The kidneys in systemic disease

Question 1

What is an immune complex

Answer 1

An antigen and an antibody joined together which can cause inflammatory reactions due to the antibody attached

Question 2

What are the symptoms of nephrotic syndrome

Answer 2

Proteinuria, oedema, Hypoalbuminaemia and dyslipidaemia

Question 3

What are the symptoms of nephritic state

Answer 3

Precipitates in the urine such as haematuria
Sometime proteinuria
High blood pressure

Question 4

What is the leading cause of kidney failure

Answer 4

Diabetic nephropathy

Question 5

How does diabetes lead to kidney failure

Answer 5

Diabetes causes hyperglycaemia and this causes changes to the kidney

The main cause is the weakened blood vessels in the glomerulus which causes the glomerular basement membrane to weaken and causes protein to be let through the glomerulus

Question 6

What is the identifying feature of lupus

Answer 6

A butterfly rash that appears on the face

Question 7

Who is most at risk of systemic lupus erythematosus

Answer 7

African, Carribean or asian descent at risk

Question 8

What are the symptoms of lupus

Answer 8

Butterfly rash
Fever
fatigue
chest pain
achy joints
mouth ulcer
kidney disease
weight loss
ankle oedema

Question 9

What is lupus nephritis

Answer 9

A form of immune mediated glomerulonephritis - it is proliferative type of GN and causes nephrotic syndrome and a nephritic state

Question 10

What is key in the management of systemic lupus erythematous

Answer 10

Early treatment with immunosuppressive drugs or corticoid steroids

Question 11

What is multiple myeloma

Answer 11

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

Question 12

What is a myeloma

Answer 12

Type of blood cancer that develops from plasma cells

Question 13

How does myeloma present

Answer 13

Marked elevated ESR
Anaemia
weight loss
fractures
infection
back pain

Question 14

What does a high ESR mean (erythrocyte sedimentation rate)

Answer 14

That there is inflammation

Question 15

How is myeloma diagnosed

Answer 15

Bone marrow aspirate > 10% clonal plasma cells
urinary bence-jones protein (BJP)
Lytic lesions

Question 16

What are Bence-jones protein diagnostic of when over produced

Answer 16

Myeloma

Question 17

What can cause a osteolytic lesion

Answer 17

Cancer building up in the bone marrow

Question 18

What does myeloma do to the kidneys

Answer 18

Casts fill up the kidneys and block them (cast nephropathy)
Amyloidosis
Hyper-uricaemia - the myeloma generates too much urate which damages the kidney
Hypercalcaemia

Question 19

What is amyloidosis

Answer 19

Amyloid fibril protein is deposited all around the body which causes a big systemic illness

Question 20

What will urine dip show in multiple myeloma patients

Answer 20

heavy proteinuria

Question 21

What symptoms should raise suspicion about systemic diseases involvement with a renal issue

Answer 21

Fever
Weight loss
Rash
Breathlessness
Haemoptysis
Oedema
Malaise
Arthralgia
Myalgia
epistaxis
Haematuria

Question 22

What signs raise suspicion about systemic diseases involvement with a renal issue

Answer 22

Splinter haemorrhages
Purpura
Raynaud’s
vasculitic rash
scleritis, uveitis, retinal vasculitis
Hypertension, murmur
Crepitations, haemoptysis
stroke, encephalopathy

Question 23

What is purpura

Answer 23

Occurs when little blood vessels under the skin bleed

Question 24

What is Raynaud’s

Answer 24

Bad blood flow to the hands

Question 25

What is the main investigation done for systemic diseases involvement with a renal issue

Answer 25

Urine dip