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
What will a renal biopsy show in vasculitis?
segmental necrotizing glomerulonephritis
crescents
Name the cutaneous manifestations of vasculitis.
Purpura affecting lower extremities eg ankle
How should vasculitis in renal terms be treated?
immunosuppression
plasma exchange
may require renal support
Who is SLE most common in?
women in 20s/30s
What does SLE cause most commonly in the kidneys?
most common abnormality = proteinuria
nephrotic syndrome
granular or red cell casts
What antibodies etc are high in SLE?
positive ANA, dsDNA, SmAb, low complement
Treatment of SLE?
ace Is and ARBS
also immunosuppression eg cyclophomude/MMF
Predisolone
What syndrome may make prognosis of SLE worse?
antiphospholipid syndrome
What percentage of renovascular disease is ostium?
85%
What percentage of renovascular disease is bilateral?
30-80%
Who is renal vascular disease more common in?
older men
What may flash pulmonary oedema be seen in?
renal artery stenosis
When are ACE Is contraindicated?
BILATERAL renal artery stenosis
What are the main features of myeloma kidney?
lymphoid malignancy
bone pain, weakness/fatigue/weight loss
hypercalaemia, renal failure, amyloidosis
In whom is incidence of myeloma kidney doubled?
blacks
What are treatment options of myeloma kidney?
stop any nephrotoxins eg NSAIDs treat hypercalaemia avoid contrast agents Chemo to reduce tumour load eg dexamethasone Plasma exchange to remove light chains Dialysis
