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8. Urology (Medical Knowledge) > The Kidneys in Systemic Disease > Flashcards

The Kidneys in Systemic Disease Flashcards

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USMLE® Step 1 flashcards
1
Q

What organ receives the most blood flow per unit volume?

A

Kidneys

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2
Q

What are the different things that can happen to proteins at the glomerular?

A

Glomerular may filter proteins which are then reabsorbed by the tubule epithelial cells:

Or may trap proteins or immune complexes

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3
Q

What are some systemic diseases that affect the kidney?

A
  • Diabetes mellitus
  • CVD
    • 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 are some drugs that affect the kidneys?

A
  • Aminoglycosides
  • ACE inhibitors
  • Penicillamine, gold
  • NSAIDs
  • Radiocontrast
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5
Q

Describe the natural history of diabetic nephropathy?

A
  1. Silent sub-clinical phase
    1. Hyperfiltration
    2. Increased GFR
  2. Microalbuminuria (20-200ug/d)
  3. Clinical nephropathy (proteinuria > 0.5g/d)
  4. Established renal failure

So causes development of proteinuria and decline in GFR

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6
Q

Describe the long term risk of diabetic nephropathy with type 1 and 2 diabetes?

A
  • Type 1 diabetes
    • 4% develop nephropathy within 10 years
    • 25% develop nephropathy within 25 years
  • Type 2 diabetes
    • 10% develop nephropathy within 5 years
    • 30% develop nephropathy within 20 years
  • 30% of those with diabetic nephropathy will progress to ESRF
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7
Q

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

A

30%

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8
Q

What is the single commonest cause of ESRF?

A

Diabetes

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9
Q

Is the incidence of ESRF due to diabetes increasing or decreasing?

A

Increasing

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10
Q

Out of type 1 and 2 diabetes, who is at the greatest risk of diabetic nephropathy?

A

Equal risk

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11
Q

What is increasing proteinuria usually associated with in terms of GFR?

A

Declinging GFR

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12
Q

What is chronic kidney disease classified based on?

A

Classification is based on kidney function (GFR)

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13
Q

What classification system does CKD use?

A

Uses NKF K/DOQI classification system

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14
Q

What is stage 1 CKD?

A
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15
Q

What is stage 2 CKD?

A
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16
Q

What is stage 3 CKD?

A
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17
Q

What is stage 4 CKD?

A
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18
Q

What is stage 5 CKD?

A
19
Q

What is the relationship between CKD and CVD?

A
20
Q

What is the commonest cause of renal failure in older patients?

A

Commonest cause of renal failure in older patients is reno-vascular disease:

  • Atheroembolic disease
    • Eosinophilia
    • Peripheral skin lesion
    • Warfarin therapy
    • Vascular procedures
21
Q

What is vasculitis?

A

Is inflammatory reaction in the wall of any blood vessel

22
Q

What is vasculitis defined by?

A

Defined by size of vessels involved

23
Q

Explain the nomenclature of vasculitis?

A
  • Aorta/large artery
    • Takayasu arteritis
    • Giant cell arteritis
  • Medium artery
    • Polyarteritis nodosa
    • Kawasaki disease
  • Small vessel
    • Wegener’s granulomatosis
      • Granulomatous inflammation in respiratory tract
      • Focal necrotising glomerulonephritis with crescents
      • Slightly more common in males
      • Affects all age groups, most common 40-60 years
      • Upper respiratory tract symptoms
        • Epistaxis, nasal deformity, sinusitis, deafness
      • Lower respiratory tract symptoms
        • Cough, dyspnoea, haemoptysis
        • Pulmonary haemorrhage
      • Other organs
        • Kidney – glomerulonephritis
        • Joints – arthralgia, myalgia
        • Eyes – scleritis
        • Heart – pericarditis
        • Systemic – fever, weight loss, vasculitic skin rash
    • Microscopic polyarteritis
      • Can present with systemic disease, renal and pulmonary involvement
      • More commonly renal limited disease
    • Churg-Strauss syndrome
24
Q

What is vasculitis of aorta/large artery called?

A
  • Takayasu arteritis
  • Giant cell arteritis
25
Q

What is vasculitis of a medium artery called?

A
  • Polyarteritis nodosa
  • Kawasaki disease
26
Q

What is vasculitis of a small vessel called?

A

Wegener’s granulomatosis

Microscopic polyarteritis

Churg-Strauss syndrome

27
Q

What is the presentation of Wegener’s granulomatosis?

A
  • Upper respiratory tract symptoms
    • Epistaxis, nasal deformity, sinusitis, deafness
  • Lower respiratory tract symptoms
    • Cough, dyspnoea, haemoptysis
    • Pulmonary haemorrhage
  • Other organs
    • Kidney – glomerulonephritis
    • Joints – arthralgia, myalgia
    • Eyes – scleritis
    • Heart – pericarditis
    • Systemic – fever, weight loss, vasculitic skin rash
28
Q

What investigations are used for diagnosis in vasculitis?

A
  • Urine
    • Blood/protein
  • Renal function
    • Raised urea/creatinine
  • Biochemistry
    • Raised alk phos, CRP, low albumin
  • Haematology
    • Anaemia, thrombocytosis, leucocytosis
  • Immunology
    • Hyperglobulinaemia
    • Positive antineutrophil cytoplasmic antibodies (ANCA)
  • Renal biopsy
29
Q

What are the different kinds of ANCA?

A
  • C-ANCA (cytoplasmic)
  • P-ANCA (perinuclear)
30
Q

What is C-ANCA and what is P-ANCA associated with?

A

C-ANCA, Wegener’s granulomatosis

P-ANCA, microscopic polyarteritis

31
Q

What does infective endocarditis result from?

A

Result of bacterial (or fungal) infection on cardiac valves

32
Q

What are the typical infections that cause endocarditis?

A
  • Staphylococcus aureus
  • Viridans streoptococci
  • Enterococci
33
Q

What does infective endocarditis lead to in terms of the urinary system?

A

Leads to glomerulonephritis with or without small vessel vasculitis due to immune complex formation

34
Q

What is renal involvement in infective endocarditis suggested by?

A
  • Abnormal urea/creatinine
  • Haematuria, red cell casts
  • Reduced complement levels
35
Q

Can renal disease due to infective endocarditis be recovered?

A

Renal disease should recover when underlying infection is treated

36
Q

What is multiple myeloma?

A

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

37
Q

In what age group is multiple myeloma common in?

A

Elderly

38
Q

What are the clinical features of multiple myeloma?

A
  • Markedly elevated ESR
  • Anaemia
  • Weight loss
  • Fractures
  • Infections
  • Back pain/cord compression
39
Q

What is multiple myeloma diagnosed by?

A
  • Bone marrow aspirate >10% clonal plasma cells
  • Serum paraprotein with or without immunoparesis
  • Urinary bence-jones protein (BJP)
  • Skeletal survery
40
Q

What renal failure is seen in myeloma?

A
  • Cast nephropathy
  • Light chain nephropathy
    • Tubular basement membrane (TBM) Ig deposition
  • Amyloidosis
    • Deposition of abnormal fibrillary proteins that persist
    • Primary/secondary
  • Hypercalcaemia
  • Hyperuricaemia
41
Q

What are the typical symptoms of renal involvement in systemic disease?

A
  • Fever
  • Malaise
  • Weight loss
  • Arthralgia
  • Myalgia
  • Skin rash (vasculitic)
  • Gritty eyes
  • Breathlessness
  • Haemoptysis
  • Epistaxis
  • Haematuria
  • Oedema
42
Q
A
43
Q

What are the typical signs of renal involvement in systemic disease?

A
  • Hands
    • Spinter haemorrhages
    • Purpura
    • Raynaud’s
  • Face
    • Scleritis
    • Uveitis
    • Nasal cartilage deformity
    • Retinal vasculitis
    • Hypertensive retinopathy
  • Skin
    • Vasculitic rash
    • Scleroderma
  • CVS
    • Hypertension
    • Murmur
  • Chest
    • Crepitations
    • Haemoptysis
  • Locomotor
    • Joint swelling
    • Tenderness
  • CNS
    • Stroke
    • Encephalopathy
44
Q

What investigations should be done for renal involvement in systemic disease?

A

Initial investigations:

  • Urine
    • Blood/protein on urinalysis
    • Microscopy – red cell casts
  • Blood
    • Elevated urea/creatinine
    • Raised CRP
    • Thrombocytosis, anaemia
    • Raised alkaline phosphatase

Further investigations:

  • Bloods
    • ANCA (anti-MPO/anti-PR3 antibodies)
    • ANA, dsDNA antibodies
    • Complement levels C3, C4
    • Blood cultures
  • Radiology
    • CXR
    • USS abdomen
      • Renal size
    • CT thorax
      • Pulmonary granulomas, interstitial disease
    • Echocardiography
  • Biopsy
    • Kidney
    • Nasal mucosa
    • Lung
    • Skin

8. Urology (Medical Knowledge) (17 decks)

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