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Nephrology > Systemic diseases > Flashcards

Systemic diseases Flashcards

1
Q

Diabetic Nephropathy

A

Causes ~20% of ESRF

Advanced / ESRF occurs in 40% of T1 and T2 DM

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2
Q

Pathology of diabetic nephropathy

A

Diabetic nephropathy describes conglomerate of lesions occurring concurrently.
Hyperglycaemia → renal hyperperfusion → hypertrophy and ↑ renal size
Hypertrophy and metabolic defects inc. ROS production → glomerulosclerosis and nephron loss
Nephron loss → RAS activation → HTN

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3
Q

Clinical effects

A

Microalbuminuria (30-300mg/d or albumin:creatinine >3) Strong independent RF for CV disease
Progresses to proteinuria (albuminuria >300mg/d)
Diabetic retinopathy usually co-exists and HTN is
common

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4
Q

Screening for diabetic nephropathy

A

T2DMs should be screened for microalbuminuria 6moly

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5
Q

Histology of diabetic nephropathy

A

Damage to the glomerular basement membrane allows proteins in the blood to leak through, leading to accumulation in Bowman’s space - called Kimmelstiel–Wilson nodules

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6
Q

Treatment of diabetic nephropathy

A

Good glycaemic control delays onset and progression
UKPDS: UK Prospective Diabetes Study
DCCT: Diabetes Control and Complications Trial
Control HTN: BP target 130/80
ACEi/ARB: even if normotensive
Stop smoking
Combined kidney pancreas Tx possible in selected pts

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7
Q

Amyloidosis and features

A 
Renal involvement usually caused by AL/AA amyloid
  Features:
  Proteinuria
  Nephrotic syndrome
  Progressive renal failure
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8
Q

Differentiating features and investigations

A

Large kidneys on US

Biopsy

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9
Q

Malignancy - direct

A

Renal infiltration: leukaemia, lymphoma Obstruction: pelvic tumour
Mets

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10
Q

Malignancy - nephrotoxicity

A

Toxic chemo
Analgesics
Tumour lysis syndrome

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11
Q

Effects of high PTH

A

High Ca2+

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12
Q

Effects of sarcoidosis

A

High Ca2+ and TIN

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13
Q

Myeloma pathology

A

Excess production of monoclonal Ab ± light chains (excreted and detected in 60% as urinary BJP).
Light chains block tubules and have direct toxic effects → ATN.
Myeloma also assoc. ̄c ↑↑Ca2+

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14
Q

Myeloma presentation

A

ARF / CRF Amyloidosis

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15
Q

Myeloma treatment

A

Ensure fluid intake of 3L/d to prevent further impairment Dialysis may be required in ARF

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16
Q

RA

A

NSAIDs → ATN

Penicillamine and gold → membranous GN AA amyloidosis occurs in 15%

17
Q

SLE pathogenesis and treatment

A

Involves glomerulus in 40-60% → ARF/CRF
Immune complex deposition → T3 hypersensitivity
Typically membranous GN
Proteinuria and ↑BP common
Rx
Proteinuria: ACEi
Aggressive GN: immunosuppression

18
Q

Diffuse systemic sclerosis and treatment

A

Renal crisis: malignant HTN + ARF Commonest cause of death

Rx: ACEi if ↑BP or renal crisis

19
Q

Reno vascular disease causes

A 
Cause
  Atherosclerosis in 80%
  Fibromuscular dysplasia
  Thromboembolism
  External mass compression
20
Q

Presentation of renovascular disease

A

Presentation
Refractory hypertension
Renal bruits
Worsening renal function after ACEi/ARB
Flash pulmonary oedema (no LV impairment on echo) Other signs of PVD

21
Q

Investigations of renovascular disease

A

US + doppler: small kidney + ↓ flow
CT/MR angio
Renal angiography: gold standard

22
Q

Treatment of renovascular disease

A

Rx medical CV risk factors Angioplasty and stenting

AVOID ACEi/ARB

23
Q

Hypertension effects on the kidney

A

HTN can be both the cause and effect of renal damage.
Renal diseases are commonest causes of 2O HTN
Activation of RAS
Retention of Na and water due to ↓ excretion

24
Q

What is haemolytic uraemia syndrome

A

E. coli O157:H7: verotoxin → endothelial dysfunction

25
Q

Features of HUS

A

You children eating undercooked meals e.g. burgers.
Bloody diarrhoea and abode pain precedes
1. MAHA
2. Thrombocytopenia
3. Renal failure

26
Q

Investigation of HUS

A

Schistocytes, ↓ plats
↓Hb
Normal clotting

27
Q

Treatment of HUS

A

Usually resolves spontaneously

Dialysis or plasma exchange may be needed

28
Q

What is Thrombotic thrombocytopenia pupura (TTP)

A

Genetic or acquired deficiency of ADAMTS13 → giant vWF multimers

29
Q

Features of Thrombotic thrombocytopenia pupura (TTP)

A 
Adult females   
Pentad:
  Fever
  CNS signs: confusion, seizures   
MAHA
  Thrombocytopenia
  Renal failure
30
Q

Investigating TTP

A

↓ plats
↓Hb
Normal clotting

31
Q

Treatment of TTP

A

Plasmapheresis, immunosuppression, splenectomy

Nephrology (17 decks)

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