The kidneys in systemic disease Flashcards
List 4 reasons why the kidney is a particular target for systemic diseases
receives more blood flow per unit than any other organ
glomeruli may filter proteins absorbed by tubule epithelial cells
Glomeruli may trap proteins or immune complexes
kidney metabolises or excretes certain drugs which may be toxic to the kidney
What are the clinical features or diabetic nephropathy
proteinuria and declining GFR
4 phases of diabetic nephropathy
silent sub-clinical phase
microalbuminuria
clinical nephropathy
established renal failure
5 CKD stages
stage 1 - >90 stage 2 - 60-89 stage 3 - 30-59 stage 4- 15-30 stage 5 <15
Who is particularly at risk of reno-vascular disease
the elderly
Vasculitis
Inflammatory reaction in the wall of any blood vessel
What is vasculitis defined by?
the size of vessel affected
Vasculitis in aorta/large artery
giant cell arteritis
takyasu arteritis
Medium artery vasculitis
polyarteritis nodosa
Kawasaki disease
Small artery vasculitis
wegners granulomatosis
microscopic polyarteritis
churg-strauss syndrome
What is wegners granulomatosis?
granulomatous inflammation in respiratory tract
focal necrotising GN with crescents
Who does wegners granulomatosis affect?
males
usually 40-60
Upper resp tract symptoms of wegners
epistaxis, nasal deformity, sinusitis, deafness
Lower resp tract symptoms of wegners
cough, dyspnoea, haemoptysis, pulmonary haemorrhage
Systemic symptoms of wegners
kidney - GN joints - arthralgia and myalgia eyes - scleritis heart - pericarditis systemic - fever, weight loss, vasculitis skin rash
How does microscopic polyarteritis present?
usually renal disease but can also have pulmonary and systemic involvement
similar clinical spectrum to wegners
Diagnosing vasculitis and what is looked for a) urine b)renal function c) biochemistry d) haematology e)immunology renal biopsy
a - blood and protein b - raised urea/creatinine c - raised alk phos, CRP, low albumin d - anaemia, thrombocytosis, leucocytosis e - hyperglobulinaemia - positive ANCA
2 types of ANCA and what they stand for
p - perinuclear and c - cytoplasmic
P-ANCA and C-ANCA in wegners and microscopic polyarteritis
c - wegners
p - M.P
When can ANCA be a false positive
IBD
What Is infective endocarditis?
A result of bacterial or fungal infection in cardiac valves
3 typical organisms of infective endocarditis
staph aureus
virdians streptococci
enterococci
What does infective endocarditis lead to?
GN +/- small vessel vasculitis due to immune complex formation
3 ways in which renal involvement is suggested in infective endocarditis
raised urea/creatinine
haematuria, red cell clasts
decreased complement levels
Will the renal disease recover when infective endocarditis is treated?
yes
What is multiple myeloma?
A monoclonal proliferation of plasma cells producing an excess of immunoglobulins and light chains
Who is multiple myeloma common in?
elderly
6 clinical features of multiple myeloma
anaemia infections spinal cord compression fractures weight loss elevated ESR
5 ways in which multiple myeloma is diagnosed
bone marrow aspirate >10% clonal plasma cells serum paraprotein +/- immunoparesis urinary Bence-jones protein skeletal survey - lytic lesions serum free light chains
5 suggestions of renal failure in multiple myeloma
cast nephropathy - myeloma kidney light chain nephropathy amyloidosis hypercalcaemia hyperuricaemia
How is cast nephropathy seen?
light microscopy
anti-lambda immunochemistry
Amyloid
deposition of abnormal fibrillary proteins that persist
History of renal disease with systemic involvement
fatigue malaise weight loss anaemia arthralgia, myalgia uveitis, scleritis gritty eyes SOB, haemoptysis epistaxis haematuria oedema vasculitic rash
Hand signs in renal systemic disease
splinter haemorrhages, purpura, raynauds
Face signs in renal systemic disease
scleritis, uveitis, nasal cartilage deformities, hypertensive retinopathy
Skin signs in renal systemic disease
vasculitic rash and scleroderma
CVS signs in renal systemic disease
hypertension, murmur
Chest signs in renal systemic disease
crepitations, haemoptysis
locomotor signs in renal systemic disease
joint swelling, tenderness
CNS signs in renal systemic disease
stroke, encephalopathy
Initial urine investigations
blood and protein
microscopy - red cell clasts
Initial blood tests
urea/creatinine
CRP
thrombocytosis, anaemia
raised alkaline phosphatase
Further blood investigations
ANCA blood cultures IG and electrophoresis complement levels C3.4 ANA, dsDNA antibodies
Radiology
CXR
echo
USS abdomen
CT thorax
4 biopsies
kidney
lung
nasal mucosa
skin
