The Kidney in Systemic Disease

Question 1

what is dysproteinaemia?

Answer 1

overproduction of immunoglobulin (a protein) by clonal expansion of cells from B-cell lineage

myeloma

Question 2

myeloma is a cancer of what?

Answer 2

plasma cells (WBC that produces antibodies)

Question 3

clinical symptoms and signs of myeloma?

Answer 3

bone pain
weak
fatigue
weight loss
recurrent infection
anaemia
hypercalcaemia
renal failure
lytic bone lesions

Question 4

back pain and renal failure

diagnosis?

Answer 4

myeloma

Question 5

myeloma diagnosis/investigatons?

Answer 5

bloods - serum protein electrophoresis

urine - Bence Jones proteins

bone marrow biopsy

Question 6

myeloma management?

Answer 6

stop nephrotoxics

chemotherapy and stem cell transplant

refer to haematology

Question 7

deposition of extracellular amyloid in organs or tissues is called what?

Answer 7

amyloidosis

Question 8

2 most common forms of amyloidosis?

Answer 8

AL and AA

Question 9

what is seen in AL amyloidosis?

Answer 9

production of abnormal immunoglobulin light chains from plasma cells

age 55-60 years

Question 10

what is AA Amyloidosis associated with?

Answer 10

systemic inflammation

production of serum amyloid A protein (SAA)

Question 11

investigation for amyloidosis ?

Answer 11

urinalysis and uPCR
blood test

renal biopsy

Question 12

what is seen on renal biopsy in those with amyloidosis?

Answer 12

congo red staining - apple green under polarised light

Question 13

amyloidosis management?

Answer 13

not curative

immunosuppression - steroids, chemo and stem cell transplant

Question 14

in what age does ANCA associated vasculitis?

Answer 14

50-70s

Question 15

ANCA diagnosis?

Answer 15

blood and protein in urine
raised CRP and PV
ANCA, anti-MPO and anti-PR3
renal biopsy

Question 16

wegners/GPA = _ANCA and anti-PR3

Answer 16

wegners/GPA = cANCA and anti-PR3

Question 17

microscopic polyangitis = _ANCA and anti-MPO

Answer 17

microscopic polyangitis = pANCA and anti-MPO

Question 18

eosinophilic GPA = ?

Answer 18

eosinophilic GPA = Churg-Strauss

Question 19

what is seen on the face of those with GPA?

Answer 19

saddle nose

Question 20

vasculitis treatment?

Answer 20

immunosuppression - steroids and Cyclophosphamide / Rituximab

Question 21

rash seen in lupus?

Answer 21

butterfly

Question 22

antibodies present in lupus?

Answer 22

ANA and anti-dsDNA

Question 23

is complement levels high in active SLE?

Answer 23

no! - low complement

Question 24

what is seen on urinalysis of those with SLE?

Answer 24

proteinuria

Question 25

first line test in those with lupus?

Answer 25

urinalysis