Week 5 - E(2) - Myeloma and Vasculitis and Drug reactions

Question 1

What is myeloma?

Answer 1

Cancer of the plasma cells causing collections of abnormal plasma cells to accumulate in the bone marrow

Question 2

What type of lesions are described on xray in myeloma?

Answer 2

Lytic lesions - punched out lesions on xray

Question 3

What is the classic presentation of myeloma?

Answer 3

Back pain, renal failure, with weight loss and fatigue

Question 4

What would the biochemisty of myeloma show?

Answer 4

Would show an increased calcium +/- phosphate Normal alk phoosphate

Question 5

What is seen in the nephron in myeloma?

Answer 5

Amyloid and light chain deposits in the nephron which are damaging

Question 6

How is amyloid see? (ie what test for it)

Answer 6

Classic apple-green birefringence on congo red staining under polarized light

Question 7

What percentage of patinets with myeloma require dialysis at presentation? What is seen in the uirne?

Answer 7

10% require dialysis at presentation Bence-Jones proteins on protein electrophoresis of the urine

Question 8

What is looked for in the serum in myeloma?

Answer 8

Monoclonal production of a paraprotein (abnormal antibody)

Question 9

What other markers are raised in the blood in myeloma and what drug is given for the bone disease?

Answer 9

raised CP and PV Give biphophonates for the bone

Question 10

What is he treatment of myeloma?

Answer 10

Chemotherapy + stem cell transplant

Question 11

Vasculitis (=inflammation of blood vessels) Nephrologists generally deal with small vessel vasculitis What are the stages of diagnosig a small vessel vasculitis?

Answer 11

High index of suspicion Urinalysis Bloods for antibodies Renal biopsy

Question 12

What is the typical antibodies in Wegener’s and microscopic polyangiits?

Answer 12

Granulomatosis with polyangiitis Predominantly c-ANCA to PR3 Microscopic Polyangitis Predominantly p-ANCA to MPO

Question 13

What is Churg-Strauss associated with that other small vessel vasuclitis are not?

Answer 13

Asthma and eosinophilia

Question 14

Which do and do not have any granuloma?

Answer 14

Wegener’s and Churg-Strauss - granuloma MPA - no granuloma formation

Question 15

What system are wegener’s granulomatosis associated with? What system are microscopic polyangiits?

Answer 15

Wegener’s - lungs, renal and ENT MPA - usually lungs and renal

Question 16

What is the treatment of vasculitis?

Answer 16

IV Steroids and cyclophosphamide

Question 17

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?

Answer 17

Systemic Lupus erythematous

Question 18

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?

Answer 18

Proteinuria

Question 19

After looking for antibodies, what is carried out to differential in most cases of proteinuria?

Answer 19

A biopsy

Question 20

What should all patients with lupus be on as a drug?

Answer 20

Hydroxychloroquine + NSAIDs +steroids

Question 21

What type of glomerular nehritis is associated with lupus?

Answer 21

Membranous glomerulonephritis and rapidly progressive glomerulonephritis

Question 22

Pre-renal failure –hypotension, hypovoemia Examples of drugs which can cause the hypovalaemia?

Answer 22

This could be ACEi/ARBS where a patinet then experiences vomiting and diarrhoea or diuretics in heart failure

Question 23

Name some cytotoxic drugs to the kidney?

Answer 23

This would aminoglycosides, sulfonamides, aspirin