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The Kidney in Systemic Disease Flashcards

1
Q

What organ receives more blood flow per unit volume than any other organ in the body?

A

Kidneys

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2
Q

What can the glomeruli do to proteins?

A
  • The glomeruli may filter proteins which are then reabsorbed by the tubule epithelial cells
  • The glomeruli may trap proteins or immune complexes
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3
Q

What types of systemic disease can affect the kidneys?

A

Diabetes mellitus

Cardiovascular disease

  • Cardiac failure
  • Atheroembolism
  • Hypertension
  • Atherosclerosis

Infection

  • Sepsis
  • Post-infectious GN
  • Infective endocarditis

Inflammation in blood vessels

  • SLE
  • Vasculitis
  • Scleroderma and other connective tissue diseases
  • Cryoglobulinaemia

HUS/TTP

Myeloma

Amyloidosis

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4
Q

What drugs can affect the kidneys?

A
  • Aminoglycosides
  • ACEI
  • Penicillamine
  • Gold
  • NSAIDs
  • Radiocontrast
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5
Q

Describe the natural history of diabetic nephropathy.

A
  • Silent sub-clinical phase. Hyper filtration. Increased GFR
  • Microalbuminaemia [20-200ug/d]
  • Clinical nephropathy [proteinuria >0.5g/d]
  • Established renal failure
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6
Q

What percentage of those with diabetic nephropathy will progress to ESRF?

A

30%

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7
Q

What is the long term risk of nephropathy for T1DM and T2DM patients?

A
  • 4% with Type 1 DM will develop nephropathy within 10 years
  • 25% with Type 1 DM will develop nephropathy within 25 years
  • 10% with Type 2 DM will have nephropathy by 5 years
  • 30% with Type 2 DM will have nephropathy by 20 years
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8
Q

What is the commonest single cause of ESRF?

A

Diabetic nephropathy

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9
Q

What is increasing proteinuria usually associated with?

A

Declining GFR

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10
Q

What is classification of chronic kidney disease based on?

A

Kidney function

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11
Q

What classification system is used for chronic kidney disease?

A

NKF K/DOQI classification system

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12
Q

What are the 5 stages of chronic kidney disease?

A
  • 1 Kidney damage/ normal or high GFR (GFR >90)
  • 2 Kidney damage/ mild reduction in GFR (GFR 60-89)
  • 3 Moderately impaired (GFR 30-59)
  • 4 Severely impaired (15-29)
  • 5 Advanced or on dialysis (GFR<15)
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13
Q

What is a common cause of renal failure in older patients?

A

Renal vascular disease

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14
Q

What is indicative of atheroembolic disease?

A
  • Eosinophilia
  • Peripheral skin lesions
  • Warfarin therapy
  • Vascular procedures
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15
Q

What is vasculitis?

A

Inflammatory reaction in the wall of any blood vessel

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16
Q

How is vasculitis defined?

A

By the size of vessel involved

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17
Q

What can vasculitis affect?

A
  • Can affect single or multiple organs

- Wide spectrum of clinical presentations

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18
Q

What types of vasculitis affect large arteries/aorta?

A
  • Takayasu arteritis

- Giant cell arteritis

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19
Q

What kind of vasculitis affects medium arteries?

A
  • Polyarteritis nodosa

- Kawasaki disease

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20
Q

What kind of vasculitis affects small vessels?

A
  • Wegener’s granulomatosis
  • Microscopic polyarteritis
  • Churg-Strauss syndrome
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21
Q

Who does Wegener’s granulomatosis affect?

A
  • Slightly more common in males

- Affects all age groups, most common 40-60 y

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22
Q

What is Wegener’s granulmatosis?

A
  • Granulomatous inflammation in respiratory tract

- Focal necrotising glomerulonephritis with crescents

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23
Q

How can Wegener’s granulomatosis present in the upper respiratory tract?

A
  • Epitaxis
  • Nasal deformity
  • Sinusitis
  • Deafness
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24
Q

How can Wegener’s granulamosis present in the lower respiratory tract?

A
  • Cough
  • Dyspnoea
  • Haemoptysis
  • Pulmonary haemorrhage
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25
How can Wegener's granulomatosis present in systems other than the respiratory system?
Kidney -Glomerulonephritis Joints - Arthralgia - Myalgia Eyes Scleritis Heart -Pericarditis Systemic - Fever - Weight loss - Vasculitis skin rash
26
What condition has a similar clinical spectrum to Wegener's granulomatosis?
Microscopic polyarteritis
27
How can microscopic polyarteritis present?
- Can present with systemic disease, renal and pulmonary involvement - More commonly renal limited disease
28
How is vasculitis diagnosed?
Urine -Blood/protein Renal function -Raised urea/creatinine Biochemistry -Raised alk phos, CRP, low albumin Haematology -Anaemia, thrombocytosis, leukocytosis Immunology -Hyperglobulinaemia, Positive ANCA Renal biopsy
29
What is C-ANCA?
Cytoplasmic
30
What is P-ANCA?
Perinuclear
31
What antibodies are associated with P-ANCA?
Myeloperoxidase
32
What antibodies are associated with C-ANCA?
Proteinase-3
33
Give an example of when ANCA can give a false positive.
IBD
34
What form of ANCA is associated with microscopic polyarteritis?
P-ANCA
35
What form of ANCA is associated with Wegener's granulomatosis?
>90% C-ANCA
36
What is endocarditis a result of?
A bacterial (or fungal) infection on cardiac valves
37
What are the typical infections associated with infective endocarditis?
- Staphlococcus aureus - Viridans streptococci - Enterococci
38
What can infective endocarditis lead to?
Leads to glomerulonephritis ± small vessel vasculitis due to immune complex formation
39
In infective endocarditis, what is renal involvement suggested by?
- Abnormal urea/creatinine - Haematuria, red cell casts - Reduced complement levels
40
When should renal disease get better in infective endocarditis?
Renal disease should recover when underlying infection treated
41
What is multiple myeloma?
A monoclonal proliferation of plasma cells producing an excess of immunoglobulins and light chains
42
Who is multiple myeloma common in?
Elderly
43
What are the clinical features of multiple myeloma?
- Markedly elevated ESR - Anaemia - Weight loss - Fractures - Infections - Back Pain /Cord compression
44
How is multiple myeloma diagnosed?
- Bone marrow aspirate >10% clonal plasma cells - Serum paraprotein ± immunoparesis - Urinary Bence-Jones protein (BJP) - Skeletal survey - lytic lesions
45
What can cause renal failure in myeloma?
- Cast nephropathy - ‘myeloma kidney’ - Light chain nephropathy - Amyloidosis - Hypercalcaemia - Hyperuricaemia
46
What is there deposition of in light chain disease?
TBM Ig deposition
47
What is there deposition of in amyloid?
Deposition of abnormal fibrillary proteins that persist. [AA /AL
48
What history may suggest a systemic disease with renal involvement?
- Fever - Malaise - Weight loss - Arthralgia - Myalgia - Skin rash (vasculitis) - Gritty eyes - Breathlessness - Haemoptysis - Epistaxis - Haematuria - Oedema
49
How common is systemic disease with renal involvement?
Relatively rare but frequently missed
50
What does the outcome of systemic disease with renal involvement depend on?
Prompt diagnosis and treatment
51
What signs may be present on the hands in systemic disease with renal involvement?
- Splinter haemorrhages - Purpura - Raynaud's
52
What signs may be present on the face in systemic disease with renal involvement?
- Scleritis - Uveitis - Nasal cartilage deformity - Retinal vasculitis - Hypertensive retinopathy
53
What signs may be present on the skin in systemic disease with renal involvement?
- Vasculitic rash | - Scleroderma
54
What CVS signs may be present in systemic disease with renal involvement?
- Hypertension | - Murmur
55
What chest signs may be present in systemic disease with renal involvement?
- Crepitation's | - Haemoptysis
56
What locomotor signs may be present in systemic disease with renal involvement?
- Joint welling | - Tenderness
57
What CNS signs may be present in systemic disease with renal involvement?
- Stroke | - Encephalopathy
58
What initial investigations should be carried out for systemic disease with renal involvement?
Urine - Blood/protein on urinalysis - Microscopy - red cell casts FBCs - Elevated urea/creatinine - Raised CRP - Thrombocytosis, anaemia - Raised alkaline phosphatase
59
What can further investigation of the blood show in systemic disease with renal involvement?
- ANCA (anti-MPO/anti-PR3 antibodies) - ANA, dsDNA antibodies - Complement levels C3, C4 - Blood cultures - Immunoglobulins and electrophoresis
60
What radiological investigations could be carried out for investigating systemic disease with renal involvement?
- CXR - USS abdomen (Renal size) - CT thorax (Pulmonary granulomas, interstitital disease) - Echocardiography
61
What biopsies may you consider taking in systemic disease with renal involvement?
- Kidney - Nasal mucosa - Lung - Skin

Systems: Urinary AB (26 decks)

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