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Renal week 5 > The kidney in systemic disease > Flashcards

The kidney in systemic disease Flashcards

1
Q

What is the most common cause of end stage renal disease in the UK?

A

DM

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2
Q

How is diabetic nephropathy first characterised ?

A
  • By persistent albuminuria
  • So albuminuria of 300mg/24h or more on at least 2 occasions separated by 3- 6 months
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3
Q

What are the 3 main stages in the development of diabetic nephropathy and what can uncontrolled diabetic nephropathy result in ?

A
  1. Pre-diabetic nephropathy
  2. Incipient (Beginning to develop) diabetic nephropathy
  3. Ovart diabetic nephropathy

Can result in ESRD

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4
Q

Describe the features of Pre-diabetic nephropathy

A
  1. Due to high plasma glucose levels, this stimulates growth factors such as IGF-1
  2. This causes renal hypertrophy
  3. This results in increase in GFR (hyperfiltration)
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5
Q

Describe the features of incipient (Beginning to develop) diabetic nephropathy

A
  1. Mesangial expansion + glomerular basement membrane (GBM) thickening
  2. This causes microalbuminruia + hypertension
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6
Q

Describe the features of overt diabetic nephropathy

A
  • Mesangial nodules known as kimmelstiel-wilson lesions formed + tubulointersitial fibrosis and thickened GBM
  • This causes proteinuria, nephrotic syndrome + decreased GFR
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7
Q

How is diabetic nephrapathy diagnosed ?

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

DM pts screened for it annually using urinary albumin:creatinine ratio (ACR) - a ratio >2.5 = microalbuminuria ==> commence treatment

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8
Q

How is diabetic nephropathy prevented/treated ?

A

Glycaemic control Maintain tight glycaemic control (HbA1c < 7)

Anti-hypertensive therapy:

  • Tight BP control
  • ACE inhibitors and ARBs

Lipid control - statin

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9
Q

When should a patient with DM be put on an ACEi/ARB?

A

If there is presence of microalbuminuria - this si the first detectable sign of diabetic nephropathy so they are put on ACEi/ARB regardless of wether or not they have high BP, as it reduces proteinuria and the progression of the disease

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10
Q

What is the target BP for someone with DM + someone with DM + proteinuria ?

A
  • DM - <130/80
  • DM + proteinuria - <125/75
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11
Q

Define renovascular disease

A

It is stenosis of the renal artery or one of its branches

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12
Q

What are the 2 main causes of renovascular disease ?

A
  • Atherosclerosis
  • Fibromusclar dysplasia
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13
Q

What is fibromuscular dysplasia ?

A
  • It is a condition that causes narrowing (stenosis) and enlargement (aneurysm) of the medium sized arteries in your body
  • It most commonly occurs in the arteries of the kidneys and tends to affect young to middle aged women (15-50)
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14
Q

What is atherosclerotic renovascular disease ?

A
  • Basically where atherosclerosis causes renal artery stenosis, patients often have atherosclerosis related disease elsewhere in the body e.g. angina
  • This usually affects older patients and males
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15
Q

What is renovascular hypertension ?

A

It is a secondary form of hypertension usually caused by renal artery stenosis

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16
Q

What are the signs of renovascular disease ?

A
  • Hypertension resistant to treatment
  • AKI after treatment of hypertension with ACEi/ARB
  • CKD in elderly with diffuse vascular disease (angina, PVD, history of MI etc)
  • Flash pulmonary oedema
  • Microscopic haematuria
  • Abdominal bruit (stenosis causes bruit)
  • Weak leg pulses may be found
17
Q

How is renovascular disease diagnosed ?

A
  1. Renal US of kidney ==> affected kidney is smaller
  2. CT/MRI angiography
  3. Gold standard for diagnosis - renal angiography, but this is more invasive so CT/MRI angiogrpahy done first
18
Q

What is the treatment of atherosclerotic renal artery stenosis ?

A
  • 1st line = antihypertensive therapy (ACEi/ARB) + statin + antiplatelet (aspirin)
  • 2nd line = Renal artery stenting + continuation of medial therapy (1st line treatment) + post-stent clopidogrel

2nd line is done for bilateral RAS or uncontrolled RAS

19
Q

What is the treatment of fibromuscular dysplasia causing RAS?

A
  • 1st line = antihypertensive therapy + renal artery balloon angioplasty
  • 2nd line = renal artery stenting + dual antiplatelet therapy (aspirin + clopidogrel)
  • 3rd line = + post-surgical reconstruction of the renal arteries
20
Q

When is an ACEi contraindicated in the treatment of RAS?

A

It is contraindicated in BILATERAL renal artery stenosis

Renal week 5 (14 decks)

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