Systemic disease of the kidney

Question 1

Describe the kidney involvement in diabetes?

Answer 1

• Diabetic nephropathy
• Advanced from microalbuminuria to dipstick positive proteinuria
• => Worsening HTN and renal function

Question 2

Describe the pathogenesis of diabetic nephropathy?

Answer 2

• Not fully understood
• Activation of RAS => local and systemic effects
• Prolonged hyperglycaemia => renal fibrosis

Question 3

Describe the management of kidney disease secondary to DM?

Answer 3

• ACEi/ARBs slow progression of diabetic nephropathy
• SGLT2 inhibitors
  
  • Empagliflozin
  • Cause glycosuria which improves CV and renal outcomes
  • More genital infections

Question 4

What are the renal manifestations of multiple myeloma?

Answer 4

• Cast nephropathy
• Hypercalcaemia
• Fanconi’s syndrome
• AL (primary) amyloidosis
• Monoclonal immunoglobulin disease

Question 5

Describe Cast nephropathy?

Answer 5

• Light chains combine with Tamm-Horsfall protein in kidneys tubules
• Presents with AKI, little/no proteinuria

Question 6

Describe the pathogenesis of Fanconi’s syndrome?

Answer 6

• Proximal tubular injury
• Due to light chain deposition in tubular epithelium

Question 7

Describe the presentation of Fanconi’s syndrome?

Answer 7

• Glycosuria
• Phosphaturia
• Aminoaciduria
• Proximal (type II) renal tubular acidosis

Question 8

Describe AL (primary amyloidosis)?

Answer 8

• Misfolded light chains form amyloid depositions in the glomeruli (lambda)
• Proteinuria/nephrotic syndrome

Question 9

Describe Monoclonal immunoglobulin deposition disease?

Answer 9

• Light chains are deposited in glomeruli (kappa)
• Causes nodular glomerulosclerosis
• Proteinuria and renal impairment

Question 10

Describe hyperglycaemia manifestation of multiple myeloma?

Answer 10

• Bony destruction from metastases
• Thirst, polyuria, bony pain, headache

Question 11

Describe the renal manifestations of sarcoidosis?

Answer 11

• Hypercalcaemia
• From 1-α-vitamin D formation in granulomas

Question 12

Name some conditions which cause renal manifestations of systemic vasculitis?

Answer 12

• ANCA vasculitis
  
  • Microscopic polyangitis
  • Granulomatosis with polyangitis

Question 13

How can glomerulonephritis with systemic vasculitis be managed?

Answer 13

• High dose glucocorticoids + cyclophosphamide
• Plasma exchange may offer additional benefits

Question 14

Describe some renal manifestations of Systemic sclerosis?

Answer 14

• Renal lesion from:
  
  • Intimal cell proliferation
  • Luminal narrowing of renal arteries
• Intrarenal vasospasm
• Elevated plasma renin activity
• Severe HTN

Question 15

Describe renal manifestations of SLE?

Answer 15

• Haematuria
• Hypertension
• Variable renal impairment
• Heavy proteinuria

Question 16

Describe sickle-cell nephropathy?

Answer 16

• Microvascular occlusion
  
  • Most pronounced in renal medulla
• Loss of urinary concentrating ability + polyuria
• Distal renal tubular acidosis
• Impaired potassium excretion