Week 5 - E(2) - Myeloma and Vasculitis and Drug reactions Flashcards
What is myeloma?
Cancer of the plasma cells causing collections of abnormal plasma cells to accumulate in the bone marrow
What type of lesions are described on xray in myeloma?
Lytic lesions - punched out lesions on xray
What is the classic presentation of myeloma?
Back pain, renal failure, with weight loss and fatigue
What would the biochemisty of myeloma show?
Would show an increased calcium +/- phosphate Normal alk phoosphate
What is seen in the nephron in myeloma?
Amyloid and light chain deposits in the nephron which are damaging
How is amyloid see? (ie what test for it)
Classic apple-green birefringence on congo red staining under polarized light
What percentage of patinets with myeloma require dialysis at presentation? What is seen in the uirne?
10% require dialysis at presentation Bence-Jones proteins on protein electrophoresis of the urine
What is looked for in the serum in myeloma?
Monoclonal production of a paraprotein (abnormal antibody)
What other markers are raised in the blood in myeloma and what drug is given for the bone disease?
raised CP and PV Give biphophonates for the bone
What is he treatment of myeloma?
Chemotherapy + stem cell transplant
Vasculitis (=inflammation of blood vessels) Nephrologists generally deal with small vessel vasculitis What are the stages of diagnosig a small vessel vasculitis?
High index of suspicion Urinalysis Bloods for antibodies Renal biopsy
What is the typical antibodies in Wegener’s and microscopic polyangiits?
Granulomatosis with polyangiitis Predominantly c-ANCA to PR3 Microscopic Polyangitis Predominantly p-ANCA to MPO
What is Churg-Strauss associated with that other small vessel vasuclitis are not?
Asthma and eosinophilia
Which do and do not have any granuloma?
Wegener’s and Churg-Strauss - granuloma MPA - no granuloma formation
What system are wegener’s granulomatosis associated with? What system are microscopic polyangiits?
Wegener’s - lungs, renal and ENT MPA - usually lungs and renal
What is the treatment of vasculitis?
IV Steroids and cyclophosphamide
Chronic inflammatory disease of unknown origin Affecting skin, joints, kidneys, lungs, nervous system, serous membranes Women in their 20s -30s more commonly affected (10:1) African Americans and Hispanics What is this?
Systemic Lupus erythematous
Up to 50% of lupus patients will have renal involvement at presentation and up to 60% during the course of their disease What is the most frequent finidng on urinalysis in lupus?
Proteinuria
After looking for antibodies, what is carried out to differential in most cases of proteinuria?
A biopsy
What should all patients with lupus be on as a drug?
Hydroxychloroquine + NSAIDs +steroids
What type of glomerular nehritis is associated with lupus?
Membranous glomerulonephritis and rapidly progressive glomerulonephritis
Pre-renal failure –hypotension, hypovoemia Examples of drugs which can cause the hypovalaemia?
This could be ACEi/ARBS where a patinet then experiences vomiting and diarrhoea or diuretics in heart failure
Name some cytotoxic drugs to the kidney?
This would aminoglycosides, sulfonamides, aspirin
