The kidney in systemic disease

Question 1

What are the haemodynamic changes seen with dibaetic nephropathy initially?

Answer 1

afferent arteriolar vasodilation mediated by a range of vaso-active mediators–hyperfiltration–increased GFR

Question 2

What happens in response to the hyperfiltration in the kidney?

Answer 2

renal hypertrophy

Question 3

What happens in renal hypertrophy?

Answer 3

plasma glucose stimualtes growth factors within the kidney leading to mesnagial expansion, nodule formation of diffuse glomerulosclerosis; tubulointerstital fibrosis

Question 4

What causes proteinuria in diabetic nephroapthy?

Answer 4

GBM thickening and podocyte dysfunction

Question 5

What is the name of mesangial nodules in diabetic nephropathy?

Answer 5

Kimmelstiel-Wilson lesions

Question 6

What is the management of diabetic nephropathy?

Answer 6

tight glycaemic control; tight BP control (<130/80); statins; ACEi

Question 7

What is the problem with peritoneal dialysis in diabetic patients?

Answer 7

can mess up gycaemic control

Question 8

What is one of the main reasons that diabetic survival on dialysis is so poor?

Answer 8

once a diabetic patient gets to ESRF they have a very high CVS risk

Question 9

What is ischaemic nephropathy?

Answer 9

reduced GFR associated with reduced renal blood flow beyond the level of autoregulatory compensation

Question 10

What does long periods of ischaemic nephropathy lead to?

Answer 10

renal atrophy and progressive CKD

Question 11

What are the renovascular causes of secondary HT?

Answer 11

atherosclerotic renal artery stenosis and fibromuscular dysplasia

Question 12

Why does renal artery stenosis and fibromuscular dysplasia cause seondary HT?

Answer 12

a reduction in renal perfusion activates a reponseto increase systemic arterial BP

Question 13

Who gets renal artery stenosis?

Answer 13

> 50s; males; risk factors for generalised atherosclerosis

Question 14

What is the presentation of renal artery stenosis?

Answer 14

AKI after treatment of HT- usually with ACEi; flash pulmonary oedema; renal bruit; discrepancy in kidney size (as renal artery stenosis is usually unilateral)

Question 15

What is the treatmnet for renal artery stenosis?

Answer 15

statins; anti-platelets and ACEi

Question 16

When are ACEi contra-indicated?

Answer 16

bilateral renal artery stenosis

Question 17

What is the presentation of fibromuscular dysplasia?

Answer 17

female 15-40 who presents with really high BP

Question 18

What other conditions is fibromuscular dysplasia assocaited with?

Answer 18

Ehlers-Danlos

Question 19

What other arteries can fibromuscular dysplasia invovle?

Answer 19

cerebral arteries eg carotid artery dissection

Question 20

What is the treatmnet for fibromuscular dysplasia?

Answer 20

angiography and stenting

Question 21

What happens in myeloma?

Answer 21

cancer of plasma cells- collections of abnormal cells in bone marrow impariing the production of normal blood cells and production of paraprotein

Question 22

What is paraprotein?

Answer 22

abnormal antibody

Question 23

What are the signs of multiple myeoma?

Answer 23

lytic bone lesions; serum/urine Ig; plasma cells in bone; hypercalcaemia

Question 24

What are the clinical manifeestations of multiple myeloma?

Answer 24

anaemia; hypercalcaemia; renal fialure; amyloidosis; recurrent infections; bone pain; weakness; fatigue; weight loss

Question 25

What is the classic presentation of multplie myeloma?

Answer 25

back pain and renal failure

Question 26

What happens at the glomerulus with myeloma?

Answer 26

immunoglobulin deposition

Question 27

What happens to the tubules in myeloma?

Answer 27

light chain cast nephropathy which irritates the tubules and causes scarring

Question 28

What is done on bloods to look for myeloma?

Answer 28

serum protein electrophoresis and serum free light chains

Question 29

What is done on urine to look for myeloma?

Answer 29

Bence Jones Protein- may be dipstick negative

Question 30

What is the treatmnet for myeloma?

Answer 30

stop nephrotoxics and manage hypercalcaemia; chemo and stem cell transplant

Question 31

What types of vasculitis tend to affect the kidneys?

Answer 31

small vessel

Question 32

What type of inflammation does GPA cause?

Answer 32

nectrotising granulomatous inflammation

Question 33

What other organ does GPA affect?

Answer 33

lungs

Question 34

What is EGPA assocaited with?

Answer 34

astham and eosinophilia; 2/3 have skin involvement

Question 35

What are antibodies formed against in microscopic polyangiitis?

Answer 35

MPO

Question 36

What is the treatmnet for vasculitis?

Answer 36

immunosuppression- steorids and cyclophsophamide; plasma exchange

Question 37

What is the most frequently observed abnoamlity to do with kidneys in SLE?

Answer 37

proteinuria

Question 38

What type of kidney disase is caused by SLE?

Answer 38

lots- differentiated by biopsy

Question 39

Wh is it important to know the type of rean ldisease with SLE?

Answer 39

determines how aggressive the treatment is