The Kidneys In Systemic Disease Flashcards
What are the systemic diseases affecting the kidney?
Cardiovascular disease (cardiac failure, atheroembolism, hypertension, atherosclerosis)
Infection (sepsis, post infective GN, Infective endocarditis)
Inflammation in blood vessels (SLE, vasculitis, scleroderma)
Myeloma
Amyloidosis
Drugs
What is the progression of diabetic nephropathy?
- Silent sub-clinical phase
Hyperfiltration
Increased GFR
- Microalbuminuria
[20 - 200ug/d]
- Clinical nephropathy
[proteinuria > 0.5g/d]
- Established renal failure
Increasing proteinuria is usually assocaited with a declining GFR
Does diabetic nephropathy depend on the type of diabetes you have?
No, it just depends on glycaemic control
What is the commonest single cause of ESRF?
Diabetes
Leading to the need for dialysis or transplantation
What are the classifications of renal disease?
What are the common causes of atheroembolic disease?
Eosinophilia
Peripheral Skin lesions
Warfarin Therapy
Vascular Procedures
What is vasculitis?
Inflammatory reaction in the wall of any blood vessel
Defined by size of vessel involved - can affect single or multiple organs, wide spectrum of clinical presentations
What are the vasculitic conditions that affect large arteries?
Takayasu arteritis
Giant cell arteritis
What are the vasculitic conditions that affect medium arteries?
Polyarteritis nodosa
Kawasaki disease
What are the vasculitic conditions that affect the small vessels?
–Wegener’s granulomatosis
–Microscopic polyarteritis
–Churg-Strauss syndrome (eosinophilic polyarteritis)
What type of glomerulonephritis does Wegner’s cause?
Focal necrotising glomerulonephritis with crescents
What are the manifestations of wegners?
Upper respiratory tract
–Epistaxis, nasal deformity, sinusitis, deafness
Lower respiratory tract
–Cough, dyspnoea, haemoptysis
–Pulmonary haemorrhage
Kidney - glomerulonephritis
Joints - arthralgia, myalgia
Eyes - scleritis
Heart - pericarditis
Systemic - fever, weight loss, vasculitic skin rash
Microscopic polyarteritis
Similar clinical spectrum to Wegener’s granulomatosis
Can present with systemic disease, renal and pulmonary involvement
More commonly renal limited disease
How do we make a diagnosis of vasculitis?
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
What immunostaining test do you use for Wegners and microscopic polyangitis?
What is infective endocarditis and what are the typical infections?
Endocarditis: a result of bacterial (or fungal) infection on cardiac valves
–Staphylococcus aureus
–Viridans streptococci
–Enterococci
Why does infective endocarditis cause glomerulonephritis with or without small vessel vasculitis?
Due to immune complex formation
What are clues that there is renal involvement in glomerulonephritis?
Renal involvement suggested by
–Abnormal urea/creatinine
–Haematuria, red cell casts
–Reduced complement levels
Renal disease should recover when underlying infection treated
What is multiple myeloma?
A monoclonal proliferation of plasma cells producing an excess of immunoglobulins and /or light chains
Light chain is part of an immunoglobulin
What are the clinical features of multiple myeloma?
–Markedly elevated ESR
–Anaemia
–Weight loss
–Fractures
–Infections
–Back Pain /Cord compression
How is multiple myeloma diagnosed?
–Bone marrow aspirate >10% clonal plasma cells
–Serum paraprotein ± immunoparesis
–Urinary Bence-Jones protein (BJP)
–Skeletal survey - lytic lesions
What are the causes of renal failure in myeloma?
Cast nephropathy - ‘myeloma kidney’
Light chain nephropathy
Amyloidosis
Hypercalcaemia
Hyperuricaemia
