The Kidney in Systemic Disease Flashcards
what is macrovascular disease?
disease that affects the large vessels of the body eg aorta, coronary arteries
what is microvascular disease?
disease that affects the small vessels of the body eg optic vessels, small coronary arteries etc
how does diabetes cause renal hypertrophy?
plasma glucose stimulates growth factors in kidney
mesangial cells get bigger and nodules form
BM thickening
how does diabetes haemodynamically affect the kidneys?
vasodilates the kidneys
causes hyperfiltration
increases GFR
diabetes decreases GFR: T or F
F, increases it until you get diabetic nephropathy which then decreases it
how does diabetes cause renal hypertension?
dilates the afferent arteriole
constricts the efferent arteriole
diabetic nephropathy is a slow progressive disease T or F
T
how does diabetic nephropathy cause inflammation in the kidney?
proteins are lost from the glomerulus and deposited into the cytoplasm causing cell activation and inflammation
what causes the decreased GFR in diabetic nephropathy?
microalbuminuria
hypertension
albumin is higher in end stage renal disease from diabetic nephropathy than at the start T or F
T
management of diabetic nephropathy?
HbA1c <7%
BP <130/80
ACEi
lipid control
what effect do ACEi’s have on the blood pressure of the kidneys and how do they do this?
decrease it by decreasing pressure in the efferent arteriole
renal replacement therapy for diabetics?
if young + T1, kidney/pancreas transplant
if young, kidney transplant
if not, dialysis
diabetic patients are more symptomatic at a lower GFR T or F
F, more symptomatic when their GFR is high
first sign of renal damage in diabetes
microalbuminuria
there is a good prognosis for dialysis in diabetic patients T or F
F, very low survival rate over 5yrs
hypertensive patients with shrunken kidneys on imaging and proteinuria?
hypertensive nephropathy
what is ischaemic nephropathy
reduced GFR associated with reduced renal blood flow beyond the ability to compensate
consequences of ischaemic nephropathy?
renal atrophy
progressive CKD
what type of hypertension is most commonly the cause of hypertensive nephropathy?
essential
what renal conditions can cause hypertension?
renal artery stenosis fibromuscular disease (growth of BV wall)
who gets renal artery stenosis?
older men with risk factors
renal artery stenosis is usually unilateral T pr F
T
signs of hypertensive nephropathy?
atherosclerotic disease
flash pulmonary oedema
abdo bruit
AKI/CKD
how is hypertensive nephropathy diagnosed?
renal USS
CT/MR angiography to confirm
3 mainstays of treatment for hypertensive nephropathy patients
statin
anti-platelet
ACEi
surgical intervention for hypertensive nephropathy?
angioplasty +/- stenting
when should an ACEi not be given for renal artery stenosis?
if it is bilateral
who gets fibromuscular dysplasia?
females aged 15-50
what are the main vessels affected in renal artery stenosis?
carotid arteries
renal arteries
how is cardiorenal functon decreased in kidney disease?
kidneys trying to correct injury by reabsorbing more Na and H20 but this overloads the heart and decreases its function
what is a myeloma?
cancer of the plasma cells
how can antibodies be damaging to the kidneys?
are proteins so can deposit in the kidney and cause inflammation
what is a paraprotein?
an abnormal antibody
clinica signs of myeloma?
anaemia hypercalcaemia renal failure amyloidosis recurrent infection
symptoms of myeloma?
bone pain
weakness
fatigue
w loss
classic presentation of myeloma?
back pain and renal failure
where does AL amyloidosis from a myeloma deposit?
glomerulus
how is myeloma detected via blood test?
serum protein electrophoresis
serum free light chains
what biopsies should be done in suspected myeloma?
bone marrow
renal
Tx of myeloma?
chemo
stem cell transplant
how is hypercalcaemia managed in myeloma?
saline +/- bisphosphonates
small vessel vasculitis presents in what decades of life?
50s-70s
what findings would indicate kidney involvement in vasculitis?
proteinuria
creatinine high
if there are 2 people with lupus standing next to each other, what would they be called?
lupi
most common renal abnormality found in lupus?
proteinuria
lupus nephritis is common in lupus patients T or F
T
Tx for mild lupus nephritis?
treat lupus only
Tx for severe lupus nephritis?
steroids
cyclophosphamide
azathioprne
