The kidneys in systemic disease

Question 1

what are systemic diseases associated with the kidney?

Answer 1

Question 2

what connection does diabetes mellitus have on kidneys?

Answer 2

Question 3

what is the natural history following raised GFR for a diabetic patient?

Answer 3

Question 4

what are associated general and systemic diseases with type 2 diabetes?

Answer 4

Question 5

summarise diabetic patients risk of nephorpathy?

Answer 5

Diabetic nephropathy develops over many years
Type I and Type II patients are both at risk, ESRD and increasing cardiovascular mortality
Increasing proteinuria is usually associated with declining GFR
Diabetic nephropathy is the single commonest cause of ESRD leading to the need for dialysis or transplantation
Monitoring and managing proteinuria and glucose control is key

Question 6

what is systemic lupus erythematosus?

Answer 6

Autoimmune illness
Affects both men and women, but predominantly women ages 15-45
Those of African, Caribbean or Asian descent at risk risk

Question 7

what is lupus nephritis?

Answer 7

Upwards of 60% of Lupus patients will develop Lupus Nephritis

A form of immune mediated glomerulonephritis

Varying degrees of immune deposits, pattern of glomerular injury

Question 8

summarise lupus nephritis?

Answer 8

Renal involvement is common in patients with lupus
Lupus nephritis is a form of glomerulonephritis
Early recognition and management of SLE with immunosuppressive drugs or corticosteroids is key

Question 9

what is multiple myeloma?

Answer 9

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

This spike in a specific form of immunoglobulin can be seen as a monoclonal band on serum and urine electrophoresis.

Common in the elderly
1 in 4000

Question 10

what is the presentation of myeloma?

Answer 10

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

Question 11

how is myeloma diagnosed?

Answer 11

Bone marrow aspirate >10% clonal plasma cells
Serum paraprotein ± immunoparesis
Urinary Bence-Jones protein (BJP)
Skeletal survey - lytic lesions

Question 12

what is a lytic lesion?

Answer 12

areas where bone has been destroyes leaving holes in the bone

Question 13

how does myeloma affect the kidney?

Answer 13

When first diagnosed, as many as 20-40% of patients with multiple myeloma will have some amount of kidney failure.
Cast nephropathy

Question 14

summarise multiple myeloma?

Answer 14

Myeloma is relatively common in the elderly
Cast nephropathy is the most common mechanism of renal injury
Patients may present with renal dysfunction at initial presentation
Treatment of myeloma will often result in improvement of kidney function
Urine dip would show heavy proteinuria

Question 15

what symptoms should raise suspicion of systemic disease with renal involvement?

Answer 15

Fever Malaise
Weight loss Arthralgia Myalgia
Skin rash Gritty eyes
Breathlessness
Haemoptysis Epistaxis Haematuria
Oedema

Question 16

what signs should raise suspicion of systemic disease with renal involvement?

Answer 16

Splinter haemorrhages, purpura, Raynaud’s

Scleritis, uveitis, nasal cartilage deformity, retinal vasculitis, hypertensive retinopathy

(Skin) Vasculitic rash, scleroderma

Hypertension, murmur

Crepitations, haemoptysis

Joint swelling, tenderness

Stroke, encephalopathy

Question 17

what investigation is most important?

Answer 17

urine dip

Question 18

what alternate investigations should be done?

Answer 18

Bloods - ANCA (anti-MPO/anti-PR3 antibodies), ANA, dsDNA antibodies, Complement levels C3, C4, Blood cultures
Radiology – CXR, USS abdomen, CT thorax
Echocardiography
Kidney Biopsy