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URINARY > The kidneys in systemic disease > Flashcards

The kidneys in systemic disease Flashcards

1
Q

name some systemic diseases that can affect the kidneys

A
  • diabetes mellitus
  • cardiovascular disease
  • infection
  • inflammation of the blood vessels
  • Haemolytic Uraemic Syndrome(HUS)/Thrombotic Thrombocytopenic Purpura (TTP)
  • myeloma
  • amyloidosis

drugs

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2
Q

give examples of CVS disease that can affect the kidneys

A

Cardiac failure
Atheroembolism
Hypertension
Atherosclerosis

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3
Q

give examples of infection that can affect the kidneys

A

Sepsis
Post-infectious GN
Infective endocarditis

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4
Q

give examples if inflammation in the blood vessels that can affect the kidneys

A

SLE
Vasculitis
Scleroderma and other connective tissue diseases
Cryoglobulinaemia

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5
Q

give examples of drugs that can affect the kidneys

A

Aminoglycosides NSAIDs
ACE inhibitors Radiocontrast
Penicillamine, gold

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6
Q

in the natural history of diabetic nephropathy describe the four stages of the development of proteinuria and decline in GFR

A
  1. silent sub clinical phase
    - hyperfiltration
    - increased GFR
  2. microalbuminuria
    - 20-200 micrograms/day
  3. clinical nephropathy
    - proteinuria >0.5g/day
  4. 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

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7
Q

what % of patients with diabetic nephropathy will progress to ESRF

A

30%

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8
Q

who is more at risk of diabetic nephropathy - Type I or Type II

A

both are equally at risk

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9
Q

what is the relationship between proteinuria and GFR

A

as proteinuria increases GFR decreases

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10
Q

what is the single commonest cause of ESRF leading to the need for dialysis or transplantation

A

diabetic nephropathy

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11
Q

what are the different stages for classifying chronic kidney disease

A

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
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12
Q

what is reno-vascular disease

A

atherosclerosis affecting the renal artery

  • usually unilateral stenosis
  • common cause of renal failure in older patients
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13
Q

what are some common causes of atheroembolic disease in renal patients

A

eosinophilia
peripheral skin lesions
warfarin therapy
vascular procedures

*cholesterol clefts - after intervention, embellished cholesterol moved from plaque, sticks further down in artery - causes blockage

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14
Q

what is vasculitis

A

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

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15
Q

what type of vasculitis is present in the aorta/large arteries

A

takayasu arteritis

giant cell arteritis

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16
Q

what type of vasculitis is present in medium arteries

A

polyarteritis nodosa

kawasaki disease

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17
Q

what type of vasculitis is present in small vessels

A

wegeners granulomatosis (granulomatosis polyarteritis)

microscopic polyarteritis

Churg-strauss syndrome
(eosinophilic polyarteritis)

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18
Q

what is wegeners granulomatosis

A

granulomatous inflammation in the respiratory tract

characteristic focal necrotising glomerulonephritis with crescents

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19
Q

what are upper respiratory tract symptoms of wegeners

A

Epistaxis (nose bleed), nasal deformity, sinusitis, deafness

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20
Q

what are lower respiratory tract symptoms of wegeners

A

Cough, dyspnoea, haemoptysis

Pulmonary haemorrhage

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21
Q

what are systemic symptoms of wegeners

A

fever, weight loss, vasculitic skin rash

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22
Q

name some other areas affected by wegeners and how they present

A

Kidney
- glomerulonephritis

Joints
- arthralgia, myalgia

Eyes
- scleritis

Heart
- pericarditis

23
Q

how does microscopic polyarteritis present

A

similar clinical spectrum to wegeners

can present with systemic disease, renal and pulmonary involvement

24
Q

Diagnosing vasculitis - what would you look for in the urine

A

blood

protein

25
Q

Diagnosing vasculitis - what would you look for in the renal function tests

A

raised urea

raised creatinine

26
Q

Diagnosing vasculitis - what would you look for in the biochemistry

A

raised alk phos
CRP
low albumin

27
Q

Diagnosing vasculitis - what would you look for in the haematology

A

anaemia
thrombocytosis
leukocytosis

28
Q

Diagnosing vasculitis - what would you look for in the immunology

A 
hyperglobulinaemia 
positive ANCA (antineutrophil cytoplasmic antibodies)
29
Q

what other diagnostic procedure would help diagnose vasculitis

A

renal biopsy

check clotting first

30
Q

What is ANCA

A

antineutrophil cytoplasmic antibodies

31
Q

what is the importance of ANCA in diagnosis

A

2 types can show up on immunostaining

  • C-ANCA (cytoplasmic)
  • P-ANCA (perinuclear)

can help determine type of disease:

Wegeners = >90% C-ANCA

Microscopic polyarteritis = usually P-ANCA

32
Q

after immunostaining for ANCA why are renal biopsies still important

A

ANCA can be a false positive e.g. inflammatory bowel disease so need a renal biopsy to determine if renal involvement

33
Q

what causes infective endocarditis

A

bacterial (or fungal) infection on cardiac valves

typically caused by

  • staphylococcus aureus
  • viridans streptococci
  • enterococci
34
Q

how does infective endocarditis lead to glomerulonephritis +/- small vessel vasculitis

A

due to immune complex formation

35
Q

what suggests renal involvement n infective endocarditis

A

Abnormal urea/creatinine

Haematuria, red cell casts

Reduced complement levels

36
Q

what is multiple myeloma

A

a monoclonal proliferation of plasma calls producing an excess of immunoglobulins and light chains

37
Q

what are clinical features of myeloma

A 
Markedly elevated ESR
Anaemia
Weight loss
Fractures
Infections
Back Pain /Cord compression
38
Q

how can multiple myeloma be diagnosed

A

bone marrow aspire >10% clonal plasma cells

serum paraprotein +/-immunoparesis

urinary bence-jones protein

skeletal survey - lytic lesions

serum free light chains

39
Q

what would a head x-ray classically show with multiple myeloma

A

“pepper pot skull” - lots of tiny black lesions

40
Q

what may cause renal failure in myeloma

A

1/3rd patients present with kidney disease

cast nephropathy -“myeloma kidney”

light chain nephropathy

amyloidosis

hypercalcaemia - promotes dehydration - can lead to acute kidney injury

hyperuricaemia

41
Q

what is amyloidosis

A

depostition of abnormal fibrillary proteins that persist

can be primary/secondary

42
Q

when should you suspect a systemic disease has renal involvement

A

when history includes any of:

Fever, malaise, weight loss, arthralgia, myalgia, skin rash (vasculitic), gritty eyes, breathlessness, haemoptysis, epistaxis, haematuria, oedema

43
Q

what signs of renal involvement may be seen on the hands

A

Splinter haemorrhages, purpura, Raynaud’s

44
Q

what signs of renal involvement may be seen on the face

A

Scleritis, uveitis, nasal cartilage deformity, retinal vasculitis, hypertensive retinopathy

45
Q

what signs of renal involvement may be seen on the skin

A

sculitic rash, scleroderma

46
Q

what signs of renal involvement may be associated with the CVS

A

hypertension, murmur

47
Q

what signs of renal involvement may be associated with the chest

A

crepitations, haemoptysis

48
Q

what signs of renal involvement may be associated with the locomotor system

A

joint swelling, tenderness

49
Q

what signs of renal involvement may be associated with the CNS

A

stroke encephalopathy

50
Q

what initial investigations should be done if renal involvement suspected

A

urine

  • bloos/protein urinalysis
  • microscopy - red cell casts

blood

  • Elevated urea/creatinine
  • Raised CRP
  • Thrombocytosis, anaemia
  • Raised alkaline phosphatase
51
Q

what further investigations should be done to confirm renal involvement

A

blood

radiology

biopsy

52
Q

what further blood investigations should be done

A
  • ANCA (anti-MPO/anti-PR3 antibodies)
  • ANA, dsDNA antibodies
  • Complement levels C3, C4
  • Blood cultures
  • Immunoglobulins and electrophoresis
53
Q

what radiology investigations should be done

A

CXR

USS abdomen - Renal size

CT thorax - Pulmonary granulomas, interstitital
disease

Echocardiography

54
Q

what biopsies should be done

A

kidney, nasal mucosa, lung, skin

URINARY (27 decks)

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