The Kidneys in Systemic Disease Flashcards
Why are the kidneys more likely to be involved in systemic disease?
The kidneys receive more blood flow per unit volume than any other organ
While urine dipsticks can identify when there is protein in the urine, how can this be quanitfied?
Send off a urine sample to labs for overt proteinuria/microalbuminuria
Which cardiovascular conditions also affect the kidneys?
BTW do not need to memorise the next few cards, more important just to appreciate that the kidneys are involved in many conditions
Hypertension
Cardiac failure
Atheroembolism
Atherosclerosis
How can hypertension cause CKD?
Hypertension causes progressive proteinuria which in turn causes CKD
List some infections which can cause kidney damage.
HIV
Hepatitis
Infective endocarditis
Post-infectious GN
Which haematological malignancies involve the generation of abnormal proteins which can get caught in the kidney and cause kidney disease?
Myeloma
Amyloidosis
Which autoimmune conditions can affect the kidneys?
Lupus
Sjogrens
Scleroderma
List some drugs which can be toxic to the kidneys.
NSAIDs
ACEi
Aminoglycosides
Radiocontrast
Interstitial nephritis?
Inflammatory reaction within the interstitium of the kidney, often in response to certain medications, most commonly antibiotics and penicillin
List some blood-vessel conditions which can have an affect on the kidneys.
ANCA associated vasculitis
Thrombotic microangiopathy
End-stage kidney disease is increasing globally, what is one of the main reasons for this?
The increasing prevalence of type 2 diabetes worldwide
What % of people with type 2 diabetes go onto develop diabetic nephropathy?
30-40%
If there is hyperglycaemia, how can this lead to changes in the kidney?
There will be generation of glycosylation end products and different growth factors.
These cause haemodynamic and hormonal changes to the kidney.
There will be hyperfiltration of these end products, increasing leakage of albumin
Which lesions are commonly seen in kidney biopsies in someone with diabetes?
Kimmeslstiel-Wilson nodules
Those with diabetes have hyperfiltration which leads to albumin leaking. What effect does this have GFR?
Increased GFR
In those with diabetes, due to the albumin leak, there is microalbuminuria. What does this progress to?
Clinical nephropathy w proteinuria
This then can progress to renal failure
What does increasing proteinuria do to GFR?
Decreases GFR
What is the most common cause of end stage renal disease?
Diabetic nephropathy
Who is more commonly affected by the autoimmune condition lupus?
Can affect men and women but typically women aged 15-45
Which ethnicities are at higher risk of lupus?
Those of African, Caribbean or Asian descent
Why is it called Lupus?
Lupus = Latin for wolf
Disease starts with rash appearing like a wolf bite! Also presents with butterfly rash over bridge of nose and cheeks
->think Remus Lupin
What are some of the symptoms of Lupus?
Rash- butterfly on face
Joint pain
Fever
Fatigue
What % of patients with Lupus develop Lupus Nephritis?
> 60%
What is Lupus Nephritis?
A form of immune mediated glomerulonephritis
What are some of the signs of Lupus Nephritis which can be detected in Lupus patients?
Proteinuria
Nephrotic syndrome
Haematuria
Elevated creatinine
Which types of medications can be used for Lupus Nephritis?
Immunosuppressive drugs
Corticosteroids
Multiple myeloma?
A monoclonal proliferation of plasma cells producing an excess of immunoglobulins and light chains
In which group of people is multiple myeloma more common?
In the elderly
What is the presentation of myeloma?
Markedly elevated ESR
Anaemia
Weight loss
Fractures
Infections
Back pain/cord compression
What four things are looked at for a diagnosis of myeloma to be made?
-Bone marrow aspirate >10% clonal plasma cells
-Serum paraprotein +/- immunoparesis
-Urinary Bence-Jones protein
-Skeletal survey for lytic lesions
How does myeloma damage the kidneys?
Abnormal proteins are made by these plasma cells and they pass into the kidneys and into the tubules.
They join with another protein called Tamm-Horsfall protein and the two together form casts which block tubules
Therefore what is the most common mechanism of renal injury relating to multiple myeloma?
Cast nephropathy
If doing a urine dip with someone with multiple myeloma, what would it show?
Heavy proteinuria
What are some signs on examination which suggest systemic disease with renal involvement?
Splinter haemorrhages
Raynaud’s
Vasculitic rash
Hypertensive retinopathy
Scleritis
Hypertension
Heart murmurs
Joint swelling
