Systemic Kidney Disease Flashcards
What haemodynamic changes does diabetes cause upon the kidney?
Afferent vasodilation mediated by vasoactive mediators (IGF-1)
Hyperfiltration
Increased GFR
Which lesions are typical of diabetic glomerulosclerosis?
Kimmelstiel-Wilson lesions
There is no need for renal biopsy for suspected diabetic nephropathy if there is co-inciding retinopathy. True/False?
True
The worse proteinuria is, the more likely the patient is to have diabetic complications. True/False?
True
Which type of transplant can be done for type 1 diabetics with nephropathy?
Dual pancreas-kidney transplant
Does reducing proteinuria slow progression of diabetic nephropathy? If so, which drugs can be used?
Yes ACE inhibitor (BP <130/80)
What is the difference between renovascular hypertension and ischaemic renal disease?
RV hypertension is secondary hypertension due to renal artery stenosis
Ischaemic renal disease is due to hypoperfusion and reduced GFR
Name the 2 main renovascular diseases causing hypertension
Fibromuscular dysplasia
Atherosclerotic renovascular disease
ACE inhibitors are contraindicated in bilateral renal artery stenosis. True/False?
True
What happens in multiple myeloma? What is its effect on kidneys?
Cancer of plasma cells that causes Ig to accumulate in bone marrow - impairs normal RBC production and monoclonal antibodies
Produces protein that causes kidney problems
Which protein is produced by multiple myeloma that causes kidney problems?
Bence-Jones protein
Bence-Jones protein is usually picked up on urinalysis. True/False?
False
Urinalysis picks up albumin; BJ is abnormal protein that isn’t picked up
What is amyloidosis? What does it look like on histopathology?
Deposition of protein in extracellular spaces
Congo red staining showing apple-green birefringence
How is myeloma diagnosed?
Bloods (serum protein electrophoresis, free light chains)
BM and renal biopsy
Skeletal survey
Outline the management of myeloma
Stop nephrotoxic agents
Manage hypercalcaemia (saline +/- BPs)
Plasma exchange
Supportive dialysis
What is the earliest sign of diabetic nephropathy?
Albuminuria
How is renal artery stenosis diagnosed?
Imaging (US, RA duplex, MR angiography)
Outline management options for renal artery stenosis
Statin
Antiplatelet
ACEi
Angioplasty +/-stenting
List classical signs and symptoms of myeloma
Bone pain (usually back) Weakness, fatigue, anaemia Hypercalcaemia Amyloidosis Renal failure Recurrent infections
Which form of vasculitis classically has renal involvement?
Microscopic polyangitis
How is microscopic polyangitis diagnosed?
Immunology (anti-MPO antibodies)
Urinalysis
Renal biopsy
Bloods (inflammatory markers)
Outline the management of microscopic polyangitis
Immunosuppressants (cyclophosphamide)
Steroids
Supportive dialysis
What disease would you consider in a 20-30 yr old female with proteinuria?
Lupus with renal involvement
