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Urinary System > The Kidneys in Systemic Disease > Flashcards

The Kidneys in Systemic Disease Flashcards

1
Q

Why are the kidneys a particular target for many systemic diseases?

A

They receive more blood flow per unit volume than any other organ in the body
The glomeruli may filter proteins which are then reabsorbed by the tubule epithelial cells
The glomeruli may trap proteins or immune complexes
The kidney metabolises/excretes drugs which may be nephrotoxic

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2
Q

What are some of the systemic disease that affect the kidney?

A 
Diabetes mellitus
CV disease 
Infection 
Inflammation in blood vessels 
Haemolytic-Uremic Syndrome (HUS)
Thrombotic Thrombocytopenic Purpura (TTP) 
Myeloma
Amyloidosis
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3
Q

What cardiovascular diseases affect the kidney?

A

Cardiac failure
Atheroembolism
Hypertension
Atherosclerosis

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4
Q

What infections affect the kidney?

A

Sepsis
Post-infective glomerulonephritis
Infective endocarditis

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5
Q

What types of inflammation in the blood vessels affect the kidney?

A

SLE
Vasculitis
Scleroderma and other connective tissue diseases
Cryoglobulinaemia

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6
Q

What drugs affect the kidney?

A 
Aminoglycosides
ACEIs
Penicillamine
Gold 
NSAIDs
Radiocontrast
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7
Q

What are the stages of diabetic nephropathy?

A

Development of proteinuria and decline in GFR

  1. Silent sub-clinical phase, hyperfiltration, increased GFR
  2. Microalbuminaemia (20-200ug/d)
  3. Clinical nephropathy (proteinuria > 0.5 g/d)
  4. Established renal failure
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8
Q

What percentage of people with type 1 diabetes will develop nephropathy within 10 years?

A

4%

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9
Q

What percentage of people with type 1 diabetes will develop nephropathy within 25 years?

A

25%

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10
Q

What percentage of people with type 2 diabetes will develop nephropathy within 5 years?

A

10%

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11
Q

What percentage of people with type 2 diabetes will develop nephropathy within 20 years?

A

30%

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12
Q

What percentage of people with diabetic nephropathy will progress to ESRF?

A

30%

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13
Q

What is the single commonest cause of end-stage renal failure?

A

Diabetes

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14
Q

What is increasing proteinuria in diabetic patients usually associated with?

A

Declining GFR

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15
Q

What is the single commonest cause of ESRF leading to the need for dialysis or transplant?

A

Diabetic nephropathy

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16
Q

What is stage 1 kidney disease?

A

Kidney damage/normal or high GFR

GFR > 90

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17
Q

What is stage 2 kidney disease?

A

Kidney damage/mild reduction in GFR

GFR 60-89

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18
Q

What is stage 3 kidney disease?

A

Moderately impaired

GFR 30-59

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19
Q

What is stage 4 kidney disease?

A

Severely impaired

GFR 15-29

20
Q

What is stage 5 kidney disease?

A

Advanced or on dialysis

GFR < 15

21
Q

What are the features of atheroembolic disease?

A 
Common cause of renal failure in older patients 
Eosinophilia
Peripheral skin lesions
Warfarin therapy 
Vascular procedures
22
Q

What is vasculitis?

A

Inflammatory reaction in the wall of any blood vessel
Defined by size of vessel involved
Can affect any single or multiple organs
Wide spectrum of clinical presentations

23
Q

What are the types of vasculitis in the aorta/large arteries?

A

Takayasu arteritis

Giant cell arteritis

24
Q

What are the types of vasculitis in medium sized arteries?

A

Polyarteritis nodosa

Kawasaki disease

25
Q

What are the types of vasculitis in small vessels?

A

Granulomatous polyarteritis
Microscopic polyarteritis
Churg-Strauss syndrome

26
Q

What are the features of granulomatous polyarteritis?

A

Granulomatous inflammation in the respiratory tract
Focal necrotising glomerulonephritis with crescents
Slightly more common in males

27
Q

What age groups are affected by granulomatous polyarteritis?

A

All age groups affected but most common in 40-60s

28
Q

What are the upper respiratory tract symptoms of granulomatous polyarteritis?

A

Epistaxis
Nasal deformity
Sinusitis
Deafness

29
Q

What are the lower respiratory tract symptoms of granulomatous polyarteritis?

A

Cough
Dyspnoea
Haemoptysis
Pulmonary haemorrhage

30
Q

What are the kidney symptoms of granulomatous polyarteritis?

A

Glomerulonephritis

31
Q

What are the joint symptoms of granulomatous polyarteritis?

A

Arthralgia

Myalgia

32
Q

What are the eye symptoms of granulomatous polyarteritis?

A

Scleritis

33
Q

What are the heart symptoms of granulomatous polyarteritis?

A

Pericarditis

34
Q

What are the systemic symptoms of granulomatous polyarteritis?

A

Fever
Weight loss
Vasculitic skin rash

35
Q

What is the presentation of microscopic polyarteritis?

A

Similar clinical spectrum to granulomatous polyarteritis
Can present with systemic disease, renal and pulmonary involvement
More commonly renal-limited disease

36
Q

How is vasculitis diagnosed?

A

Urine - blood/protein
Renal function - raised urea/creatinine
Biochemistry - raised alkaline phosphatase, CRP, low albumin
Haematology - anaemia, thrombocytosis, leukocytosis
Immunology - hyperglobulinaemia, positive ANCA
Renal biopsy

37
Q

What are the typical causative organisms of infective endocarditis?

A

Staphylococcus aureus
Viridans streptococci
Enterococci

38
Q

How does infective endocarditis lead to kidney problems?

A

Leads to glomerulonephritis +/- small vessel vasculitis due to immune complex formation

39
Q

What suggests renal involvement in infective endocarditis?

A

Abnormal urea/creatinine
Haematuria, red cell casts
Reduced complement levels

40
Q

What are the clinical features of multiple myeloma?

A 
Markedly elevated ESR
Anaemia
Weight loss
Fractures
Infections
Back pain/cord compression
41
Q

How is multiple myeloma diagnosed?

A

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

42
Q

What suggests renal failure in multiple myeloma?

A 
Cast nephropathy 
Light chain nephropathy 
Amyloidosis 
Hypercalcaemia 
Hyperuricaemia
43
Q

What features of the history might suggest a systemic disease with renal involvement?

A 
Fever
Malaise
Weight loss
Arthralgia
Myalgia
Skin rash
Gritty eyes
Breathlessness
Haemoptysis
Epistaxis
Haematuria
Oedema
44
Q

What signs might suggest a systemic disease with renal involvement?

A 
Splinter haemorrhages
Purpura
Raynaud's
Scleritis
Uveitis
Nasal cartilage deformity
Renal vasculitis
Hypertensive retinopathy 
Vasculitis rash 
Scleroderma
Hypertension
Murmur
Crepitations
Haemoptysis
Joint swelling 
Tenderness
Stroke
Encephalopathy
45
Q

What initial investigations should be done when suspecting a systemic disease with renal involvement?

A

Urine - blood/protein on urinalysis, microscopy showing red cell casts
Blood - elevated urea/creatinine, raised CRP, thrombocytosis, anaemia, raised alkaline phosphatase

46
Q

What further investigations should be done when suspecting a systemic disease with renal involvement?

A

Blood - ANCA, ANA, dsDNA antibodies, complement C3 and C4, blood cultures

Radiology - CXR, USS abdomen, CT thorax, echocardiography

Biopsy - kidney, nasal mucosa, lung, skin

Urinary System (22 decks)

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