Systemic Disease And The Kidney Flashcards
What three diseases are encompassed in ANCA vasculitis
Granulomatosis with polyangitits -wegeners granulomatosis Inflammation in the blood vessels small and large in the nose, sinuses, throats, lungs and kidneys, necrotising granulomatous inflammation and vasculitis of small and medium vessels -kidney RPGN with crescent formation cANCA Macroscopic polyangitis Associated with pANCA MPO No granulomatous inflammation Eosinophilic granulomatosis with polyangitis Late onset progressive asthma High eosinophils also called churg Strauss Nasal polyps Pulmonary infiltrates
WHat are the main presentations of kidney disease
Nephrotic syndrome
Nephritic syndrome
Abnormal kidney function found incidentally
Unexplained haematuria/proteinuria
What are the complications of diabetes
Microvascular Neuropathy Retinopathy Nephropathy Macrovascular Brain -stroke Heart -CAD PVD Renal artery disease
What is diabetic kidney disease
Any kidney disease in a patient with diabetes no matter the underlying cause
What is diabetic nephropathy
Any kidney disease presumed to be caused by diabetes
What is diabetic glomerulonephropathy
Diabetic kidney disease proven with a biopsy changes that are caused by diabetes
How is kidney disease screened for in diabetes
eGFR but this being decreased would be a late complication so may be too late
Albuminuria is an early sign - 2 samples 3-6 months apart prefer MSU first thing in the morning
Also need to exclude physiological causes of albuminuria such as vigourous exercise, dehydration, and ill with a high fever
Some patients have deteriorating CKD but no proteinuria and patients can have albuminuria with normalcy renal function.
What other causes if kidney disease are those with diabetes likely to have or could have instead but have similar symptoms to diabetic nephropathy
Severed or persistent hypertension
Haematuria
Nephrotic syndrome
Rapidly deteriorating function
What other features would a patient need to have to diagnose diabetic nephropathy
Need to have other microvasuclar complication signs
Retinopathy and neuropathy
What is the pathology of diabetic glomerulopathy
Mesangial expansion Inc deposits of ECM - mesangium, BM, tubulars-interstitium -vascular changes -fibrosis -> sclerosis Kimmelstiel-Wilson nodules on pathology imaging
Risk factors for the development /progression of diabetes nephropathy
Modifiable -glycaemic control -BP control -lifestyle factors salt intake, smoking RAS blockade -proteinuria -lipid control
Timeline of changes in those with diabetes to renal function
Pre diabetic nephropathy -hyperfiltration 0-5 years
Incipient diabetic nephropathy - dec eGFR, rising proteinuria not vast changes 5-15 years
Overt diabetic nephropathy eGFR drops significantly and proteinuria rises 15 -25 years
ESRF eGFR below 10 transplant, dialyse or palliative care
What are diabetic patients annually screened for
ACR
Retinal screening
Foot checks -sensory neuropathy
Diabetic nephropathy management
Optimism diabetes control -diet exercise -anti diabetic medication Optimise blood pressure control -salt restriction -weight management -antihypertensives Treatment or micro albuminuria/proteinuria -ACE /ARB even in normal blood pressure Smoking cessation Other interventions under investigation -none in clinical use yet
What does ANCA stand for
Anti neutrophil cytoplasmic antibodies
What are the types of ANCA and what molecules are they against
Myeloperoxidase pANCA
cANCA Proteinase 3
How are ANCA detected
By direct immune fluorescence
Neutrophil fixed and stained ab in patients blood are tagged mixed together is they are on the neutrophil then that is the +be result and the type of ANCA
What syndrome to patients with vasculitis get
Nephritic syndrome Haematuria proteinuria Oedema Salt and water retention Usually AKI