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Renal > The kidney in systemic disease > Flashcards

The kidney in systemic disease Flashcards

1
Q

Saddle nose

A

GPA

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2
Q

Renal biopsy shows segmental necrotising glomerulonephritis

A

Vasculitis

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3
Q

Class I

A

Minimal mesangial

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4
Q

Class II

A

Mesangial proliferative

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5
Q

Class III

A

Focal proliiferative

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6
Q

Class IV

A

Diffuse proliferative

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7
Q

Class V

A

Membranous

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8
Q

Class VI

A

Advanced sclerosing

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9
Q

Anaemia in myeloma

A

Normocytic anaemia

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10
Q

ESR/PV in myeloma

A

ESR/PV is raised

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11
Q

Rouleaux formation

A

Myeloma

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12
Q

The proportion of patients who develop proteinuria and elevated serum Cr is related to what?

A

The duration of diabetes

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13
Q

What is overt diabetic nephropathy?

A

Overt diabetic nephropathy is characterized by persistent albuminuria .300mg/24h on at least 2 occasions separated by 3- 6 months

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14
Q

Diagnosis of diabetic nephropathy?

A

History of Diabetes Mellitus
Proteinuria
Presence of other diabetic complications eg retinopathy
Renal Impairment in later stages

Note no haematuria – if present may require renal biopsy

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15
Q

Haematuria in diabetic nephropathy

A

This is not essential for diagnosis of diabetic nephropathy

-if this is present then you will need to do biopsy to establish the cause of it

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16
Q

Prevention and treatment of diabetic nephropathy?

A 
Glycaemic control
Maintain tight glycaemic control 
	(HbA1c < 7)
Anti-hypertensive therapy
Tight BP control 
ACE inhibitors and ARBs
Lipid control
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17
Q

Most common cause of renal failure in the UK?

A

Diabetes

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18
Q

In diabetic nephropathy, what does microalbuminuria progress to?

A

Progresses to proteinuria and frank nephropathy

19
Q

Which type of vasculitis do nephrologists usually encounter?

A

Small vessel vasculitis

20
Q

How might small vessel ANCA associated vasculitis present?

A

Patients present with constitutional symptoms eg fever, migratory arthralgia, weight loss, anorexia and malaise
Prodromal symptoms may last for weeks to months before specific organ involvement

21
Q

Characterised by chronic rhinosinusitis, asthma, and prominent peripheral blood eosinophilia

Lung most commonly involved (asthma in > 95%)
2/3 have skin involvement (palpable purpura to subcutaneous nodules)

A

Churg-Strauss

22
Q

Nasal crusting, sinusitis, persistent rhinorrhea, otitis media, oral/nasal ulcers, bloody nasal discharge
WG-evidence of bony/cartilage destruction (saddle nose)

A

Granulomatosis with Polyangitis (Wegeners)

23
Q

Granulomatosis with polyangitis (Wegeners)

A

Nasal crusting, sinusitis, persistent rhinorrhea, otitis media, oral/nasal ulcers, bloody nasal discharge
WG-evidence of bony/cartilage destruction (saddle nose)

24
Q

Microscopic polyangitis lung symtpoms

A

Cough, hoarseness, haemoptysis, SOB, pleuritic pain

25
Q

Renal presentation in vasculitis

A

AKI- with proteinuria, red cell casts

Renal biopsy shows SEGMENTAL NECROTISING GLOMERULONEPHRITIS

26
Q

Segmental necrotising glomerulonephritis

A

Vasculitis (renal biopsy)

27
Q

Diagnosis of vasculitis and renal involvement

A

Examination
Routine bloods, CRP, PV, complement, ANCA, virology
Urinalysis
Tissue –kidney, skin, nasal, lung

28
Q

Treatment for vasculitis and renal involvement

A

Immunosuppressive therapy
Plasma Exchange
May require renal support

29
Q

Most frequent presentation of lupus nephritis

A

Abnormality in proteinuria

30
Q

Complement in SLE/lupus nephritis

A

Low

31
Q

Antibodies in SLE

A

ANA
dsDNA
Sm
Low complement

32
Q

Target BP in SLE?

A

130/80

33
Q

Immunosuppressive therapy for SLE

A

Cyclophosphamide
MMF
Prednisolone

34
Q

Poor prognosis factors for SLE survival

A 
Renal disease
Male sex
Young age or older age at presentation
Poor socioeconomic status
ANTIPHOSPHOLIPID SYNDROME
High overall disease activity
35
Q

Clinical presentation of renovascular disease?

A

AKI after treatment of hypertension, usually with ACEi.
CKD in elderly with diffuse vascular disease
‘Flash’ pulmonary oedema

Microscopic haematuria
Hypertension
Abdominal bruit
Atherosclerotic disease elsewhere

36
Q

Diagnosis of ischaemic renal disease

A

Renal ultrasound
Renal doppler studies
MRA

37
Q 
Bone Pain
Weakness and Fatigue
Weight Loss
Symptoms related to other manifestations
Hypercalcaemia
Renal Failure
Amyloidosis
Increased risk of infection
A

Myeloma Kidney

38
Q

M protein

A

Multiple myeloma

39
Q 
Normocytic Anaemia 75%
Raised ESR/PV 30%
Rouleaux formation 50%
Renal Impairment
Monoclonal Band 97%
IgG 50%  IgA 20% LC only 16%
Kappa: Lambda 2:1
Increased β2-microglobulin
Lytic lesions on skeletal survey
A

Multiple myeloma

40
Q

Kappa:lambda

A

Multiple myeloma

41
Q

Increased beta 2 microglobulin?

A

Multiple myeloma

42
Q

Incidence of MM in blacks?

A

Risk doubles in blacks

43
Q

Drug management of the patient with MM and acute renal failure

A

Stop nephrotoxins (NSAIDS, diuretics in view of risk increasing cast formation)

Treat hypercalcemia:
IV NaCL to volume resucitate
IV Palmidronate if required

AVOID contrast agents!!

Chemotherapy to reduce tumour load
High dose dexamethasone may help reduce tumour load.
Thalidomide/ bortezomib

Plasma exchange
To remove light chains.

Dialysis to support AKI and CKD

44
Q

What is IV palmidronate?

A

Good for treating hypercalcemia of malignancy

Renal (44 decks)

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