The kidney in systemic disease Flashcards
What are the haemodynamic changes seen with dibaetic nephropathy initially?
afferent arteriolar vasodilation mediated by a range of vaso-active mediators–hyperfiltration–increased GFR
What happens in response to the hyperfiltration in the kidney?
renal hypertrophy
What happens in renal hypertrophy?
plasma glucose stimualtes growth factors within the kidney leading to mesnagial expansion, nodule formation of diffuse glomerulosclerosis; tubulointerstital fibrosis
What causes proteinuria in diabetic nephroapthy?
GBM thickening and podocyte dysfunction
What is the name of mesangial nodules in diabetic nephropathy?
Kimmelstiel-Wilson lesions
What is the management of diabetic nephropathy?
tight glycaemic control; tight BP control (<130/80); statins; ACEi
What is the problem with peritoneal dialysis in diabetic patients?
can mess up gycaemic control
What is one of the main reasons that diabetic survival on dialysis is so poor?
once a diabetic patient gets to ESRF they have a very high CVS risk
What is ischaemic nephropathy?
reduced GFR associated with reduced renal blood flow beyond the level of autoregulatory compensation
What does long periods of ischaemic nephropathy lead to?
renal atrophy and progressive CKD
What are the renovascular causes of secondary HT?
atherosclerotic renal artery stenosis and fibromuscular dysplasia
Why does renal artery stenosis and fibromuscular dysplasia cause seondary HT?
a reduction in renal perfusion activates a reponseto increase systemic arterial BP
Who gets renal artery stenosis?
> 50s; males; risk factors for generalised atherosclerosis
What is the presentation of renal artery stenosis?
AKI after treatment of HT- usually with ACEi; flash pulmonary oedema; renal bruit; discrepancy in kidney size (as renal artery stenosis is usually unilateral)
What is the treatmnet for renal artery stenosis?
statins; anti-platelets and ACEi
When are ACEi contra-indicated?
bilateral renal artery stenosis
What is the presentation of fibromuscular dysplasia?
female 15-40 who presents with really high BP
What other conditions is fibromuscular dysplasia assocaited with?
Ehlers-Danlos
What other arteries can fibromuscular dysplasia invovle?
cerebral arteries eg carotid artery dissection
What is the treatmnet for fibromuscular dysplasia?
angiography and stenting
What happens in myeloma?
cancer of plasma cells- collections of abnormal cells in bone marrow impariing the production of normal blood cells and production of paraprotein
What is paraprotein?
abnormal antibody
What are the signs of multiple myeoma?
lytic bone lesions; serum/urine Ig; plasma cells in bone; hypercalcaemia
What are the clinical manifeestations of multiple myeloma?
anaemia; hypercalcaemia; renal fialure; amyloidosis; recurrent infections; bone pain; weakness; fatigue; weight loss
What is the classic presentation of multplie myeloma?
back pain and renal failure
What happens at the glomerulus with myeloma?
immunoglobulin deposition
What happens to the tubules in myeloma?
light chain cast nephropathy which irritates the tubules and causes scarring
What is done on bloods to look for myeloma?
serum protein electrophoresis and serum free light chains
What is done on urine to look for myeloma?
Bence Jones Protein- may be dipstick negative
What is the treatmnet for myeloma?
stop nephrotoxics and manage hypercalcaemia; chemo and stem cell transplant
What types of vasculitis tend to affect the kidneys?
small vessel
What type of inflammation does GPA cause?
nectrotising granulomatous inflammation
What other organ does GPA affect?
lungs
What is EGPA assocaited with?
astham and eosinophilia; 2/3 have skin involvement
What are antibodies formed against in microscopic polyangiitis?
MPO
What is the treatmnet for vasculitis?
immunosuppression- steorids and cyclophsophamide; plasma exchange
What is the most frequently observed abnoamlity to do with kidneys in SLE?
proteinuria
What type of kidney disase is caused by SLE?
lots- differentiated by biopsy
Wh is it important to know the type of rean ldisease with SLE?
determines how aggressive the treatment is
