabetic nephropathy.
- haemodynamic change (casodilation, Increased GFR)
- Renal hypertrophy (due to plasma glucose stimulating renal growth factors)
- Mesangial expansion, nodule formation
- proteinuria
- tubulointerstitial fibrosis
Is there haematuria in diabetic nephropathy?
not normally no
How should diabetic nephropathy be treated?
Maintain glycaemic control (HBa1c of less than 7)
Antihypertensives eg ACEIs
Lipid control
Dialysis
In type 1, may be able to do kidney pancreas transplant
Name some types of small vessel vasculitis.
Polyarteritis nodosa, Kawasaki disease , ANCA associated Churg strauss
What are the main features of Churg Strauss?
chronic rhinosinutis, asthma and prominent peripheral blood eosinophilia, also involvement of lung
Is there skin involvement in Churg Strauss?
yes in 2/3 of patients
What symptoms are common in Wegener’s (GPA)?
ALL very ENT ish symptoms Nasal crusting Sinusitis Persistent rhinorrheoa Otitis media SADDLE NOSE
What are the main features of MPA (microscopic polyangiitis)?
pulmonary features
cough, hoarsness, haemoptysis, SOB, pleuritic pain
In which two conditions is renal involvement of vasculitis very common?
GPA and MPA
How does vasculitis present in the kidney?
AKI - proteinuria, red cell casts