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The Renal System > The Kidneys in Systemic Disease > Flashcards

The Kidneys in Systemic Disease Flashcards

1
Q

What is the most common cause of renal pathology?

A

Diabetic nephropathy

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2
Q

What is usually the first sign of diabetic nephropathy?

A

Microalbuminaemia

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3
Q

Why does renal hypertrophy occur in diabetes?

A

Plasma glucose stimulates growth factors in the kidney

(causing mesangial expansion, nodule formation and diffuse glomerlulosclerosis)

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4
Q

What is the cause of diabetic nephropathy?

A

High levels of glucose in the blood (can’t enter cells)

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5
Q

Why is excess glucose in the blood a problem (and reason) for developing diabetic nephropathy?

A

Non-enzymatic glycation occurs (as glucose alters surrounding proteins)

  1. Glucose passes throught he endothelium and has effects on the basement membrane
  2. This process if hyaline arteriosclerosis
  3. This makes arteries stiffer and increases filtration pressure
  4. This causes an increase in GFR called hyperfiltration
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6
Q

Why does hyperfiltration lead to damage in the kidneys?

A

Supportive mesangial cells secrete increased amounts of structural matrix expanding the glomerular size and causing spreading out of filtration slits of podocytes

This increases permeabilty of the basement membrane to proteins

This then decreases GFR as the blood cannot be filtered as effectively by the damaged glomeruli

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7
Q

In which two ways can excess structural matric be deposited in the kidneys during diabetic nephropathy?

A
  1. Uniformly
  2. Nodules called Kimmelstiel-Wilson nodules
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8
Q

What are the symptoms of diabetic nephropathy?

A

Hyperfiltration stage - Typically no symptoms

Eventually end stage renal failure will cause symptoms

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9
Q

Why do diabetics require regular screening for diabteic nephropathy?

A

There are no overt symptoms

Protein in the urine must be monitored (30-300mg of proteina day is microalbuminaemia and signifies the beginning of diabetic nephropathy)

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10
Q

Which medications can be used in diabetic nephropathy to slow disease proression?

A

ACEI

ARBs

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11
Q

What is ischaemic nephropathy?

A

Reduced GFR associated with reduced renal blood flow beyond the level of autoregulatory compensation

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12
Q

What are the main causes for ischaemic nephropathy?

A
  1. Essential hypertension
  2. Secondary hypertension
    • Atherosclerotic renal artery stenosis
    • Fibromuscular dysplasia
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13
Q

Which patients are generally affected by renal artery stenosis?

A

Older (>50) males

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14
Q

Renal artery stenosis is usually __________

A

Renal artery stenosis is usually unilateral

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15
Q

How do patients with renal artery stenosis present?

A

CKD in the elderly

Flash pulmonary oedema

Abdominal bruit (turbulent blood flow)

Athersclerotic disease elsewhere

Kidney size discrepancy

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16
Q

What are the two main causes for renal artery stenosis?

A

Atherosclerotic build up

Renal fibromuscular dysplasia

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17
Q

What is renal fibromuscular dysplasia?

A

Abnormal development of collagen and smooth mucle in the renal artery walls

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18
Q

How does renal fibromuscular dysplasia occur on imaging?

A

Renal artery appears like a string of beads

19
Q

Who generally suffers from renal fibromuscular dysplasia?

A

Young females

20
Q

How can renal artery stenosis be diagnosed?

A

Imaging

  • USS
  • Renal artery duplex studies
  • CT/MRI angiography

Serum creatinine/urinalysis (for evidence of associated renal failure)

21
Q

How can renal artery stenosis be treated?

A

Blood pressure management (ACEI)

Statin and anti-platelet agent

Balloon angioplasty

Renal artery bypass graft

Kidney removal

22
Q

In which instance would ACEI not be used in renal artery stenosis?

A

Bilateral RAS

(Azotaemia risk increases - urea, creatinine, various body waste compounds, and other nitrogen-rich compounds build up in the blood)

23
Q

Why is fibromusclular dysplasia often worse than renal artery stenosis caused by atherosclerotic reasons?

A

It is often bilateral

24
Q

Which condition is renal fibromuscular dysplasia associated with?

A

Ehlers-Danlos

25
Q

Whatis myeloma?

A

Cancer of plasma cells

26
Q

How does multiple myeloma affect calcium levels?

A

Increases serum calcium

(due to bone breakdown)

27
Q

Whta is the classic presentation of multiple myeloma?

A

Back pain and renal failure

28
Q

What are the signs of multiple myeloma?

A

Anaemia

Hypercalcaemia

Renal failure

Amyloidosis

Recurrent infections

29
Q

What are the main symptoms of multiple myeloma?

A

Bone pain

Weakness

Fatigue

Weight loss

30
Q

Which different conditions can myeloma cause in the kidney?

A

AL amyloidosis (free light chain fibrils within glomerulus)

Light chain deposition disease (free light chain deposition along basement membrane)

Cast nephropathy (myeloma kidney) - Forms waxy casts in distal tubule lumen

31
Q

Which blood tests can be done to diagnose multiple myeloma?

A

Serum protein electrophoresis

Serum free light chains

32
Q

Which protein can be found in the urine that is suggestive of multiple myeloma?

A

Bence Jones protein

33
Q

Besides blood tests and urinalysis, which other tests can be done to diagnose multiple myeloma?

A

Bone marrow biopsy

Skeletal survey

Renal biopsy

34
Q

How can multiple myeloma be treated?

A

Chemotherapy

Stem cell transplant

Plasma exchange (removes light chains)

(hypercalcaemia must also be managed)

35
Q

How do patients present with ANCA associated vasculitis?

A

Fever

Migratory arthralgia

Weight loss

Anorexia

Malaise

36
Q

GPA involves which antibodies predominantly?

A

Anti-PR3

37
Q

Where in the body does GPA predominantly affect?

A

Respiratory tract

(pulmnary/renal syndrome)

38
Q

Microscopic polyangiitis is predominantly associated with which antibodies?

A

Anti-MPO

39
Q

EGPA is associated with which other condition?

A

Asthma

40
Q

What are the most frequent clinical manifestations in patients with lupus?

A

Fever and weight loss (100%)

MSK symmptoms - Arthralgias, synovitis, arthritis (95%)

Serosa - Pleuritis, pericarditis (80%)

Skin - Butterfly rash, photodermatosis, alopecia (75%)

Haematological - Anaemia, leukopenia, thrombocytopenia, thromboses (50%)

Kidney - proteinuria, nephrotoic syndrome, haemturia, hypertension, hyperkalaemia etc

41
Q

What are the best differential diagnoses for SLE?

A

Sjogren’s syndrome

Fibromyalgia

Primary anti-phospholipid syndrome

Thrombotic micro-angiopathies

42
Q

How many lupus patients develop lupus nephritis?

A

50%

43
Q

What is the treatment for lupus nephritis?

A

Hydroxychloroquine

Steroids

Cyclophsophamide or mycophenalate mofetil

Azathioprine

The Renal System (37 decks)

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