The Kidneys and Systemic Disease

Question 1

What factors make the kidneys susceptible impact by systemic disease?

Answer 1

Kidney receives more blood than any other organ
Glomeruli may filter and reabsorb proteins
Glomeruli may trap proteins/complexes
Kidney metabolises/excretes certain drugs

Question 2

Which systemic diseases may affect the kidneys?

Answer 2

CV disease 
Diabetes mellitus 
Sepsis
Infective endocarditis 
Vascular inflammation 
Myeloma
Amyloidosis

Question 3

Which drugs are high risk of causing kidney damage?

Answer 3

Aminoglycosides 
ACEI
Penicillamine 
Gold
NSAIDs
Radiocontrast

Question 4

What diseases of blood vessel inflammation are associated with renal disease?

Answer 4

SLE
Vasculitis
Scleroderma
Connective tissue diseases
Cryoglobulinaemia

Question 5

How does diabetic nephropathy progress to renal failure?

Answer 5

Silent subclinical increase in GFR
Microalbuminaemia
Clinical nephropathy
Established renal failure

Question 6

What is the risk of nephropathy with T1DM?

Answer 6

4% - 10y

25% - 25y

Question 7

What is the risk of nephropathy with T2DM?

Answer 7

10% - 5y

30% - 20y

Question 8

What proportion of patients with diabetic nephropathy progress to ESRD?

Answer 8

30%

Question 9

What is increased proteinuria associated with in diabetic nephropathy?

Answer 9

Declining GFR

Question 10

What is the commonest cause of ESRF leading to the need for dialysis or transplantation?

Answer 10

Diabetic nephropathy

Question 11

What classification system is used for CKD?

Answer 11

GFR:

NKF K/DOQI

Question 12

Chronic Kidney Disease is associated with which CV diseases?

Answer 12

LVH
CCH/IHD
CVD
Hypertension

Question 13

What are the typical presentations of atheroembolic disease?

Answer 13

Eosinophilia
Peripheral skin disease
Cholesterol clefts on biopsy

Question 14

What is an atheroembolism?

Answer 14

Cholesterol embolism released from an atherosclerotic plaque

Question 15

What can precipitate an atheroembolic incident?

Answer 15

Warfarin therapy

Vascular procedures

Question 16

What is vasculitis?

Answer 16

Inflammatory reaction in the wall of any blood vessel

Question 17

How is vasculitis defined?

Answer 17

Small, medium or large vessel involvement

Question 18

What are the main forms of large artery vasculitis?

Answer 18

Takayasu arteritis

Giant cell arteritis

Question 19

What are the main forms of medium artery vasculitis?

Answer 19

Polyarteritis nodosa

Kawasaki disease

Question 20

What are the main forms of small artery vasculitis?

Answer 20

Wegener’s granulomatosis
Microscopic polyarteritis
Churg-Strauss syndrome

Question 21

What is Wegener’s Granulomatosis?

Answer 21

Granulomatous inflammation in respiratory tract

Focal necrotising glomerulonephritis

Question 22

Wegener’s Granulomatosis is more common in which group?

Answer 22

Males

40-60y

Question 23

What are the respiratory symptoms of Wegener’s Granulomatosis?

Answer 23

Upper Respiratory tract:
Epistaxis
Nasal deformity
Sinusitis
Deafness
Lower Respiratory tract
Cough, dypnoea, haemoptysis, haemorrhage

Question 24

Wegener’s Granulomatosis affects which parts of the body?

Answer 24

Lungs
Kidneys
Joints
Eyes
Heart
Systemic

Question 25

What is the effect of Wegener's Granulomatosis on the joints?

Answer 25

Arthralgia | Myalgia

Question 26

What is the effect of Wegener's Granulomatosis on the eyes?

Answer 26

Scleritis

Question 27

What is the effect of Wegener's Granulomatosis on the heart?

Answer 27

Pericarditis

Question 28

What are the systemiceffect of Wegener's Granulomatosis?

Answer 28

Fever Weight loss Vasculitic skin rash

Question 29

How does Microscopic polyarteritis present?

Answer 29

Systemic disease Renal disease Pulmonary disease

Question 30

How is vasculitis diagnosed?

Answer 30

``` Urine blood/protein Renal function Raised Alk Phos, CRP Low albumin Anaemia Hyperglobulinaemia Positive ANCA Renal biopsy ```

Question 31

P-ANCA is suggestive of what?

Answer 31

Microscopic polyarteritis

Question 32

C-ANCA is suggestive of what?

Answer 32

Wegener's Granulomatosis

Question 33

What conditions can give ANCA testing a false positive?

Answer 33

Inflammatory Bowel Disease

Question 34

What pathogens are typically responsible for infective endocarditis?

Answer 34

Straphylococcus aureus Viridans streptococci Enterococci

Question 35

What are the renal impacts of Infective Endocarditis?

Answer 35

Glomerulonephritis Small vessel vasculitis Due to immune complex formation

Question 36

How can renal involvement be detected in Infective Endocarditis?

Answer 36

Abnormal urea/creatinine Haematuria Red cell casts Reduced complement

Question 37

What is Multiple myeloma?

Answer 37

A monoclonal proliferation of plasma cells producing an excess of immunoglobulins and light chains

Question 38

Myeloma is more common in which group?

Answer 38

Elderly

Question 39

What are the clinical features of myeloma?

Answer 39

``` Markedly elevated ESR Anaemia Weight loss Fractures Infections Back Pain /Cord compression ```

Question 40

How is myeloma diagnosed?

Answer 40

Bone marrow aspirate Urinary Bence Jones protein Serum paraprotein +/- immunoparesis Skeletal survey - lytic lesions

Question 41

How does renal failure present in myeloma?

Answer 41

``` Light chain nephropathy Cast nephropathy Amyloidosis Hypercalcaemia Hyperuricaemia ```

Question 42

When should you suspect systemic disease with renal involvement?

Answer 42

``` History - systemic illness Signs in: Hand Face Skin CVS Chest Locomotor CNS ```

Question 43

How should suspected systemic diseases with renal involvement be investigated?

Answer 43

``` Urine blood/protein Microscopy (red cell casts) Bloods: U+E, creatinine, CRP Thrombocytosis, anaemia Raised Alk Phos ANCA ANA/dsDNA Complement C3, C4 Blood cultures Radiology Biopsy ```