Systemic Kidney Disease

Question 1

What haemodynamic changes does diabetes cause upon the kidney?

Answer 1

Afferent vasodilation mediated by vasoactive mediators (IGF-1)
Hyperfiltration
Increased GFR

Question 2

Which lesions are typical of diabetic glomerulosclerosis?

Answer 2

Kimmelstiel-Wilson lesions

Question 3

There is no need for renal biopsy for suspected diabetic nephropathy if there is co-inciding retinopathy. True/False?

Answer 3

True

Question 4

The worse proteinuria is, the more likely the patient is to have diabetic complications. True/False?

Answer 4

True

Question 5

Which type of transplant can be done for type 1 diabetics with nephropathy?

Answer 5

Dual pancreas-kidney transplant

Question 6

Does reducing proteinuria slow progression of diabetic nephropathy? If so, which drugs can be used?

Answer 6

Yes
ACE inhibitor (BP <130/80)

Question 7

What is the difference between renovascular hypertension and ischaemic renal disease?

Answer 7

RV hypertension is secondary hypertension due to renal artery stenosis
Ischaemic renal disease is due to hypoperfusion and reduced GFR

Question 8

Name the 2 main renovascular diseases causing hypertension

Answer 8

Fibromuscular dysplasia

Atherosclerotic renovascular disease

Question 9

ACE inhibitors are contraindicated in bilateral renal artery stenosis. True/False?

Answer 9

True

Question 10

What happens in multiple myeloma? What is its effect on kidneys?

Answer 10

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

Question 11

Which protein is produced by multiple myeloma that causes kidney problems?

Answer 11

Bence-Jones protein

Question 12

Bence-Jones protein is usually picked up on urinalysis. True/False?

Answer 12

False

Urinalysis picks up albumin; BJ is abnormal protein that isn’t picked up

Question 13

What is amyloidosis? What does it look like on histopathology?

Answer 13

Deposition of protein in extracellular spaces

Congo red staining showing apple-green birefringence

Question 14

How is myeloma diagnosed?

Answer 14

Bloods (serum protein electrophoresis, free light chains)
BM and renal biopsy
Skeletal survey

Question 15

Outline the management of myeloma

Answer 15

Stop nephrotoxic agents
Manage hypercalcaemia (saline +/- BPs)
Plasma exchange
Supportive dialysis

Question 16

What is the earliest sign of diabetic nephropathy?

Answer 16

Albuminuria

Question 17

How is renal artery stenosis diagnosed?

Answer 17

Imaging (US, RA duplex, MR angiography)

Question 18

Outline management options for renal artery stenosis

Answer 18

Statin
Antiplatelet
ACEi
Angioplasty +/-stenting

Question 19

List classical signs and symptoms of myeloma

Answer 19

Bone pain (usually back)
Weakness, fatigue, anaemia
Hypercalcaemia
Amyloidosis
Renal failure
Recurrent infections

Question 20

Which form of vasculitis classically has renal involvement?

Answer 20

Microscopic polyangitis

Question 21

How is microscopic polyangitis diagnosed?

Answer 21

Immunology (anti-MPO antibodies)
Urinalysis
Renal biopsy
Bloods (inflammatory markers)

Question 22

Outline the management of microscopic polyangitis

Answer 22

Immunosuppressants (cyclophosphamide)
Steroids
Supportive dialysis

Question 23

What disease would you consider in a 20-30 yr old female with proteinuria?

Answer 23

Lupus with renal involvement