The Kidneys in Systemic Disease

Question 1

What are some systemic diseases that commonly affect the kidneys?

Answer 1

• Diabetes mellitus
• CVS diseases (CF, emboli, high BP, atherosclerosis)
• Infections
• Inflammation in blood vessels
• Myeloma
• Amyloidosis

Question 2

What are some drugs that commonly cause kidney disease?

Answer 2

Aminoglycosides		
NSAIDs
ACE inhibitors			
Radiocontrast
Penicillamine 
Gold

Question 3

What are some signs of diabetic nephropathy leading to end stage renal disease?

Answer 3

• Increasing proteinuria

- Decreasing GFR

Question 4

What histological signs do you expect to see in a patient with Wegener’s granulomatosis?

Answer 4

Granulomatous inflammation in respiratory tract

Focal necrotising glomerulonephritis with crescents

Question 5

What clinical signs do you expect to see in a patient with Wegener’s granulomatosis?

Answer 5

• Cough, dyspnoea, haemoptysis
• Pulmonary haemorrhage
• glomerulonephritis
• arthralgia, myalgia
• scleritis
• pericarditis
• fever, weight loss

Question 6

How does infective endocarditis tend to affect the kidneys?

Answer 6

Leads to glomerulonephritis ± small vessel vasculitis due to immune complex formation

(IE: bacterial (or fungal) infection on cardiac valves)

Question 7

How is renal involvement in IE diagnosed? How is it treated?

Answer 7

Renal involvement suggested by:
Abnormal urea/creatinine
Haematuria, red cell casts
Reduced complement levels

Treat infection and renal problems should resolve