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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
What are the types of vasculitis in small vessels?
Granulomatous polyarteritis Microscopic polyarteritis Churg-Strauss syndrome
26
What are the features of granulomatous polyarteritis?
Granulomatous inflammation in the respiratory tract Focal necrotising glomerulonephritis with crescents Slightly more common in males
27
What age groups are affected by granulomatous polyarteritis?
All age groups affected but most common in 40-60s
28
What are the upper respiratory tract symptoms of granulomatous polyarteritis?
Epistaxis Nasal deformity Sinusitis Deafness
29
What are the lower respiratory tract symptoms of granulomatous polyarteritis?
Cough Dyspnoea Haemoptysis Pulmonary haemorrhage
30
What are the kidney symptoms of granulomatous polyarteritis?
Glomerulonephritis
31
What are the joint symptoms of granulomatous polyarteritis?
Arthralgia | Myalgia
32
What are the eye symptoms of granulomatous polyarteritis?
Scleritis
33
What are the heart symptoms of granulomatous polyarteritis?
Pericarditis
34
What are the systemic symptoms of granulomatous polyarteritis?
Fever Weight loss Vasculitic skin rash
35
What is the presentation of microscopic polyarteritis?
Similar clinical spectrum to granulomatous polyarteritis Can present with systemic disease, renal and pulmonary involvement More commonly renal-limited disease
36
How is vasculitis diagnosed?
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
What are the typical causative organisms of infective endocarditis?
Staphylococcus aureus Viridans streptococci Enterococci
38
How does infective endocarditis lead to kidney problems?
Leads to glomerulonephritis +/- small vessel vasculitis due to immune complex formation
39
What suggests renal involvement in infective endocarditis?
Abnormal urea/creatinine Haematuria, red cell casts Reduced complement levels
40
What are the clinical features of multiple myeloma?
``` Markedly elevated ESR Anaemia Weight loss Fractures Infections Back pain/cord compression ```
41
How is multiple myeloma diagnosed?
Bone marrow aspirate > 10% clonal plasma cells Serum paraprotein +/- immunoparesis Urinary Bence-Jones protein Skeletal survey - lytic lesions
42
What suggests renal failure in multiple myeloma?
``` Cast nephropathy Light chain nephropathy Amyloidosis Hypercalcaemia Hyperuricaemia ```
43
What features of the history might suggest a systemic disease with renal involvement?
``` Fever Malaise Weight loss Arthralgia Myalgia Skin rash Gritty eyes Breathlessness Haemoptysis Epistaxis Haematuria Oedema ```
44
What signs might suggest a systemic disease with renal involvement?
``` 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
What initial investigations should be done when suspecting a systemic disease with renal involvement?
Urine - blood/protein on urinalysis, microscopy showing red cell casts Blood - elevated urea/creatinine, raised CRP, thrombocytosis, anaemia, raised alkaline phosphatase
46
What further investigations should be done when suspecting a systemic disease with renal involvement?
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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