The kidneys in systemic disease Flashcards
name some systemic diseases that can affect the kidneys
- diabetes mellitus
- cardiovascular disease
- infection
- inflammation of the blood vessels
- Haemolytic Uraemic Syndrome(HUS)/Thrombotic Thrombocytopenic Purpura (TTP)
- myeloma
- amyloidosis
drugs
give examples of CVS disease that can affect the kidneys
Cardiac failure
Atheroembolism
Hypertension
Atherosclerosis
give examples of infection that can affect the kidneys
Sepsis
Post-infectious GN
Infective endocarditis
give examples if inflammation in the blood vessels that can affect the kidneys
SLE
Vasculitis
Scleroderma and other connective tissue diseases
Cryoglobulinaemia
give examples of drugs that can affect the kidneys
Aminoglycosides NSAIDs
ACE inhibitors Radiocontrast
Penicillamine, gold
in the natural history of diabetic nephropathy describe the four stages of the development of proteinuria and decline in GFR
- silent sub clinical phase
- hyperfiltration
- increased GFR - microalbuminuria
- 20-200 micrograms/day - clinical nephropathy
- proteinuria >0.5g/day - established renal failure
over this time there is a slight rise in GFR at the beginning then constant decline
urinary albumin starts to rise very slowly until GFR >1/2 normal value - sudden rise in urianry albumin until GFR nearly 0 then sudden fall in urianry albumin as kidneys fail
what % of patients with diabetic nephropathy will progress to ESRF
30%
who is more at risk of diabetic nephropathy - Type I or Type II
both are equally at risk
what is the relationship between proteinuria and GFR
as proteinuria increases GFR decreases
what is the single commonest cause of ESRF leading to the need for dialysis or transplantation
diabetic nephropathy
what are the different stages for classifying chronic kidney disease
stage 1
- kidney damage/normal or high GFR
- GFR >90
stage 2
- kidney damage/mild reduction in GFR
- GFR - 60-89
stage 3
- moderately impaired
- GFR - 30-59
stage 4
- severely impaired
- GFR - 15-29
stage 5
- advanced or on dialysis
- GFR <15
what is reno-vascular disease
atherosclerosis affecting the renal artery
- usually unilateral stenosis
- common cause of renal failure in older patients
what are some common causes of atheroembolic disease in renal patients
eosinophilia
peripheral skin lesions
warfarin therapy
vascular procedures
*cholesterol clefts - after intervention, embellished cholesterol moved from plaque, sticks further down in artery - causes blockage
what is vasculitis
inflammatory reaction on the wall of any blood vessel - defined by the size of the vessel involved
can affect single or multiple organs
has a wide spectrum of clinical presentations
what type of vasculitis is present in the aorta/large arteries
takayasu arteritis
giant cell arteritis
what type of vasculitis is present in medium arteries
polyarteritis nodosa
kawasaki disease
what type of vasculitis is present in small vessels
wegeners granulomatosis (granulomatosis polyarteritis)
microscopic polyarteritis
Churg-strauss syndrome
(eosinophilic polyarteritis)
what is wegeners granulomatosis
granulomatous inflammation in the respiratory tract
characteristic focal necrotising glomerulonephritis with crescents
what are upper respiratory tract symptoms of wegeners
Epistaxis (nose bleed), nasal deformity, sinusitis, deafness
what are lower respiratory tract symptoms of wegeners
Cough, dyspnoea, haemoptysis
Pulmonary haemorrhage
what are systemic symptoms of wegeners
fever, weight loss, vasculitic skin rash
name some other areas affected by wegeners and how they present
Kidney
- glomerulonephritis
Joints
- arthralgia, myalgia
Eyes
- scleritis
Heart
- pericarditis
how does microscopic polyarteritis present
similar clinical spectrum to wegeners
can present with systemic disease, renal and pulmonary involvement
Diagnosing vasculitis - what would you look for in the urine
blood
protein
