The Kidneys in Systemic Disease Flashcards
What are 2 important renal signs in systemic disease?
Proteinuria
Microscopic haematuria
What are some systemic diseases?
Diabetic nephropathy
Lupus nephritis
Small vessel vasculitis
Myeloma
Amyloid
Haemolytic uraemic syndrome (HUS)
Thrombotic thrombocytopenic purpura (TTP)
Atherosclerotic renovascular disease
What are the features of Diabetic nephropathy?
Most common cause of end stage renal failure
1. Hyperfiltration and increased GFR
2. Microalbuminuria
3. Overt proteinuria and declining GFR
4. Established renal failure
What is the pathology of diabetic nephropathy?
Hypoglycaemia causes increased growth factors and glycosylation end products, leading to…
-Podocyte damage
- Increased Glomerular capillary pressure
- Endothelial cell dysfunction
- Albuminuria
- Glomerulosclerosis
What is the management of diabetic nephropathy?
Intensive DM control
Antihypertensives
Sodium restriction
Statins to reduce CV risk
What are the features of lupus nephritis?
SLE is a systemic autoimmune disease
Predominantly affects women
Form of immune mediated glomerulonephritis
What is the presentation of lupus nephritis?
Malar rash (butterfly shaped)
Photosensitivity
Mouth ulcers
Arthritis
Swollen ankles
Haematuria and proteinuria
What is the management of lupus nephritis?
Immunosuppression:
- Mycophenolate
- Cyclophosphamide
- Corticosteroids
What are the features of myeloma?
Disease of plasma cells
Malignancy
Common in elderly
What is the pathology of myeloma?
Monoclonal proliferation of plasma cells producing excess of immunoglobulins and light chains
Form depositions in glomerulus (cast nephropathy)
What is the presentation of myeloma?
Elevated ESR
Anaemia
Weight loss
Infections
Bone pain/fractures
Back pain/spinal cord compression
Hypercalcaemia
What investigations are done for myeloma?
Bone marrow aspirate- clonal plasma cells
Serum paraprotein
Urine- proteinuris
Lytic lesions on x ray
