The Kidneys in Systemic Disease

Question 1

Why are the kidneys more likely to be involved in systemic disease?

Answer 1

The kidneys receive more blood flow per unit volume than any other organ

Question 2

While urine dipsticks can identify when there is protein in the urine, how can this be quanitfied?

Answer 2

Send off a urine sample to labs for overt proteinuria/microalbuminuria

Question 3

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

Answer 3

Hypertension
Cardiac failure
Atheroembolism
Atherosclerosis

Question 4

How can hypertension cause CKD?

Answer 4

Hypertension causes progressive proteinuria which in turn causes CKD

Question 5

List some infections which can cause kidney damage.

Answer 5

HIV
Hepatitis
Infective endocarditis
Post-infectious GN

Question 6

Which haematological malignancies involve the generation of abnormal proteins which can get caught in the kidney and cause kidney disease?

Answer 6

Myeloma
Amyloidosis

Question 7

Which autoimmune conditions can affect the kidneys?

Answer 7

Lupus
Sjogrens
Scleroderma

Question 8

List some drugs which can be toxic to the kidneys.

Answer 8

NSAIDs
ACEi
Aminoglycosides
Radiocontrast

Question 9

Interstitial nephritis?

Answer 9

Inflammatory reaction within the interstitium of the kidney, often in response to certain medications, most commonly antibiotics and penicillin

Question 10

List some blood-vessel conditions which can have an affect on the kidneys.

Answer 10

ANCA associated vasculitis
Thrombotic microangiopathy

Question 11

End-stage kidney disease is increasing globally, what is one of the main reasons for this?

Answer 11

The increasing prevalence of type 2 diabetes worldwide

Question 12

What % of people with type 2 diabetes go onto develop diabetic nephropathy?

Answer 12

30-40%

Question 13

If there is hyperglycaemia, how can this lead to changes in the kidney?

Answer 13

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

Question 14

Which lesions are commonly seen in kidney biopsies in someone with diabetes?

Answer 14

Kimmeslstiel-Wilson nodules

Question 15

Those with diabetes have hyperfiltration which leads to albumin leaking. What effect does this have GFR?

Answer 15

Increased GFR

Question 16

In those with diabetes, due to the albumin leak, there is microalbuminuria. What does this progress to?

Answer 16

Clinical nephropathy w proteinuria
This then can progress to renal failure

Question 17

What does increasing proteinuria do to GFR?

Answer 17

Decreases GFR

Question 18

What is the most common cause of end stage renal disease?

Answer 18

Diabetic nephropathy

Question 19

Who is more commonly affected by the autoimmune condition lupus?

Answer 19

Can affect men and women but typically women aged 15-45

Question 20

Which ethnicities are at higher risk of lupus?

Answer 20

Those of African, Caribbean or Asian descent

Question 21

Why is it called Lupus?

Answer 21

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

Question 22

What are some of the symptoms of Lupus?

Answer 22

Rash- butterfly on face
Joint pain
Fever
Fatigue

Question 23

What % of patients with Lupus develop Lupus Nephritis?

Answer 23

> 60%

Question 24

What is Lupus Nephritis?

Answer 24

A form of immune mediated glomerulonephritis

Question 25

What are some of the signs of Lupus Nephritis which can be detected in Lupus patients?

Answer 25

Proteinuria
Nephrotic syndrome
Haematuria
Elevated creatinine

Question 26

Which types of medications can be used for Lupus Nephritis?

Answer 26

Immunosuppressive drugs
Corticosteroids

Question 27

Multiple myeloma?

Answer 27

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

Question 28

In which group of people is multiple myeloma more common?

Answer 28

In the elderly

Question 29

What is the presentation of myeloma?

Answer 29

Markedly elevated ESR
Anaemia
Weight loss
Fractures
Infections
Back pain/cord compression

Question 30

What four things are looked at for a diagnosis of myeloma to be made?

Answer 30

-Bone marrow aspirate >10% clonal plasma cells
-Serum paraprotein +/- immunoparesis
-Urinary Bence-Jones protein
-Skeletal survey for lytic lesions

Question 31

How does myeloma damage the kidneys?

Answer 31

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

Question 32

Therefore what is the most common mechanism of renal injury relating to multiple myeloma?

Answer 32

Cast nephropathy

Question 33

If doing a urine dip with someone with multiple myeloma, what would it show?

Answer 33

Heavy proteinuria

Question 34

What are some signs on examination which suggest systemic disease with renal involvement?

Answer 34

Splinter haemorrhages
Raynaud’s
Vasculitic rash
Hypertensive retinopathy
Scleritis
Hypertension
Heart murmurs
Joint swelling