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Kidney Involvement in Systemic Diseases

The document discusses kidney involvement in systemic diseases. It provides examples of diseases that can affect the kidneys such as diabetes mellitus, HIV, vasculitis, lupus, and malignancies. It then focuses on diabetic nephropathy and lupus nephritis, outlining their clinical features, management, and risks factors. Kidney involvement can occur at the pre-renal, glomerular, interstitial or post-renal levels depending on the underlying disease. Early detection and treatment of kidney damage in systemic diseases is important.

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213 views13 pages

Kidney Involvement in Systemic Diseases

The document discusses kidney involvement in systemic diseases. It provides examples of diseases that can affect the kidneys such as diabetes mellitus, HIV, vasculitis, lupus, and malignancies. It then focuses on diabetic nephropathy and lupus nephritis, outlining their clinical features, management, and risks factors. Kidney involvement can occur at the pre-renal, glomerular, interstitial or post-renal levels depending on the underlying disease. Early detection and treatment of kidney damage in systemic diseases is important.

Uploaded by

Jake Miller
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Kidney Involvement in systemic

diseases
Dr Chimezie Okwuonu
Gregory University Umuahia Campus
Introduction
• The kidneys may be directly involved in a
number of multisystem diseases

• It may also be affected by diseases of other


organs

• Involvement may be at Pre-renal, glomerular,


interstitial or post-renal level
Disorder with renal involvement
• Diabetes mellitus
• HIV infection
• Systemic vasculitis
• Systemic Lupus Erythematosus
• Malignancy
• Pregnancy related complications
Diabeteic Nephropathy
• It is the commonest cause of ESRD worldwide

• Assuming increased important in Nigeria as a


cause of CKD/ESRD
• Earliest manifestation is microalbuminuria

• Its presence increased patient cardiovascular


risk
Risk factors for developing Diabetic
Nephropathy
• Poor control of blood glucose,
• Long duration of Diabetes,
• Presence of other diabetic complication,
• Ethnicity (Asian, Pima Indians and Blacks),
• Pre-existing High BP,
• Family hx of Diabetic Nephropathy,
• Family hx of Hypertension.
• Cigarette smoking
Natural history of DM Nephropathy
• Acute renal hypertrophy & Hyperfunction

• Normoalbuminuria

• Microallbuminuria

• Overt proteinuria

• ESRD
Microalbuminuria & macroalbuminuria

Micro- Macro-
Parameter Normal albuminuria albuminuria
Urine AER
< 30 30 - 300 >300
(mg/24h)
Urine
albumin/
< 30 30 – 300 >300
Cr ratio
(mg/gm)
Clinical features
Long standing hx of DM
Hx poor glycaemic control
Foamy urine
Body swelling
Anaemia (earlier)
Symptoms of ureamia (earlier)
Features of other chronic complications of DM
(DM retinopathy, Neuropathy, peripherial
arterial disease)
hypertension
Management

Aims of management

• To slow down albumin excretion rate


• To preserve the glomerular filtration rate
• Retard progression to ESRD and delay the need
for renal replacement therapy
• Optimal control blood glucose
• Control blood pressure to target
• Treat other identifiable cardiovascular risk
Lupus Nephritis
• Renal involvement
– Early Course: 30-50% of unselected patients
– Later Course: 60-80%
• Most patients present with proteinuria
• Hypertension ±
• Hyperkalemic renal tubular acidosis

10
Clinical Features of Lupus Nephritis
%
Proteinuria 100
Nephrotic Syndrome 45-65
Granular casts 30
Red cell chasts 10
Microscopic hematuria 80
Macroscopic hematuria 1-2
Reduced renal function 40-80
Rapidly deteriorating function 30
Acute renal failure 1-2
Hypertension 15-50
Hyperkalemia 15
Tubular abnormalities 60-80

Kumar
Lab tests in Lupus Nephritis

• ANA, Anti Double Stranded DNA antibody


• Anemia of moderate degree, Coombs + in minority,
severe hemolytic anemia – rarely
• Leukopenia, thrombocytosis
• Hypocomplementemia: C4 and C1q are depressed
more than C3 suggesting classic pathway activation
(never occurs in idiopathic MPGN
• Antiphospholipid antibody - ⅓ - ½ of patients with
lupus nephritis
– Renal arterial, venous and glomerular cap thrombosis, Libman-
Sacks arthritis, cerebral thrombosis

12
Diagnosis and Differential Diagnosis

• Suspect in
– Middle aged, nephrotic female
– Idiopathic membranous nephropathy in a young
woman
• Routine screening of all nephrotic patients
with ANA
• Differential: Rheumatoid arthritis; Henoch
Schonlein purpura; Ig A nephropathy; vasculitis

13

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